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[Vol 38] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 381. Study: Cholesterol medicines can help lower cancer-related deaths in women

According to an analysis published in the British Journal of Clinical Pharmacology, among women with breast cancer, colorectal cancer, or melanoma, those who were taking cholesterol-lowering medications, were less likely to die from cancer. The analysis included 6,430 women in Australia who were diagnosed with breast cancer, colorectal cancer, and melanoma, respectively, from 2003 to 2013. The women had been prescribed cholesterol-lowering medications such as statins before their diagnosis. The more consistently women took these medications in the year after being diagnosed with cancer, the lower their likelihood of dying from the disease, suggesting that the drugs may have anti-tumor effects. Co-author Jia-Li Feng, BMed, MMed, PhD, of QIMR Berghofer Medical Research Institute, “If this inverse adherence-response relationship is confirmed, cholesterol-lowering medications primarily statins could be repurposed as adjuvant therapy to improve cancer prognosis.”

2. Critically ill infants given a blood transfusion before surgery have poorer outcomes: Study

According to the new study by Nemours Children’s Health System researchers, critically ill newborns who receive blood transfusions prior to surgery had about a 50% increased rate of complications or death than those who did not receive transfusions. The findings demonstrate the potential danger that blood transfusions may have on the surgical outcomes of neonatal patients. Loren Berman, MD, pediatric surgeon at Nemours Children’s Health System in Delaware, “In some cases, blood transfusions may be doing more harm than good when used before surgery in our most critically ill infants. Giving a transfusion in anticipation of blood loss may seem prudent, but our findings suggest that a “wait and see” approach to giving infants blood during surgery may reduce surgical complications and the risk of death.” Berman and her colleagues conducted a retrospective database analysis of 12,184 infants who underwent surgery between 2012 and 2015. From there, a total 1,209 were identified who received a blood transfusion within 48 hours prior to surgery. The team compared the complications and deaths that occurred in this group within 30 days after surgery to those who did not receive a pre-operative transfusion. Because the group that received transfusions was found to be sicker prior to surgery, the team also conducted propensity score matching, statistical analysis to make a more equal comparison. Dr Bermn further added, “”It is clear that research is desperately needed to inform decision-making and improve surgical outcomes in these vulnerable infants.”

3. Seasonal illnesses see a sudden peak

The change in Delhi’s weather has led to a surge in cases of influenza, marked by cold, cough, sore throat and fever, among others, symptoms similar to those for Covid-19. Due to these similarities, the doctors said that flu, otherwise considered a harmless viral infection, is causing panic among people. Dr Atul Gogia, senior consultant, internal medicine, Sir Ganga Ram Hospital said, “The mortality rate of flu is less than 0.1%, but people are frightened because its symptoms are similar to those of Covid, which has a mortality rate over ten times higher. In the case of the latter, recovery time is also longer.” Both Covid and flu, or the seasonal influenza, cause respiratory discomfort and are transmitted by contact, droplets and fomites. But, according to the World Health Organization, there are important differences between the two viral infections and how they spread. WHO says, “While the true mortality of Covid will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3% and 4% and the infection mortality rate (the number of reported deaths divided by the number of infections) is lower. For seasonal influenza, the mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of healthcare.” Those most at risk for severe influenza infection are children, pregnant women, the elderly, people with underlying chronic conditions and those who are immunosuppressed. Dr Jugal Kishore, head, department of community medicine, Safdarjung Hospital commented saying, “For flu, there exists a preventive vaccine. We advise all elderly people and those at high-risk of developing complications to avail vaccination before the onset of winter. However, there is no preventive vaccine available for Covid as yet.”

4. Cardiovascular disease after menopause linked to PCOS

According to findings presented at the virtual American Society for Reproductive Medicine (ASRM) 2020 Scientific Congress, Women with polycystic ovarian syndrome (PCOS) before menopause appear to have a greater risk of stroke, heart attack, and other cardiovascular events after menopause. Presenter Jacob Christ, MD, a resident at the University of Washington in Seattle said, “We found a PCOS diagnosis prior to menopause was associated with a 64% increased risk of cardiovascular disease after menopause independent of age at enrollment, race, body mass index, and smoking status. Taken together, our results suggest that women with PCOS have more risk factors for future cardiovascular disease at baseline, and a present PCOS diagnosis prior to menopause is associated with an increased risk of cardiovascular disease after menopause.” Amanda N. Kallen, MD, an assistant professor of reproductive endocrinology and infertility at Yale Medicine in New Haven, Connecticut said, “As fertility specialists, we often see women with PCOS visit us when they are having trouble conceiving, but often [they] do not return to our care once they’ve built their family. This excellent talk emphasized how critical it is for us as reproductive endocrinologists to have ongoing discussions with PCOS patients about long-term cardiovascular risks at every opportunity, and to emphasize that these risks persist long after the reproductive years have ended.” Characteristics of PCOS in adolescence are already understood, including hyperandrogenism, acne, irregular bleeding, and variable ages of menarche. Similarly, in women’s reproductive years, PCOS is linked to abnormal uterine bleeding, hirsutism, dyslipidemia, infertility, impaired glucose tolerance, gestational diabetes, and preeclampsia. Dr Christ further added, “What is less clear is if baseline cardiometabolic dysfunction during reproductive years translates into cardiovascular disease after menopause. Menopausal changes may reduce risk of cardiovascular disease among PCOS women, as it is known that overall, androgen levels decline during menopause. Furthermore, ovarian aging may be delayed in PCOS women, which may be protective against cardiovascular disease.” Among 1340 women included in the analysis, 174 (13%) women had PCOS and 1166 did not. The average age at screening and at menopause were not significantly different between the groups, but they did differ based on other baseline characteristics. Ginny Ryan, MD, MA, professor and division chief of reproductive endocrinology and infertility at the University of Washington School of Medicine in Seattle said, “Although the findings are not necessarily surprising, the study’s value particularly lay in its size, prospective data collection, and rigorous methods. While this study’s criteria used to identify subjects with PCOS selected a population with a particularly severe phenotype of PCOS and thus a higher risk population for cardiovascular disease, it is vital for women’s health providers to truly understand the medium- and long-term life-threatening associations found more commonly in many with PCOS.”

5. Some mouth was and oral rinse may help reduce Covid-19 spread: New Study

According to a study published in the Journal of Medical Virology, certain mouthwashes and oral antiseptics may inactivate human coronaviruses, and help reduce the spread of SARS-CoV-2 that causes Covid-19. indicate that some of these products might be useful for reducing the viral load, or amount of virus, in the mouth after infection. The researchers from the Penn State College of Medicine in the US tested several oral and nasopharyngeal rinses in a laboratory setting for their ability to inactivate human coronaviruses, which are similar in structure to SARS-CoV-2. The team found that several of the nasal and oral rinses had a strong ability to neutralise human coronavirus, which suggests that these products may have the potential to reduce the amount of virus spread by people who are Covid-19-positive. Craig Meyers, a professor at Penn State College of Medicine, “While we wait for a vaccine to be developed, methods to reduce transmission are needed. The products we tested are readily available and often already part of people’s daily routines.” They treated solutions containing a strain of human coronavirus, which served as a readily available and genetically similar alternative for SARS-CoV-2, with the baby shampoo solutions, various peroxide antiseptic rinses and various brands of mouthwash. The researchers allowed the solutions to interact with the virus for 30 seconds, one minute and two minutes, before diluting the solutions to prevent further virus inactivation. According to Meyers, the outer envelopes of the human coronavirus tested and SARS-CoV-2 are genetically similar so the research team hypothesized that a similar amount of SARS-CoV-2 may be inactivated upon exposure to the solution. Several of the mouthwash and gargle products also were effective at inactivating the infectious virus, the researchers said. Many inactivated greater than 99.9 percent of virus after only 30 seconds of contact time and some inactivated 99.99 percent of the virus after 30 seconds, they said.

Reference links:

  1. https://health.economictimes.indiatimes.com/news/diagnostics/cholesterol-medications-linked-to-lower-cancer-related-deaths-in-women-finds-study/78784977
  2. https://health.economictimes.indiatimes.com/news/diagnostics/study-finds-critically-ill-infants-given-a-blood-transfusion-before-surgery-have-poorer-outcomes/78785786
  3. https://health.economictimes.indiatimes.com/news/diagnostics/the-other-viral-seasonal-illnesses-see-sudden-peak/78779529
  4. https://www.medscape.com/viewarticle/939402
  5. https://health.economictimes.indiatimes.com/news/diagnostics/new-study-suggests-some-mouthwashes-oral-rinses-may-help-reduce-covid-19-spread/78790043

[Vol 37] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 371. New device to help detect traumatic brain injury on the spot

A method for detecting traumatic brain injury at the point of care has been developed by scientists at the University of Birmingham. Researchers are able to pinpoint when patients need urgent medical attention by using chemical biomarkers released by the brain immediately after a head injury occurs. This saves time in delivering vital treatment and avoids patients undergoing unnecessary tests where no injury has occurred. The technique was developed by a multidisciplinary team of researchers in the group of Advanced Nanomaterials, Structures and Applications (ANMSA) led by Dr Goldberg Oppenheimer at the University of Birmingham. The method works using a spectroscopic technique called surface enhanced Raman scattering, in which a beam of light is ‘fired’ at the biomarker. The biomarker, taken from a pin prick blood sample, is prepared by being inserted into a special optofluidic chip, where the blood plasma is separated and flows over a highly specialised surface. The light causes the biomarker to vibrate or rotate and this movement can be measured, giving an accurate indication of the level of injury that has occurred. Dr Pola Goldberg Oppenheimer, lead researcher on the study, explains: “This is a relatively straightforward and quick technique that offers a low-cost, but highly accurate way of assessing traumatic brain injury which up until now has not been possible. The current tools we use to diagnose TBI are really quite old fashioned, and rely on the subjective judgement of the paramedic or the emergency doctors. There’s an urgent need for new technology in this area to enable us to offer the right treatment for the patient, and also to avoid expensive and time-consuming tests for patients where there is no TBI.” The next stage for this research will be to miniaturise the device technology used to analyse the samples, so that it could be easily stored on board an ambulance for use by paramedics.

2. Sleep Health Can Determine The Success Of Mindfulness

The study led by the University of South Florida found that sleeping an extra 29 minutes each night can be the key to improving mindfulness, a critical resource that has benefits for daily well-being and work performance. It  improves next-day mindfulness, which in turn, reduces sleepiness during the day. The research focused on nurses, the largest group of healthcare professionals whose need for optimal sleep and mindful attention are particularly high.Mindfulness is achieved by purposefully bringing an individual’s awareness and attention to experiences occurring in the present moment without forming an opinion. Lead author Soomi Lee, assistant professor of ageing studies at USF said, “One can be awake and alert, but not necessarily mindful. Similarly, one can be tired or in low arousal but still can be mindful. Mindful attention is beyond just being awake. It indicates attentional control and self-regulation that facilitates sensitivity and adaptive adjustment to environmental and internal cues, which are essential when providing mindful care to patients and effectively dealing with stressful situations.” The data was observed on 61 nurses for two weeks and examined multiple characteristics of sleep health. They found that nurses’ mindful attention was greater than their usual after nights with greater sleep sufficiency, better sleep quality, lower efficiency and longer sleep duration (an extra half-hour longer). Daily mindful attention contributed to less same-day sleepiness. Those with greater mindful attention were also 66% less likely to experience symptoms of insomnia during the two-week study period. Findings from this study provide insight into developing a behavioural health intervention strategy for a broader array of healthcare workers who need better sleep and mindful attention.

3. More Studies Show Coffee Intake Linked To Reduced Parkinson’s Risk

A new study has added support to the idea that coffee consumption is associated with a reduced risk of developing Parkinson’s disease and suggests that caffeine may be particularly beneficial for individuals with a genetic mutation linked to the condition. Lead author Grace Crotty, MD, Massachusetts General Hospital, Boston said in an interview, “If confirmed in other studies, these results could pave the way for trials to test caffeine-related therapies to reduce Parkinson’s disease in people carrying the LRRK2 mutation. It has already been established that increased caffeine intake is associated with a lower risk for Parkinson’s disease. This is well recognized from epidemiological studies, and it is thought that caffeine may reduce the risk of developing Parkinson’s, although it has not been proven to be a definite causal factor, as there are many other genetic and environmental factors at play.” A total of 212 of the participants also completed questionnaires about how much caffeine they consumed each day. Results showed that among individuals with a normal copy of the LRRK2 gene, for those with Parkinson’s disease, plasma concentration of caffeine was 31% lower compared with individuals without Parkinson’s. Dr Crotty further said, “Levels of these analytes were lower in both the plasma and CSF of PD patients versus unaffected controls among LRRK2 mutation carriers, whereas among non-carriers these analytes were not significantly reduced in Parkinson’s disease versus control subjects,” they add. “Direct evidence for interaction between Parkinson’s disease and LRRK2 status (P < .01) for each of the five caffeine-related analytes suggests a true gene-environment interaction.”

4. Cell therapy is safe for anthracycline-induced cardiomyopathy

In yet another trial of cell therapy for heart failure, this time in cancer survivors with anthracycline-induced cardiomyopathy (AIC), administration of allogeneic bone marrow-derived mesenchymal stromal cells (allo-MSCs) was shown to be safe. First author Roberto Bolli, MD, professor of medicine and director of the University of Louisville’s Institute of Molecular Cardiology in Louisville, Kentucky said, “This is the first in-human clinical trial of cell therapy for patients with anthracycline-induced cardiomyopathy, a very serious disease with a very grim prognosis which is actually worse than ischemic cardiomyopathy, and for which treatment options are very limited at the moment. The study was successful in showing that the treatment is safe, we did not have any serious adverse events, and that it is feasible in all patients. We also wanted to see if there was a signal for efficacy, but I want to stress that this was a small study and was not powered or designed to establish efficacy.” After an open-label lead-in phase done in 6 volunteer patients established that the procedure was safe, the 31 patients were randomly assigned to receive either allo-MSCs (n = 14) or cell-free placebo (n = 17) administered via 20 transendocardial, electromechanically-guided injections. The patients were followed up for 12 months. A total of 93 adverse events were reported in 27 study participants. Forty-two of these met the definition of serious adverse events; however, none of the 93 events were deemed to be related to treatment with allo-MSCs. Dr Bolli further added, “That’s why we tried it in AIC. Cardiac injection of MSCs has given some encouraging results in both ischemic and non-ischemic cardiomyopathy in phase 2 trials and right now there is a phase 3 trial going on using these cells in heart failure patients,” he added. “Our study was a very rigorous study and it was done, I believe, according to the highest levels of rigor that you can possibly do. For a phase 1 trial, it is unusual to have this level of rigor. The improvement in the Minnesota Living with Heart Failure Quality of Life and 6-minute walking scores are very flaky measures; someone just maybe walked 2 or 3 seconds faster than before, so I would not put any stock in these secondary measures. What this paper shows is that the therapy is safe and it’s doable, at least in this small number of patients. But beyond that, there is truly nothing else that we can conclude.”

5. Fetal Estrogen shows positive results for safer therapy of menopause

Hormone therapy for menopausal symptoms has come a long way in the past decade, but some low risks remain, particularly for certain groups of women. But new naturally occurring estrogens are on the horizon and may provide safer options with similar efficacy. Hugh S. Taylor, MD, in an annual meeting said, “Unfortunately, there is no such thing as the perfect estrogen that has all the things that makes it favorable and none of the negative. It probably doesn’t exist. But there’s an opportunity for us to design better estrogens or take advantage of other naturally occurring estrogens that come closer to that goal of the ideal estrogen. If there’s a better cardiovascular effect without the breast cancer risk, this could be something everyone would want to take. It’s the first new estrogen we’ve had in many years, and it makes so much sense that we go back to a naturally occurring estrogen. We’ve never really been able to get a synthetic estrogen [that works].”

6. Breast Cancer Recurrence Risk Linked To Textured Implants

According to new findings in JAMA Surgery, using textured implants for reconstruction after mastectomy is associated with greater risk of breast cancer recurrence compared to smooth implants. Dr. Sa Ik Bang of Samsung Medical Center at Sungkyunkwan University School of Medicine in Seoul, South Korea said, “We initiated this study for the purpose of obtaining evidence that implant surface type is not significantly associated with breast cancer prognosis in an effort to relieve the vague anxiety of patients with breast cancer. Contrary to expectations, we found that the textured implant group had a significantly worse DFS than the smooth group, and this difference remained significant after adjusting for tumor stage and ER status. Textured implants are intended to reduce capsular contracture and implant malrotation. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was first reported in the late 1990s.” They looked at 650 patients, representing 687 cases, who underwent total mastectomy and immediate reconstruction at their hospital in 2011-2016. All were followed for at least two years after implant insertion. About 40% of cases received smooth implants and 60% textured implants. The smooth and textured groups had similar distribution of tumor stage and similar rates of adjuvant radiotherapy and chemotherapy. Five-year local and regional recurrence-free survival and disease-free survival (DFS) were 96.7% and 95.2%, respectively. Dr. Michael R. Cassidy and Dr. Daniel S. Roh of Boston University wrote, “Given the association of textured implants with ALCL, and now the suggestion that they are associated with increased risk for breast cancer recurrence, surgeons who choose textured implants should counsel their patients with breast cancer about their possible consequences. Many reconstructive surgeons across the world have already abandoned the use of textured implants altogether.”

7. Poor Air Quality Harmful For Those Vulnerable To Covid-19

Northern India, including the National Capital Region (NCR), is in the grip of worsening air pollution amid the Covid-19 pandemic as farmers in nearby states, especially Punjab, are clearing their fields by burning crop residue. The worst offenders among the districts contributing to the smog are Amritsar, with 1,158 fire counts between September 22 and October 12, compared with 345 a year ago; Tarn Taran, with 750 counts this year, up from 167 in 2019; and Patiala, with 266 counts versus 85, as per the data. Prof. Sagnik Dey, coordinator of the Centre of Excellence for Research on Clean Air at IIT Delhi said, “The number of (fire) events this year is much higher than in the last few years. The reason for the early surge in burning needs to be understood. Also, whatever measures are adopted are not working at the ground level.” Dr Naresh Trehan, chairman, Medanta said, “In the past one week, Medanta multi-super speciality hospital in Gurgaon has seen a rise in patients who were discharged and had recovered from Covid-19 coming back complaining of respiratory problems. Among other things, bad air quality could also be contributing to patients who have recently recovered from Covid infection and are now facing complications like trouble in breathing. Year after year, the problem of smog due to crop burning has not been resolved. This is cruel for those suffering from respiratory ailments, young children and old with weak lungs, especially in the year of pandemic when all are fighting the virus.”

Reference Link:

  1. https://health.economictimes.indiatimes.com/news/industry/new-device-for-detecting-traumatic-brain-injury-on-the-spot/78625530
  2. https://health.economictimes.indiatimes.com/news/diagnostics/sleep-health-dictates-success-of-practicing-mindfulness/78658516
  3. https://www.medscape.com/viewarticle/939148
  4. https://www.medscape.com/viewarticle/938518
  5. https://www.medscape.com/viewarticle/939095
  6. https://www.medscape.com/viewarticle/939069
  7. https://health.economictimes.indiatimes.com/news/industry/worsening-air-quality-harmful-for-those-vulnerable-to-covid-19-attack/78672337

[Vol 36] Medi-Scene: Your Weekly Health News Update

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Mediscene Vol 361. How to sustain a healthy heart against TFA (Trans Fatty Acid)

WHO has called for elimination of TFA from the global food supply by 2023.It is considered a health best buy – a policy measure that will positively impact several million lives. In the last few decades, India has witnessed a significant rapid change in dietary patterns that has led to the rise of NCDs and related comorbidities in young children, adolescents, young adults, and the elderly. According to the World Health Organization (WHO), ‘replacement of TFA with unsaturated fatty acids decreases the risk of CHD, in part, by eliminating the negative effects of TFA on blood lipids. Besides the harmful effect on lipid profile, there are indications that TFA may also increase inflammation and endothelial dysfunction as well. The recently launched REPLACE report 2020 by WHO emphasizes on the elimination of TFA from food supply chains as one of the most effective public health interventions and one of the ‘Best Buys’ for NCDs. This can be efficiently done by promoting the replacement of industrial TFA with healthier fats and oils. Eliminating trans-fat from food supply chains is one of the most effective public health interventions to reduce NCDs as they are non-essential dietary components. Many countries globally have achieved success in TFA reduction through combined efforts like compulsory trans-fat labelling, public awareness campaigns, and engagement with industry to reformulate products and regulation of levels of trans- fats nationally and locally for most effective outcomes.

2. Diabetes death risk cut by a third with regular exercise

Yun-Ju Lai, MD, and colleagues from the Puli branch of Taichung Veterans General Hospital in Nantou, Taiwan, found that persons with type 2 diabetes who exercised at moderate to high intensity had a 25%-32% decreased risk for death, compared with those who did not exercise.  Sheri Colberg-Ochs, PhD, professor emerita in exercise science at Old Dominion University in Norfolk, Va., in an interview said, “There is really nothing surprising about these results as others have shown that regular participation in physical activity lowers both overall mortality rates and morbidity. Regular exercise participation lowers the risk of mortality in almost all populations with many different health conditions. It is not specific to people with type 2 diabetes. These data add further support to the ADA [American Diabetes Association] recommendations by again suggesting that being more active leads to many health benefits for people with type 2 diabetes.” Dr. Lai and colleagues analyzed data on 4,859 subjects drawn from two Taiwanese databases – the National Health Interview Survey and the National Health Insurance research database – to study what effect exercise “capacity” had on the risk for death in those with type 2 diabetes. Dr. Lai said, “Information about physical activity during leisure time was collected by asking the questions: ‘How often do you exercise every week? What kind of exercise do you do? How long do you exercise?’ We included nearly all kinds of exercise in the analysis, such as jogging, swimming, walking, dancing, riding, and so on.” The study’s findings, however, were clear: Those who exercised at a higher level had a significantly decreased risk for all-cause mortality than did those with no exercise habits.

3. Knee Osteoarthritis pain can be reduced by turmeric capsules

A new clinical study suggests that people with knee osteoarthritis who take daily turmeric capsules feel less pain in the knee joint than their peers who don’t take this supplement. Researchers randomly assigned patients with symptomatic knee osteoarthritis to take two capsules of turmeric capsules (n=36) or placebo (n=34) daily for 12 weeks. At the end of the study period, turmeric improved knee pain on a visual analog scale (VAS) by -9.1 mm (95% CI, -17.8 to -0.4 mm) compared with placebo, but did not alter effusion-synovitis volume on magnetic resonance imaging. Senior study author Dr Benny Eathakkttu Antony of the Menzies Institute for Medical Research at the University of Tasmania in Hobart, Australia in an interview said, “The moderate effect we found in our trial from a short-term study is reassuring for turmeric as a treatment option. However, there are no long-term studies that explored the efficacy and safety of turmeric extracts for the treatment of osteoarthritis. There are no disease-modifying drugs approved to treat knee osteoarthritis, Antony and colleagues note in the Annals of Internal Medicine. Other pain relievers including acetaminophen and nonsteroidal anti-inflammatory drugs have only mild to moderate effects and are associated with adverse events, the researchers point out. Dr Antony further added, “Turmeric extracts are generally considered as safe in moderate doses usually seen in the over-the-counter medication. Curcumin, the most active constituent of turmeric, is generally classified ‘generally recognized as safe’ by the U.S. FDA as a food supplement.” Romy Lauche, deputy director of research at the National Centre for Naturopathic Medicine at Southern Cross University in East LiAlpha XR, NSW, Australia said, “Supplements and herbal products are one of many options that some patients may prefer over pharmacological therapies, and to some extent the treatment choice for knee osteoarthritis may come down to individual patient preferences. Supplements as well as pain medication may be able to support individuals with their osteoarthritis, for example by reducing their pain and helping them to be physically active again. However, which supplement or medication works is very individual, and patients may need to test different approaches to find the best management strategy before considering invasive treatments such as joint replacement surgery.”

4. Meat & alcohol increases colorectal cancer risk

A new meta-analysis has largely confirmed what is already known about the lifestyle factors that increase and those that decrease the risk of developing colorectal cancer. The use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a decreased risk for colorectal cancer, the new article concludes. But it also adds a number of other factors that are associated with a decreased risk for the disease, including taking magnesium and folate supplements and eating dairy products, fiber, soy, and fruits and vegetables. On the other hand, consumption of meat and alcohol was associated with an increased risk for colorectal cancer in almost all of the analyses included in this article. The authors of the study wrote, “Furthermore, in most cases, we were unable to identify an optimal dose and duration of exposure/intake for any of the products, even in the case of low-dose aspirin and other compounds that have been extensively assessed.” The American Institute for Cancer Research and the World Cancer Research Fund have published several reports during the past 10 years on the effect of diet, nutrition, and/or physical activity on risk for several cancer types. The studies included randomized controlled trials and observational studies. Most of the meta-analyses found a protective effect for aspirin, lowering the risk by between 14% and 29% even at doses as low as 75 mg/d, with a dose-response effect of up to 325 mg/d. The certainty of evidence was moderate.

5. Govt to focus on mental health, besides COVID-19: Tope

Public health minister Rajesh Tope told the valedictory session of HospitalTech 2020 National Healthcare Summit organised by CII., “The increase is a point of concern, we want to address it. The government is looking forward to adopting effective technological interventions to improve healthcare. We are expanding our Tele-ICU network and looking for more cost-effective models.” In July-end, the state task force recommended psychiatric pills be prescribed to Covid patients if their psychosis and fear over the condition was high. “All hospitals realized early on that counselling had to be part of treatment. Even patients needing post-Covid treatment need counselling,’’ said a senior doctor. WHO has warned about a mental health pandemic that is likely to follow Covid-19. Studies done to understand the impact of SARS 18 years back showed that 100% of patients had sleep disorders, 30% traumatic memories and 10% depressive thoughts. A survey by Suicide Prevention India Forum showed 54.7% mental health professionals reported an increase in people seeking therapy for the first time. SPIF founder Nelson Moses said, “With the lengthy lockdown, forced isolation, fear of virus, financial insecurity, domestic violence and rising anxiety, the crisis has deepened.”

6. Study shows link between white rice intake and type 2 diabetes risk

A new analysis of the multinational, multiethnic Prospective Urban Rural Epidemiology (PURE) study suggests that consuming more than 3 cups/day of white rice significantly increases the risk of diabetes compared with eating lower amounts. Compared with participants who ate less than 1 cup/day (150 g/day) of cooked white rice, those who ate more than 3 cups/day (> 450 g/day) had a 20% higher risk of developing diabetes over a mean follow-up of 9.5 years (P = .003). Second author Viswanathan Mohan, MD, PhD, DSc, chair and chief diabetologist at Dr. Mohan’s Diabetes Specialties Centre, India told an online health magazine platform that, “Among people of middle and lower socioeconomic status, rice consumption is very high because other food choices such as meat, fish, chicken, vegetables, and fruits are all quite expensive. Hence, people make up the calories [they need] by eating ‘polished’ rice. What we are suggesting is that protein intake should be increased, and this can come…in the form of beans and legumes, which if consumed along with the rice, would help reduce the overall glycemic load of the diet.” A total of 132,373 participants aged 35 to 70 from 21 different countries were included in the new analysis, which excluded anyone with diabetes at baseline. During the study interval, 6129 individuals developed incident diabetes. Dr Mohan further added, “There could be several reasons for this. Firstly, the actual intake of white rice in China was substantially lower than it was in other countries, especially among those living in South Asia. Secondly, the type of rice the Chinese consume may be slightly different than elsewhere in that it is ‘sticky’. Probably more importantly, however, in China, they do consume a lot of animal protein as well as vegetable protein.” In addition, there were only a handful of rice mills in India until the early 1970s, a situation which has now completely changed: there are now over a million rice mills in the country. Dr Mohan said, “This naturally led to increased consumption of high polished white rice,” Mohan emphasized, “and in general, people like the color, taste, and smell of white rice better [than brown rice] plus brown rice takes longer to cook and is difficult to chew. People need to be encouraged to be more physically active, which would also help reduce obesity rates and with it, diabetes risk.”

Reference Links:

[Vol 35] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 351. Increases diabetes risk associated with rheumatoid arthritis: Study

A new study shows that rheumatoid arthritis (RA) is associated with a 23 percent increased risk of type 2 diabetes (T2D), and may indicate that both diseases are linked to the body’s inflammatory response. Inflammation has emerged as a key factor in the onset and progression of T2D, and RA is an autoimmune and inflammatory disease. The team suggests that the systemic inflammation associated with RA might therefore contribute to the risk of individuals developing diabetes in the future. The team conducted a comprehensive search of a range of medical and scientific databases up to March 10, 2020, for cohort studies comparing the incidence of T2D among people with RA to the diabetes risk within the general population. The authors of the study said, “This finding supports the notion that inflammatory pathways are involved in the pathogenesis of diabetes. We suggest that more intensive screening and management of diabetes risk factors should be considered in people with rheumatoid arthritis. Agents that reduce systemic inflammatory marker levels may have a role in preventing type 2 diabetes. This may involve focussing on more than one pathway at a time.”

2. T cells of the immune system play a major role in reducing covid-19 severity: Study

Vaccine candidates for COVID-19 should elicit a broad immune response that includes antibodies, and the body’s helper and killer T cells, according to a study which says weak or uncoordinated immunity may lead to a poor disease outcome. Study senior author Shane Crotty from the La Jolla Institute for Immunology in the US said, “Our observations could also explain why older COVID-19 patients are much more vulnerable to the disease.” The research, published in the journal Cell, confirms that a multi-layered, virus-specific immune response is important for controlling the novel coronavirus during the acute phase of the infection and reducing COVID-19 disease severity. Shane Crotty further added, “With increasing age, the reservoir of T cells that can be activated against a specific virus declines and the body’s immune response becomes less coordinated, which looks to be one factor making older people drastically more susceptible to severe or fatal COVID-19.” The study’s co-author Sydney Ramirez further said, “It was particularly important to us to capture the whole range of disease manifestation from mild to critically ill so we could identify differentiating immunological factors.” Carolyn Moderbacher, another co-author of the study from La Jolla Institute for Immunology further added, “When we looked at a combination of all of our data across all 111 measured parameters we found that in general, people who mounted a broader and well-coordinated adaptive response tended to do better. A strong SARS-CoV-2 specific T cell response, in particular, was predictive of milder disease. Individuals whose immune response was less coordinated tended to have poorer outcomes.”

3. Targeted Treatment linked to longer survival in anaplastic thyroid cancer patients

According to a new report, with the introduction of targeted treatments for anaplastic thyroid carcinoma, patients have seen significant improvements in survival. Dr. Maria E. Cabanillas of The University of Texas MD Anderson Cancer Center, in Houston told a leading medical journal that, “Over the last 5 years, a greater understanding of the molecular genetics of anaplastic thyroid cancer has led to more personalized treatment strategies, which has greatly improved survival in these patients.” She and her colleagues examined data on 479 patients who were treated at their institution between 2000 and 2019. The patients’ median age was 65 years, and at presentation 11% were stage IVA, 36% were stage IVB and the remaining 53% were stage IVC. Overall survival at one year in the 227 patients treated between 2000 and 2013 was 35%, dropping to 18% at two years. For the 100 treated between 2014 and 2016, survival was 47% and 25%, respectively, and for those treated between 2017 and 2019, 59% and 42%. The researchers noted, “Recent work has demonstrated feasibility of complete resection and locoregional disease control when patients with BRAF V600E-variant tumors undergo surgical resection following neoadjuvant BRAF-directed therapy.” Dr. Cabanillas concluded by saying, “With this largest single-institution study, we have demonstrated that rapid molecular genetic tumor testing, personalized targeted therapies, immunotherapy, and surgery, can revolutionize the landscape of a disease that only a few years ago was considered untreatable and rapidly fatal.”

4. Severe stress linked to doubling the risk of dementia

New research shows that posttraumatic stress disorder (PTSD) is associated with up to a twofold increased risk of dementia. Researchers found that individuals with PTSD had a 61% higher risk of dementia, and pooled data from two particular studies showed that PTSD was associated with a doubling of dementia risk. Senior investigator Vasiliki Orgeta, PhD, associate professor, Division of Psychiatry, University College of London, UK, said, “These results provide important new evidence of how traumatic experience can impact brain health and how the long-term effects of trauma may impact the brain in many ways, increasing vulnerability to cognitive decline and dementia. Our study allows us to conclude for the first time that PTSD is a strong and potentially modifiable risk factor for dementia. Dementia is one of the greatest global health challenges and given that there is no cure for dementia, there’s an urgent need to identify modifiable risk factors to prevent or delay the onset of dementia.” To investigate whether a PTSD diagnosis was associated with an increased risk of dementia, the investigators analyzed findings from 13 studies conducted on four continents. Participants ranged in age from 51 to 73.6 years. A total of seven studies focused on veterans, five focused on the general population, and one study focused on refugees from war. Follow-up time ranged from 1 to 17 years. Dr Ortega further added, “This finding may point to a treatment effect since veterans are typically more likely to receive treatment for PTSD, at least in the countries where the studies were conducted, so the findings do suggest that treating PTSD may potentially reduce subsequent dementia risk. Concern about long-term consequences of PTSD might be relevant in patients hospitalized with COVID-19, which is a life-threatening condition.”

5. Aspirin may help for primary prevention of CVD in Rheumatic Diseases

Low-dose aspirin may be considered for the primary prevention of cardiovascular disease (CVD) in patients with autoimmune systemic rheumatic diseases who are at particularly high risk because of their individual cardiovascular risk profile, according to authors of a new review article in the journal Rheumatology. Secondary prevention with daily, low-dose aspirin is part of aggressive, comprehensive risk modification in patients who have experienced an MI or stroke or are considered at high risk for CVD. The authors stated that, “This review is devoted to reporting the present knowledge on the effectiveness of low-dose [aspirin] in primary CV prevention in a number of autoimmune systemic rheumatic diseases, not a systematic review or meta-analysis. We are not claiming to have covered more than a selection of the literature for each disease. Available data are not high-quality data and do not provide firm conclusions.” The authors focused primarily on accelerated, rather than spontaneous, atherosclerosis or buildup of plaque in artery walls, implicated in ischemic heart diseases such as MI and ischemic cerebrovascular diseases such as stroke. They looked at its association with autoimmune rheumatic diseases, primarily systemic lupus erythematosus (SLE) and RA, but also including antiphospholipid syndrome, systemic sclerosis, mixed connective tissue disease, dermatomyositis/polymyositis, primary Sjögren’s syndrome, and systemic vasculitis. Dr. Husni recommended keeping an open mind regarding individual approaches – for example, low-dose aspirin plus statins. She further added, “That kind of complexity in decision-making highlights the need for co management with a cardiologist. I’m a big believer in co management. At my multidisciplinary medical center, I am able to pick up the phone and talk to a cardiologist with whom our group has a relationship.”

6. Vitamin D may help lower risk for immunotherapy-induced colitis

A new study shows that taking vitamin D before starting immune checkpoint inhibitor (ICI) therapy may decrease the risk for treatment-related colitis. Senior author Osama Rahma, MD, said in a press release. Rahma is an assistant professor of medicine at Harvard Medical School, in Boston, Massachusetts said, “Our findings of a link between vitamin D intake and reduced risk for colitis could potentially impact practice if validated in future prospective studies. Vitamin D supplementation should be tested further to determine if it could be a safe, easily accessible, and cost-effective approach towards preventing immunotherapy’s gastrointestinal toxicity and extending the effectiveness of immune checkpoint inhibitor treatment in cancer patients.” They work by blocking either of two immune checkpoints, CTLA-4 or PD-1/PD-L1. This enhances the ability of the immune system to recognize and attack cancer cells. The problem is that blocking these checkpoints can unleash serious inflammatory reactions and immune-related adverse events, which can limit therapy. Patients who receive CTLA-4 blocking therapy or combined ICI therapy are more likely to develop colitis than those taking PD1/PD-L1 blockers alone. Jeffrey Weber, MD, PhD said, “The Harvard system is big enough to justify an inpatient hospital service dedicated to immune-related adverse events from checkpoint inhibitors. There are very few places in the US that could do a study like this. Most institutions wouldn’t have enough patients. These are preliminary data, but I think it’s good work that will provoke some serious thought. It provides grist for the mill for future research.”

Reference links:

  • https://health.economictimes.indiatimes.com/news/diagnostics/rheumatoid-arthritis-associated-with-23-pc-increased-risk-of-diabetes-study/78229088
  • https://health.economictimes.indiatimes.com/news/industry/immune-systems-t-cells-play-bigger-role-in-reducing-covid-19-severity-study/78179507
  • https://www.medscape.com/viewarticle/936044
  • https://www.medscape.com/viewarticle/937822#vp_2
  • https://www.medscape.com/viewarticle/937809
  • https://www.medscape.com/viewarticle/933301#vp_2

Highway To Health – World Heart Day 2020

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#UseHeart is this year’s World Heart Day theme. It is about understanding what it takes to live a heart healthy life and to act on that knowledge, changing your behaviour for a better quality of life now and in the future. In this edition of Highway To Health, learn all about heart diseases and ways to keep the heart happy!

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[Vol 34] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 34

  • Excessive drinking is linked to high blood pressure risk in Type 2 diabetics: Study

A new study published in the Journal of the American Heart Association states that having eight or more alcoholic beverages in a week’s time can increase the risk of high blood pressure (also called hypertension) among adults with Type 2 diabetes. Senior study author Matthew J. Singleton, M.D., M.B.E., M.H.S., M.Sc., a chief electrophysiology fellow at Wake Forest University School of Medicine in Winston-Salem, North Carolina said, “This is the first large study to specifically investigate the association of alcohol intake and hypertension among adults with Type 2 diabetes. Previous studies have suggested that heavy alcohol consumption was associated with high blood pressure, however, the association of moderate alcohol consumption with high blood pressure was unclear. Researchers collected and analyzed data of 10,000 adults (average of age 63) to study the relationship between alcohol consumption and blood pressure in Type 2 diabetes. All participants had Type 2 diabetes for an average of 10 years. Light drinking was not associated with elevated blood pressure or either stage of high blood pressure, moderate drinking was associated with increased odds of elevated blood pressure by 79%, Stage 1 high blood pressure by 66%, and Stage 2 high blood pressure by 62% heavy drinking was associated with increased odds of elevated blood pressure by 91%. Dr Singleton further added, “Though light to moderate alcohol consumption may have positive effects on cardiovascular health in the general adult population, both moderate and heavy alcohol consumption appear to be independently associated with higher odds of high blood pressure among those with Type 2 diabetes. Lifestyle modification, including tempering alcohol consumption, may be considered in patients with Type 2 diabetes, particularly if they are having trouble controlling their blood pressure. People with Type 2 diabetes are at higher cardiovascular risk, and our findings indicate that alcohol consumption is associated with hypertension, so limited drinking is recommended.”

  • Gestational diabetes could accelerate biological age of the child

A recent study explored how more than 1,000 children born to mothers in China aged on a cellular level and the findings were published in Journal Epigenetics. Children born to mothers who had diabetes during pregnancy may age faster biologically and be at an increased risk for obesity and high blood pressure. examined their exposure to gestational diabetes in utero and their DNA methylation, or epigenetic age, which indicates how experiences and exposures reflect true biological age even in early childhood. Accelerated aging, which can be determined by evaluating if a person’s estimated DNA methylation age is greater than their chronological age, has been shown to be associated with cardiovascular risks and poor health outcomes later in life. The researchers measured the epigenetic age of 1,156 children who were ages 3 to 10 in Tianjin, China, to see how it differed from their chronological age. Lead author Stephanie Shiau from Rutgers University in the US said, “These findings suggest that gestational diabetes may have long-term effects on epigenetic aging in offspring and lead to poorer cardiometabolic health outcomes.”

  • Brain atrophy in MS linked to cardiovascular risk factors

A new study presented by Raffaello Bonacchi, MD, Vita-Salute San Raffaele University, Milan, Italy, on September 11 at the 8th Joint European Committee for Treatment and Research in Multiple Sclerosis-Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS) 2020 states that  presence of cardiovascular risk factors in patients with multiple sclerosis (MS) is associated with a greater degree of brain atrophy even in young patients. Dr Bonacchi said, “Our results suggest that even low levels of exposure to cardiovascular risk factors are important in MS and might affect brain atrophy — and therefore long-term disability — even in young patients. It is not only smoking. Other cardiovascular risk factors also appear to be implicated. We found a synergistic effect of the different risk factors. These are only preliminary data and need to be confirmed in other studies. but it does suggest that MS neurologists need to pay attention to comprehensive care — not just MS disease activity. They also need to be discussing lifestyle with their patients, evaluating their cardiovascular risk factors, and giving advice on stopping smoking, lowering blood pressure, cholesterol, etc.” When it came to commenting on the brain changes, Dr Bonacchi said, “Small vessel disease is widespread in the population over 50 years of age, but in this study we wanted to look at the impact of cardiovascular risk factors in younger patients with MS who are not likely to have much small vessel disease to try and see whether there is still a relationship with brain atrophy or white/gray matter lesions. This is one of the first studies to have graded degrees of risk factors and we found one stringent risk factor was associated with the same effects on brain atrophy as two less stringent risk factors. As our population is under aged 50 years, who are unlikely to have much small vessel disease, our results suggest that the influence of cardiovascular risk factors on brain atrophy in MS is not just mediated through small vessel disease and is probably also mediated by increased inflammation.”

  • Weight loss shows impressive drop in type 2 diabetes risk

Intentional loss of a median of just 13% of body weight reduces the relative risk of developing type 2 diabetes by around 40% in people with obesity, among many other health benefits, shows a large real-world study in half a million adults. Christiane Haase, PhD, Novo Nordisk, Denmark, led the work together with Nick Finer, MD, senior principal clinical scientist, Novo Nordisk. Dr Finer said, “This is powerful evidence to say it is worthwhile to help people lose weight and that it is hugely beneficial. These are not small effects, and they show that weight loss has a huge impact on health. It’s extraordinary. These data show that if we treat obesity first, rather than the complications, we actually get big results in terms of health. This really should be a game-changer for those health care systems that are still prevaricating about treating obesity seriously. Weight loss was real-world without any artificial intervention and they experienced a real-life reduction in risk of various obesity-related conditions.” Carel le Roux, MD, PhD, from the Diabetes Complications Research Centre, University College Dublin, Ireland, welcomed the study and commented on it further saying, “In the study, intentional weight loss was achieved using mainly diets and exercise, but also some medications and surgical treatments. However, it did not matter how patients were able to maintain the 10% or more weight loss as regards the positive impact on complications of obesity. It helps to consider all the weight loss options available, but also for those who are not able to achieve weight loss maintenance, to escalate treatment. This is now possible as we gain access to more effective treatments.”

  • Recovery in peripheral artery disease affected by depression

Results of a new study led by Kim G. Smolderen, PhD, a clinical health psychologist and co-director of the Vascular Medicine Outcomes Research Program, Yale University School of Medicine, New Haven, Connecticut showed that women with peripheral artery disease (PAD) are almost twice as likely as their male counterparts to have depression, and all PAD patients with depression have a much worse 1-year recovery path than those without depression. Dr Smolderen further commented on that saying, “Depression may be a significant problem that may prevent physicians from getting the treatment results they were aiming for. To maximize outcomes, clinicians should spend time detecting depression and linking patients to appropriate holistic care. Although women are at least as likely as men to develop PAD, they may experience worse functional impairment. Aside from cardiovascular risk management, PAD treatments focus on relieving symptoms and improving quality of life through medications, exercise, or invasive treatments. If it’s (depression) not treated or recognized, this might complicate their recovery from PAD or their rehabilitation process. The depression rate among women in the study is about on par with that among women in general, although in some studies, it is as high as 1 in 3, said Smolderen. Such high rates are also “seen across the cardiovascular disease spectrum.”

  • ICMR: Some plasma therapies show adverse reaction

On Tuesday, The Indian Council of Medical Research said early evidence from one of its randomised controlled trials on the efficacy of convalescent plasma for Covid-19 patients has shown the possibility of adverse reactions in some cases, even as the therapy did not reduce mortality nor did it prevent progression from moderate to severe disease. The study conducted on 464 patients across 39 hospitals in 25 districts spread over 14 states and UTs was still under peer review and full publication of the results was awaited. ICMR director general Balram Bhargava said, “Once peer review happens and we get full publication out, this data will be considered again by the national task force and joint monitoring group of the health ministry and then a decision will be taken if we should continue with this or not because at the moment, we have got permission to use plasma therapy (off label) in India. There are a few cases where some reactions can occur and, therefore, we will take a considered view once we get the full publication of this study.”

Reference links:

  1. https://health.economictimes.indiatimes.com/news/diagnostics/excessive-drinking-raise-high-blood-pressure-risk-in-adults-with-type-2-diabetes-study/78077337
  2. https://health.economictimes.indiatimes.com/news/diagnostics/gestational-diabetes-may-accelerate-childs-biological-age/78060142
  3. https://www.medscape.com/viewarticle/937276
  4. https://www.medscape.com/viewarticle/937162
  5. https://www.medscape.com/viewarticle/936647
  6. https://health.economictimes.indiatimes.com/news/industry/adverse-reaction-in-some-to-plasma-therapy-icmr/78137944

[Vol 33] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 331. Doctors talk about importance of clean air

To celebrate the First International Day of Clean Air for Blue Skies on September 7, doctors from various disciplines from across the globe participated in a first-of-its-kind virtual event on September 6, called Doctors for Clean Air Conclave. Seven national medical associations that joined hands to make it happen included the Federation of Obstetric and Gynaecological Societies of India (FOGSI), the Indian Academy of Pediatrics (IAP), the Cardiological Society of India (CSI), the Indian Chest Society (ICS), the Indian Academy of Neurology (IAN), the Association of Surgeons of India (ASI) and the Medical Students Association of India (MSAI). Dr H. Paramesh, a member of the IAP, highlighted the importance of creating awareness about the depleting levels of clean air by stating, “Delhi has gone from having 10 trees per person to now having just one tree per person.” Dr Alok Gupta during the session said that, “Not even the air within homes is safe. Cooking using biomass and kerosene leads to the open fire in homes becoming a direct pollutant which causes non-communicable diseases, chronic heart diseases and chronic pulmonary and respiratory diseases.” The conclave was an initiative to bring together doctors from all over the country to try and turn the awareness campaign to attain clean air into a people’s movement.

2. Early combination therapy for type 2 diabetes: New Guidelines

The 2020 American Diabetes Association (ADA) clinical guideline stresses the importance of considering early combination therapy in patients with type 2 diabetes. Kacie Doyle-Delgado of St. Mark’s Hospital and St. Mark’s Diabetes Center, in Salt Lake City, told Reuters Health by email said, “While metformin and therapeutic lifestyle change remain the standard for new-onset diabetes diagnoses, initial combination therapy should be considered in patients presenting with hemoglobin (Hb)A1c levels >1.5 to 2 percentage points above target, as most singular medications rarely decrease HbA1c concentrations by more than 1 percentage point.” According to the guideline, metformin remains the preferred initial pharmacologic agent for the treatment of type 2 diabetes, but early combination therapy should be considered in some patients at treatment initiation as a strategy for extending the time to treatment failure. Treatment selection should be based on individual patient factors, such as cardiovascular comorbid conditions, hypoglycemia risk, impact on weight, cost, risk for side effects and patient preferences, the authors say. Medication regimens and medication-taking behavior should be reevaluated every three to six months and adjusted as needed to incorporate these specific factors. Although the guideline focuses on pharmacologic treatments, it emphasizes that the mainstay for initial treatment of type-2 diabetes includes therapeutic lifestyle change.

3. Cardiovascular disease and other health condition linked to gut bacteria

Microorganisms in the human digestive tract are linked to 29 specific health conditions, including chronic obstructive pulmonary disease, high blood pressure, and type 2 diabetes, according to a genome analysis in more than 400,000 individuals. Hilde E. Groot, MD, of the University of Groningen (The Netherlands), said in a presentation at the virtual annual congress of the European Society of Cardiology, “The extent to which the human gut microbiome can be considered a determinant of disease and healthy aging remains unknown. Over the past few years, the amount of research concerning the human gut microbiome and the associations with health and disease has tremendously increased. However, most studies investigated one or a few traits. The strength of our study is the possibility to cover a wide range of traits simultaneously within one population. Our data support the hypothesis that the human gut microbiome is a complex system, involved in many pathophysiological mechanisms in the human body. So, our results are additional to earlier research and strengthen this hypothesis. Microbiota and their metabolites might be of importance in the interplay between overlapping pathophysiological processes, and could serve as potential therapeutic targets for the maintenance of health and prevention and treatment of cardiovascular diseases. However, before it is possible to give advice for the public and medical practice, further research is needed to study causality. Currently, it is too soon to advise patients concerning their microbiome. However, genetic studies like ours might help other researchers to study causality between the gut microbiome and particular traits, which might potentially lead to new therapeutic targets. Next to genetic variants as a proxy, we’re currently studying the gut microbiome composition in myocardial infarction patients and healthy controls in a longitudinal setting.” Carol Ann Remme, MD, of the Amsterdam University Medical Center, said in an interview, “Previous studies have suggested a potential link between the gut microbiome and the development of cardiovascular disease, type 2 diabetes mellitus, and other chronic disorders. However, it is challenging to study the effect of gut microbiome composition in large patient cohorts. As an alternative approach, the study authors showed in a very large population that genetic variants previously shown to influence gut microbiome composition were significantly associated with conditions such as hypertension, type 2 diabetes, hypercholesterolemia, and heart failure.”

4. New therapy developed to detect lung cancer at an early stage

The researchers from Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR) have developed a diagnostic therapy for lung cancer that can detect the disease at an early stage paving the way for personalized medicine, said the Ministry of Science and Technology on Sunday. Govindaraju and his team have developed a small molecule for selective recognition of BCL-2 GQ through unique hybrid loop stacking and groove binding mode with turn on far-red fluorescence response and anticancer activity demonstrating the potential as GQ-targeted lung cancer theranostics. The research showed that, “Their strategy of specific topology recognition through hybrid binding mode led to capitalize on the gains of oxidative stress and genome instability to kill lung cancer cellsAin vivo. In addition, TGP18 with turn on emission band at the lower edge of far-red to NIR spectroscopic window proved to be a viable probe for tumor tissue imaging. Collectively, the theranostic agent TGP18 with outstanding biocompatibility showed in vivo tumor inhibition and tissue imaging, indicating excellent clinical translational potential. The selective recognition and imaging of oncogene specific non-canonical DNA secondary structures (G-quadruplex-GQ structures) holds great promise in the development of diagnostic therapy (theranostics) for cancer and has been challenging due to their structural dynamics and diversity. TGP18 binding to anti-apoptotic BCL-2 GQ ablates the pro-survival function and elicits anti-cancer activity by inducing death in cancer cells. The JNCASR team deciphered that inhibition of BCL-2 transcription synergized with signaling cascade of nucleolar stress, DNA damage, and oxidative stress in triggering the apoptosis signaling pathway. The intervention of GQ mediated lethality by TGP18 translated into anti-cancer activity in both in vitro 3D spheroid culture and in vivo xenograft models of lung and breast cancer with superior efficacy for the former. In vivo therapeutic efficacy, supplemented with tumor 3D spheroid and tissue imaging potential, define the role of TGP18 in GQ-targeted cancer theranostic.”

5. Study suggests gene test can predict medication risk causing liver injury

Scientists who were working on a way to determine the viability of batches of tiny liver organoids have discovered a testing method that may have far broader implications. They discovered a gene test that can possibly predict the risk of medications that cause liver injury. Their study published in the journal Nature Medicine reports identifying a “polygenic risk score” that shows when a drug, be it an approved medication or an experimental one, poses a risk of drug-induced liver injury (DILI). Jorge Bezerra, MD, Director, Division of Gastroenterology, Hepatology and Nutrition at Cincinnati Children’s said, “So far we have had no reliable way of determining in advance whether a medication that usually works well in most people might cause liver injury among a few. That has caused a number of promising medications to fail during clinical trials, and in rare cases, also can cause serious injury from approved medications. If we could predict which individuals would be most at-risk, we could prescribe more medications with more confidence.” Corresponding author Takanori Takebe, MD, an organoid expert at Cincinnati Children’s who has been studying ways to grow liver “buds” for large-scale use in research said, “Our genetic score will potentially benefit people directly as a consumer diagnostic-like application, such as 23andMe and others. People could take the genetic test and know their risk of developing DILI.” For clinicians, this would allow them to run a quick genetic test to identify patients at higher risk of liver injury before prescribing medications. The results might prompt a doctor to change the dosage, order more frequent follow-up tests to catch early signs of liver damage, or switch medications entirely. For drug research, the test could help exclude people of the high risk of liver injury from a clinical trial so that the benefits of a medication can be more accurately assessed.

6. Antibiotics affect breast milk microbiota in mothers of preterm infants: Study

The study led by researchers from the University of Toronto and The Hospital for Sick Children was published in the journal Cell Host and Microbe. The study is the largest to date of breast milk microbiota in mothers of preterm infants, and it is the first to show that antibiotic class, timing and duration of exposure have particular effects on the most common microbes in breast milk — many of which have the potential to influence growth and immunity to disease in new-borns. Deborah O’Connor, who is a professor and chair of nutritional sciences at U of T and a senior associate scientist at SickKids said, “It came as quite a shock to us that even one day of antibiotics was associated with profound changes in the microbiota of breast milk. I think the take-home is that while antibiotics are often an essential treatment for mothers of preterm infants, clinicians and patients should be judicious in their use.” Michelle Asbury, a doctoral student in O’Connor’s lab and lead author on the paper said, “Overall we saw a decrease in metabolic pathways, and increase in more pathogenic pathways in bacteria over time. Of particular concern was an association between antibiotics and a member of the Proteobacteria phylum called Pseudomonas. When elevated, Proteobacteria in a preterm infant’s gut can precede necrotizing enterocolitis. Sharon Unger is a co-author on the study and a professor of paediatrics at U of T, as well as a scientist and neonatologist at Sinai Health and SickKids says that, “The benefits of breastfeeding far outweigh the risk that antibiotics can disrupt the breast milk microbiome, and that mothers should without question continue to provide their own milk when possible. But I think we can look to narrow the spectrum of antibiotics we use and to shorten the duration when possible. Clearly the microbiome is important for their metabolism, growth and immunity. But emerging evidence on the gut-brain axis and its potential to further improve neurodevelopment for these babies over the long term warps my mind.”

Reference links: 

  1. https://health.economictimes.indiatimes.com/news/industry/doctors-come-together-to-talk-about-the-importance-of-clean-air/77972269
  2. https://www.medscape.com/viewarticle/936669
  3. https://www.medscape.com/viewarticle/936649
  4. https://health.economictimes.indiatimes.com/news/diagnostics/researchers-develop-therapy-that-can-detect-lung-cancer-at-early-stage/77972129
  5. https://health.economictimes.indiatimes.com/news/diagnostics/gene-test-can-predict-risk-of-medications-causing-liver-injury-study/77995809
  6. https://health.economictimes.indiatimes.com/news/diagnostics/study-finds-antibiotics-affect-breast-milk-microbiota-in-mothers-of-preterm-infants/77928419

[Vol 32] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 32

1. Study: Type-2 diabetes has four variations

According to a new study, type 2 diabetes can be further categorised into 4 subtypes in Indians. These dissimilarities will help doctors cut down on medications for some patients and help them prescribe drugs to prevent complications such as blindness, kidney or nerve damage in some others. The India-Scotland Partnership for Precision Medicine in Diabetes (INSPIRED) study, published in the BMJ Open Diabetes Research and Care recently, classified type 2 diabetes in Indians into four distinct clusters — SIDD (Severe Insulin Deficient Diabetes), IROD (Insulin Resistant Obese Diabetes), CIRDD (Combined Insulin Resistant and Deficient Diabetes) and MARD (Mild Age-Related Diabetes). A group of researchers examined nearly 20,000 case sheets of patients with Type 2 diabetes from Dr Mohan’s Diabetes Speciality Centre in association with the University of Dundee, School of Medicine, Scotland to categorise patients into four clusters, two of which were unique to Indians – IROD and CIRDD. Diabetologist Dr R M Anjana, the first author of the study said, “Until now, we have been treating all type 2 diabetes the same. The study shows different clusters of type 2 diabetes in Indians.”  Senior diabetologist Dr V Mohan said, “This research helps doctors predict the risk of complications and focus on individuals with the highest risk of developing complications.” Dr Colin Palmer from the Department of Pharmacogenomics, School of Medicine, University of Dundee, said “Recognizing subtypes might help doctors more specifically choose medication for their patients instead of going with the standard ones.”

2. Cancer treatments may accelerate aging in young patients

Data from new research examines the effects of cancer treatment on the aging process and finds that the expression of a gene associated with aging is higher in young patients with cancer after treatment with chemotherapy and in young cancer survivors who are frail. Previous research has shown that a protein called p16INK4a, which slows cell division, is produced at higher levels by cells as a person ages. The team first analyzed cells from 60 survivors and compared them with cells from 29 age-matched individuals without a history of cancer. Expression of the gene that codes for p16INK4a was higher in survivors than in controls, representing a 25-year age acceleration. Dr. Smitherman in an interview said, “Higher expression of p16INK4a in peripheral blood lymphocytes has been described in older adults following chemotherapy, but prior to this study, not in young adult survivors. This study is important as we try to understand the biological mechanisms underlying the manifestations of early aging in this population. Additionally, expression of p16INK4a may prove useful as a measure to study treatments aimed at mitigating the early aging effects of cancer treatment.”

3. Govt: 69% of coronavirus patients in India are men

Health Ministry data shows that the majority of the Covid-19 deaths in the country are among men who account for 69% of the total 58,390 deaths recorded so far. The age-wise distribution remains largely unchanged from that reported in the beginning of the month with those above 60 years now contributing 51% of all deaths so far. Those in the relatively younger age band of 45-60 years are contributing 36%, as compared to 37% on Aug 4 and 32% on July 9. Just 1% of deaths were of people below 17 years, another 1% was among the 18-25 age group and 11% were aged between 26-44 age groups. Indian Council of Medical Research director general Dr Balram Bhargava said that the results of the sero survey conducted in containment zones is in the process of publication and is likely to appear this week in the Indian Journal of Medical Research.

4. What to know about sodium restriction in heart failure

Sodium restriction has been the foundation of self-care for patients with heart failure (HF), given the significance of fluid balance in HF and the potential contribution of dietary sodium to fluid overload. Heart failure, particularly HF with reduced ejection fraction, is characterized by an activation of the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) as a compensatory response to maintain cardiac output through increased sodium and water retention. However, the long-term effects of this neurohormonal activation contribute to the progression of HF. The ACCF/AHA guidelines recommend moderate sodium restriction in patients with symptomatic HF (class IIa, level C). In accordance with the 2012 AHA recommendations, ACCF/AHA guidelines advise limiting dietary sodium intake to < 1500 mg/d for the general population. Epidemiologic evidence on the effects of sodium restriction on clinical outcomes in patients with HF has shown mixed results. An observational study that assessed sodium intake of ambulatory patients with HF over a mean period of 3 years suggests that patients with a sodium intake > 2800 mg/d are at greater risk for an acute HF event compared with patients with lower sodium intakes. A recent systematic review of nine studies and 479 unique participants found limited evidence of clinical improvement in outpatients with HF who followed a reduced-sodium diet, and the findings were inconclusive for inpatients with HF.

5. Study: Stress & anxiety over concern for family’s health on a rise

As coronavirus cases continue to rise in India, a month-long research conducted by Sangath found that stress and depression are also being reported. Notably, fear about family members contracting the virus has emerged as a bigger worry compared to the fear of suffering from Covid-19. Between June 11 and July 10, Sangath’s addictions research group, through a survey, reached out to around 673 individuals in Goa, Karnataka, Maharashtra and Delhi. The study found that 83% of the respondents reported feeling moderate to high levels of stress, and almost 30% reported symptoms associated with depression. Urvita Bhatia, Research Fellow, Sangath said, “The study will run during and post the pandemic to capture short and long term mental health and social outcomes. We will repeat assessments at 3,6,9,12 months post pandemic too.” Though 98% of the respondents reported that they are Covid-19 free, 38% of them said that they are worried about family members contracting Covid-19. Sangath said in the preliminary results that, “Respondents report feeling least in control of their physical and mental health, and their future plans. They reported the greatest feelings of control over their relationships with their partners and families.”

6. Early Parkinson’ symptoms inversely linked to healthy diets

New research conducted on over 47,000 participants suggests that endearment to dietary patterns that emphasize vegetables, fruits, nuts, and grains, such as in the Mediterranean diet, is inversely associated with prodromal features of Parkinson’s disease (PD), including constipation, excessive daytime sleepiness, and symptoms of depression. A growing body of evidence suggests that the gut and enteric nervous system may be involved in the pathogenesis of PD, noted lead author Samantha A. Molsberry, PhD, a postdoctoral research fellow at Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Dr Samantha told a leading medical news that, “following a healthy dietary pattern may influence risk for PD or prodromal PD features “by protecting against α-synuclein aggregation in the gut or by otherwise promoting gut health in a manner protective against degeneration in the enteric nervous system or CNS.Healthy diets include foods that are high in antioxidant and anti-inflammatory compounds. Therefore, diet patterns may reduce risk of Parkinson’s disease or prodromal Parkinson’s disease features by preventing oxidative stress and neuroinflammation. However, our study differs from their investigation in that we were able to use prospectively measured diet information that has been regularly collected in our cohorts since the 1980s, which minimizes the chance of reverse causation explaining our results. While we found similar results as Maraki et al. with respect to the Mediterranean diet pattern, we also found similarly strong associations between the Alternative Healthy Eating Index and prodromal features of Parkinson’s disease. This will allow us to further investigate whether certain behaviors and lifestyle choices, such as adherence to a healthy diet, are associated with whether an individual with prodromal features of Parkinson’s disease goes on to develop Parkinson’s disease and how quickly he or she does so.”

Reference link:

  1. https://health.economictimes.indiatimes.com/news/diagnostics/type-2-diabetes-has-four-variations-shows-study/77691429
  2. https://health.economictimes.indiatimes.com/news/industry/cancer-its-treatment-may-accelerate-the-aging-process-in-young-patients/77715191
  3. https://health.economictimes.indiatimes.com/news/industry/69-of-covid-victims-in-india-are-men-govt/77754130
  4. https://www.medscape.com/viewarticle/934673
  5. https://health.economictimes.indiatimes.com/news/industry/stress-anxiety-on-the-rise-over-concern-for-familys-health-study/77716585
  6. https://www.medscape.com/viewarticle/936125

[Vol 31] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 31

1. Zinc acts as a gatekeeper of the immune system

Previously zinc deficiency was not very prevalent, but nowadays, it is considered to be very common in developing countries. It is considered the 5th leading cause because of which one loses healthy years of life. Roughly 30% of the elderly population is known to be zinc-deficient. As zinc homeostasis is important in immunological reactions, i.e., the inflammatory and the oxidative stress response, several chronic diseases detected in the elderly are possibly related to zinc deficiency. Also, diseases such as diabetes, rheumatoid arthritis, atherosclerosis, impaired cognitive function and age-related macular degeneration might be due to zinc deficiency, which can worsen chronic inflammation and trigger oxidative stress. Anti-inflammatory and antioxidant properties of zinc are documented, but their underlying mechanisms are still not completely clear. There is a connection between altered zinc homeostasis and disease development and thus, zinc supplementation for a malfunctioning immune system is beneficial. Zinc deficiency can cause severe impairment of immune function, involving the adaptive and the innate immune system. A balanced zinc homeostasis is important for shielding against invading pathogens or protecting the human body against an overactive immune system triggering autoimmune diseases, allergies or chronic inflammation. Zinc plays a role of a gatekeeper of immune function as the sufficient function of practically all immune cells is highly zinc-dependent.

2. Health Ministry: Candidates of the vaccine to enter phase 3 of human trials

On Tuesday, the Ministry of Health and Family Welfare said that one of the three COVID-19 vaccine candidates would enter the third phase of pre-clinical human trials. The ministry officials said that the vaccine candidate entering the third phase has capitulated positive results in the inceptive phases of its trial. Dr V.K. Paul, head of the national task force on COVID-19, added that the other two vaccines are currently in phase-I or II of their preclinical trials. However, they did not reveal the names of the vaccines while sharing the status of their testing phase. The vaccine entering the third phase is Bharat Biotech’s Covaxin, jointly developed with the Indian Council of Medical Research (ICMR). The developments on the vaccine came a day after the National Expert Group on Vaccine Administration met five domestic COVID vaccine manufacturers to review the clinical trial stages of these vaccine candidates. The manufacturers included two whose products are not yet in the clinical trial stage in India.

3. Experts in South Asia develop genetic risk score for heart disease

MedGenome Lab has ushered a first-ever study on Indian population that proves a novel ‘CAD-PRS’ (coronary artery disease-genome-wide polygenic risk score) to accurately predict the risk of developing a coronary artery disease/myocardial infarction (MI) using a person’s genetic makeup. Dr. Vedam Ramprasad, CEO, MedGenome Labs said “Looking at all the available scientific evidence and our study results we are convinced that there exists a good opportunity to combine both clinical and genetic risks (polygenic risk score based) and significantly improve the primary prevention of coronary artery disease (CAD).We firmly believe that incorporating validated genetic risk scores would help in better stratification of high-risk individuals if implemented at population level.” The unique study is based on the principle of Genome-wide Polygenic Risk Score (PRS) which uses a genome-wide analysis of an individual to quantify the risk of developing heart disease. This finding lays the scientific and operational foundation for clinical implementation not just for CAD but for other diseases. Such findings and methods developed can be used to screen large populations and high-risk individuals at a cost less than 5000 INR.

4. Kidney cancer risk increases in diabetics, but only in slim

According to a new analysis from the Iowa Women’s Health Study (IWHS), diabetes increases the risk of kidney cancer in postmenopausal women, but paradoxically, only in nonobese women, as defined by body mass index (BMI) and waist circumference. Shuo Wang, PhD, of the School of Public Health, University of Minnesota, Minneapolis, and colleagues said, “Many studies have linked a history of diabetes to the increased risk of kidney cancer [but] it is unclear whether diabetes is a risk factor for kidney cancer independent of other risk factors such as obesity and hypertension. An association between diabetes and kidney cancer was not statistically significant among the whole cohort…a positive, statistically significant association was observed among nonobese women (BMI < 30 kg/m2) or waist circumference < 34.6 inches (87.9 cm). These findings should be validated in larger or pooled prospective studies. Patients with new-onset diabetes may require more thorough surveillance for cancer including kidney cancer.” The cohort for the current analysis included 36,975 women, mean age of 61.7 years, 6.4% of whom reported a diabetes diagnosis at baseline. Between 1986 and 2011, investigators identified 257 cases of kidney cancer in their cohort. The researchers further commented that, “Several characteristics were statistically significantly associated with kidney cancer risk and time-dependent diabetes was associated with an increased risk of kidney cancer in models 1 and 2. In line with this finding, we found an association among nonobese women…even in the fully adjusted model, but observed no association between diabetes and kidney cancer among obese women which could be explained by lower levels of IGF-1 among obese women.”

5. Chest pain in CAD patients linked to stress-induced brain activity

As per the data collected from a cohort study, reaction of the brain due to stress may be a significant contributor to chest pain in patients with coronary artery disease (CAD). Kasra Moazzami, MD, MPH, of Emory University in Atlanta, and his coauthors in Circulation: Cardiovascular Imaging said, “Although more research is needed, these results may potentially shift the paradigm by which angina is evaluated by refocusing clinical evaluation and management of psychological stress as adjunct to traditional cardiac evaluations.” The researchers launched a study of 148 patients with stable CAD. Their mean age was 62, 69% were male, and roughly 36% were Black. Angina symptoms were assessed at baseline and also after 2 years through the Seattle Angina Questionnaire’s angina frequency subscale. As the patients underwent stress testing that included both speech and arithmetic stressors, they also received eight brain scans via high-resolution positron emission tomography (HR-PET) brain imaging. Two scans occurred during each of the two control and two stress conditions. Subsequent analysis of these images evaluated regional blood flow relative to total brain flow. Each patient also underwent myocardial perfusion imaging (MPI) at rest, under stress conditions, and during conventional stress testing. At 2-year-follow-up, 28 (24%) of the 112 returning patients reported an increase in angina episodes. Those patients had a higher mean inferior frontal lobe activation with mental stress at baseline. cardiologist Nieca Goldberg, MD, of NYU Langone in New York City in an interview said, “Previous studies have linked mental stress with ischemia using nuclear stress testing. This study is unique in that it looked at brain activity associated with mental stress and was able to correlate that activity with angina. It shows that the heart and brain are connected.”

6. Vitamin D may not help in late life depression and boosting mood

Data from a large arbitrary controlled trial does not support the use of vitamin D3 supplementation for adults for the sole purpose of preventing depression. Olivia Okereke, MD, Massachusetts General Hospital, Boston, told an online medical news that, “The study is among the largest of its kind ever, and it was able to address whether vitamin D3 supplementation is useful for what we call ‘universal prevention’ of depression. These results tell us that there is no benefit to using vitamin D3 supplements for the sole purpose of preventing depression in the general population of middle-aged and older adults because of the high dose and long duration of treatment and the randomized placebo-controlled design, we can have high confidence in results.” The findings are based on 18,353 older adults (mean age, 67.5 years; 49% women) in the VITAL-DEP study; 16,657 were at risk for incident depression (ie, had no history of depression), and 1696 were at risk for recurrent depression (ie, had a history of depression but had not undergone treatment for depression within the past 2 years). The researchers reports that, “Cumulative incidence curves showed lack of separation between treatment groups over the entire follow-up.” Dr Olivia Okereke further added, “We cannot yet exclude the possibility of benefit of vitamin D3 for preventing depression among subgroups with certain health risk factors. We also know that vitamin D is essential for bone health, and this study does not tell us whether vitamin D3 is useful for prevention of other health outcomes.”

7. Study: 60% of children survived from Ewing’s sarcoma at BBCI

60% of children who were treated for Ewing’s sarcoma, which is one of the most common bone cancers during the stipulated five years, have survived, a study conducted at the Dr B Borooah Cancer Institute (BBCI), Guwahati, has found. The study done with patients attending paediatric cancer OPD of BBCI from 2013-2017 have shown that there was no significant difference in survival between patients with below and above poverty lines. In the study done at BBCI, Guwahati, it was observed that those patients who completed their treatment protocol had a better survival rate (68%) as compared to those who defaulted or refused treatment (14%). Dr Munlima Hazarika, professor of medical and paediatric oncology at BBCI, said, “These types of bone cancers are potentially curable, provided patients complete their planned treatment protocol. Ewing’s sarcoma most often affects bones in the legs, arms, or hip, and it usually causes pain, trouble with movement of the joints and swelling in the area of the cancer. So, awareness among general practitioners about this entity is needed for early diagnosis and referral for treatment. 87% of patients we treated with an intention to cure. Others came in a very advanced stage and could not be saved, although paediatric Ewing’s sarcoma is a curable malignancy. Depending on the type of surgery, the doctor might need to ‘rebuild’ part of the bone after surgery. Chemotherapy is used to kill these cancer cells or stop them from growing. People with Ewing’s sarcoma usually have chemotherapy both before and after surgery. Some people with Ewing’s sarcoma might be treated with radiation therapy instead of surgery.”

Reference Links:

  1. https://www.emedinexus.com/post/19754/
  2. https://health.economictimes.indiatimes.com/news/industry/vaccine-candidate-to-enter-phase-3-human-trial-health-ministry/77616065
  3. https://health.economictimes.indiatimes.com/news/diagnostics/experts-develop-a-breakthrough-genetic-risk-score-for-heart-disease-in-south-asia/77504684
  4. https://www.medscape.com/viewarticle/935648
  5. https://www.medscape.com/viewarticle/935761
  6. https://www.medscape.com/viewarticle/935327
  7. https://health.economictimes.indiatimes.com/news/industry/60-children-suffering-from-ewings-sarcoma-survived-at-bbci-study/77611987

[Vol 30] Medi-Scene: Your Weekly Health News Update

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MediScene Magazine Vol 30

1. Russia becomes first nation to register coronavirus vaccine

Speaking on Tuesday at a government meeting, Russian President Vladimir Putin said that the vaccine has proven efficient during tests, offering a lasting immunity from the coronavirus. It has been registered for use and one of his daughters has already been inoculated. Russian authorities have said that medical workers, teachers and other risk groups will be the first to be inoculated. Russia is the first country to register a coronavirus vaccine. Many scientists in the country and abroad have been skeptical, however, questioning the decision to register the vaccine before Phase 3 trials that normally last for months and involve thousands of people.

2. New probiotic shows potential in treating type 2 diabetics

New research suggests that Pendulum Glucose Control, containing gut bacteria strains that are lacking in people with type 2 diabetes unobtrusively improves blood glucose levels. It contains the oligosaccharide-consuming Akkermansia muciniphila and Bifidobacterium infantis, the butyrate producers Anaerobutyricum hallii, Clostridium beijerinckii, and Clostridium butyricum, along with the “prebiotic” dietary fiber inulin. In the 12-week trial of people with type 2 diabetes who were already taking metformin, with or without a sulfonylurea, 23 were randomized to the product and 26 received placebo capsules. Participants in the active treatment arm had significantly reduced glucose levels after a 3-hour standard meal-tolerance test, by 36.1 mg/dL (P = .05), and average A1c reduction of 0.6 percentage points (P = .054) compared with those taking placebo.There were no major safety or tolerability issues, only transient gastrointestinal symptoms (nausea, diarrhea) lasting 3-5 days. No changes were seen in body weight, insulin sensitivity, or fasting blood glucose. Nanette I. Steinle, MD, an endocrinologist with expertise in nutrition who was not involved in the research, told an online medical news portal that, “To me it looks like the research was designed well and they didn’t overstate the results. I would say for folks with mild to modest blood glucose elevations, it could be helpful to augment a healthy lifestyle.” Lead author Orville Kolterman, MD, chief medical officer at Pendulum said, “The ones sold in stores are reconfigurations of food probiotics, which are primarily aerobic organisms, whereas the abnormalities in the microbiome associated with type 2 diabetes reside in anaerobic organisms, which are more difficult to manufacture. The fiber component, inulin, is important as well. This product may make the dietary management of type 2 diabetes more effective, in that you need both the fiber and the microbes to ferment the fiber and produce short-chain fatty acids that appear to be very important for many reasons.”

3. Know how development of osteoporosis can be affected by sleep duration

7-9 hours of sleep is recommended to adults over 18 years of age. A research by Chen and colleagues analysed the correlation between sleep, daytime nap duration, and osteoporosis. It was also explored if they varied by sex, menopause, and sleep quality. Longer sleep duration has been tied to increased risk of osteoporosis. The research was conducted on 8688 participants aged 40 years or above. In a study published in Scientific Reports, sleep durations of 7–8 hours/day, 9–10 hours/day, and >10 hours/day, and longer daytime naps were therefore linked with higher risks of having osteoporosis. Higher frequency and longer duration of daytime napping were reported to be associated with lower femoral bone mineral density (BMD) in elderly women. Shorter sleep duration, on the other hand, has also been linked with osteoporosis in postmenopausal women. A study published in the Journal of Bone and Mineral Research included 11,084 postmenopausal women from the Womens Health Initiative. Women with a sleep duration of ≤5 hours per night had significantly BMD compared to women who reported sleeping 7 hours per night. Wang et al noted that both short and long sleep duration were associated with a significantly increased risk of osteoporosis in middle-aged and elderly adults.

4. Weight gain remains a concern in HIV treatments

People living with HIV who put on extra pounds and develop metabolic syndrome or related disorders linked in part to certain antiretroviral agents remain a concern today, even as the drugs used to suppress HIV infection have evolved over the decades.  W.D. Francois Venter, PhD and Andrew Hill, PhD in a recent published commentary on the topic said, “Weight gain is clearly seen in studies of dolutegravir [DTG] or bictegravir [BTG] with TAF.” Jordan E. Lake, MD, an HIV specialist at the University of Texas Health Science Center at Houston commented on the same concern saying, “Excessive weight gain, defined as more than 10% over baseline, has recently been observed among people with HIV initiating or switching to regimens incorporating TAF, an INSTI, or both, particularly DTG are at even greater risk for excessive weight gain.” Anna Maria Geretti, MD, a professor of clinical infection, microbiology, and immunology at the University of Liverpool, England in an interview said, “In recent times, it has emerged that weight gain is more pronounced with the integrase inhibitor class of agents, especially dolutegravir and bictegravir, the so-called second-generation. The effect is more pronounced in women and people of non-White ethnicity, and is of concern because of the associated potential risk of metabolic syndrome, cardiovascular disease, etc.” Dr. Sokhela said during a press briefing at the conference that, “We believe that these results support the World Health Organization guidelines that reserve TAF for only patients with osteoporosis or impaired renal function. The risk for becoming obese continued to increase after 96 weeks. Dr. Venter, a professor and HIV researcher at University of the Witwatersrand, head of Ezintsha, and lead investigator of ADVANCE said, “All regimens are now brilliant at viral control. Finding the ones that don’t make patients obese or have other long-term side effects is now the priority. Clinicians and researchers have recently thought that combining TAF and an INSTI plus FTC or a similar NRTI would be the ultimate regimen to replace the non nucleoside reverse transcriptase inhibitors (NNRTIs) such as EFV, but now we have a major headache with unexpectedly high weight gains in some patients.Weight gains over 10 kg are unlikely to be acceptable in any circumstances, especially when starting body mass index is already borderline overweight.”

5. Hypertension in patients who have history of stroke is often untreated

A new study of hypertension treatment trends, published in JAMA Neurology, found that unchecked high blood pressure along with considerable lack of treatment of the condition were widespread in individuals with a history of both hypertension and stroke. Daniel Santos, MD, and Mandip S. Dhamoon, MD, DrPH, of the Icahn School of Medicine at Mount Sinai, New York wrote, “To our knowledge, the present study is the first to analyze and report national antihypertensive medication trends exclusively among individuals with a history of stroke in the United States.” The researchers examined more than a decade of data from the National Health and Nutrition Examination Survey (NHANES). The cross-sectional survey is conducted in 2-year cycles; the authors analyzed the results from 2005 to 2016 and uncovered a total of 4,971,136 eligible individuals with a history of both stroke and hypertension. The mean age of the study population was 67.1 (95% confidence interval, 66.1-68.1), and 2,790,518 (56.1%) were women. Their mean blood pressure was 134/68 mm Hg (95% CI, 133/67–136/69), and the average number of antihypertensive medications they were taking was 1.8 (95% CI, 1.7-1.9). Of the 4,971,136 analyzed individuals, 4,721,409 (95%) were aware of their hypertension diagnosis yet more than 10% of that group had not previously been prescribed an antihypertensive medication. Louis Caplan, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston, said in an interview that, “All the studies that have ever been done show that hypertension is inadequately treated. One of the reasons is that it can be hard to get some of the patients to seek treatment, particularly Black Americans. Also, a lot of the medicines to treat high blood pressure have side effects, so many patients don’t want to take the pills. Treating hypertension really requires continued surveillance. It’s not one visit where the doctor gives you a pill. It’s taking the pill, following your blood pressure, and seeing if it works. If it doesn’t, then maybe you change the dose, get another pill, and are followed once again. That doesn’t happen as often as it should. Be evaluated more seriously. Even as home blood pressure kits and monitoring become increasingly available, many doctors are still going by a casual blood pressure test in the office, which doesn’t tell you how serious the problem is. There needs to be more use of technology and more conditioning of patients to monitor their own blood pressure as a guide, and then we go from there.”

6. Patients who are asymptomatic, don’t need hospitalization: Govt

With an increasing number of Covid-19 cases, the government said a large number of cases detected were asymptomatic and did not require hospitalization. Such cases could be in isolation and monitored and states did not need to be overawed by rising positive cases as long as they vigorously implemented testing, containment and tracking strategies.  Health secretary Rajesh Bhushan said, “Neither the Union or state governments should be overawed by the number of positive people per day, we advise home isolation (for asymptomatic cases) under medical care and control, where on a daily basis health parameters are monitored physically or telephonically.” He restated that less than 1% of active cases were on ventilators, less than 3% on oxygen and less than 4% in ICU. Commenting further Rajesh Bhushan said, “Our joint monitoring group is seized with this issue and will provide a guidance note soon. With a consistent and sustained increase in recoveries, the gap between recovered patients and active Covid-19 cases has reached nearly 950,000. India’s test, track and treat strategy is showing the desired result — the gap between percentage of recoveries and percentage of active cases of Covid-19 is growing every day.” The recovery rate of Covid-19 cases has improved to nearly 70% while the fatality rate is now a shade below 2%. India has conducted 2.5 crore tests, reaching the record of more than 7 lakh tests in a single day. 

Reference link

  1. https://health.economictimes.indiatimes.com/news/pharma/russia-registers-virus-vaccine-putins-daughter-inoculates/77486390
  2. https://www.medscape.com/viewarticle/934976
  3. https://www.emedinexus.com/post/17499/
  4. https://www.medscape.com/viewarticle/935345
  5. https://www.medscape.com/viewarticle/935516
  6. https://health.economictimes.indiatimes.com/news/policy/asymptomatic-cases-dont-need-hospitalisation-govt/77495881

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