Saturday, October 21, 2023

Journal Watch October 2023


COVID-19 

Paxlovid Weaker Against Current COVID-19 Variants: A real-world study published in  JAMA Open Network  found that Pfizer's COVID-19 antiviral Paxlovid is now less effective at preventing hospitalization or death in high-risk patients as compared to earlier studies. But when looking at death alone, the antiviral was still highly effective. 

Paxlovid was about 37% effective at preventing death or hospitalization in high-risk patients compared to no treatment. The study also looked at the antiviral Lagevrio, made by Merck, and found it was about 41% effective. In preventing death alone, Paxlovid was about 84% effective compared to no treatment and Lagevrio was about 77% effective, the study said.

 

Clinical trial reveals benefits of inhaled nitric oxide for patients with respiratory failure due to COVID-19 pneumonia: A recent multicenter international phase II clinical trial led by investigators at Massachusetts General Hospital (MGH) and the University of Alabama in Birmingham (UAB) has revealed that inhaled nitric oxide can benefit patients with respiratory failure due to COVID-19 pneumonia.

The investigator-initiated multi-center trial, which commenced recruitment in March 2020, stands as a testament to the collaborative spirit that prevailed even at the height of the pandemic. The findings are published in the American Journal of Respiratory and Critical Care Medicine.

 

Autoimmune and autoinflammatory connective tissue disorders following COVID-19: COVID-19 was associated with a substantial risk for autoimmune and autoinflammatory connective tissue disorders in this retrospective cohort study, indicating that long-term management of patients with COVID-19 should include evaluation for such disorders.  JAMA Open Network 

 

Does COVID-19 or COVID-19 vaccination worsen migraines? Research published in the European Journal of Neurology indicates that COVID-19 and COVID-19 vaccination have negligible effects on migraine severity.

 

Risk of long COVID in people with pre-existing conditions is higher among short sleepers: A new study suggests that sleep duration modulates the relationship between pre-existing medical conditions and long COVID. Compared with individuals who had no pre-existing conditions and an average sleep duration of 6 to 9 hours per night, the risk of long COVID was three times higher in people who had pre-existing conditions and a short sleep duration of less than 6 hours per night. In contrast, the risk of long COVID in people with pre-existing conditions was only 1.8 times higher among people with an average nightly sleep duration. These analyses were adjusted for potential confounders including sex, age, body mass index, vaccination status, and ethnicity. American Academy of Sleep Medicine

 


PAIN

Chronic Back Pain May Be Eased With a Type of Talk Therapy: Helping patients understand that chronic pain is often “in the brain or mind” can help reduce the intensity of their pain, a new study shows. This does not mean that people are imagining their pain, because all pain is real — and all pain is generated by neural circuits in the brain. But in cases where their pain does not have a physical cause — such as a tumor, bone fracture, infection or inflammatory condition — shifting their perspectives about the role of the brain in chronic pain can give people more control. The study, published Sept. 28 in JAMA Network OpenTrusted Source, examined the link between the brain and chronic pain. Specifically, researchers looked at the importance of people’s beliefs about the underlying causes of their pain, also known as “pain attributions.” The study looked at data from a clinical trial involving a treatment called pain reprocessing therapy (PRT), which teaches people to see pain signals sent to the brain as less threatening. PRT is a type of talk therapy that draws from cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR).

 

How Cognitive Behavorial Therapy Can Help People With Fibromyalgia: A new study, published September 20 in Arthritis & RheumatologyTrusted Source, has found that the use of cognitive behavioral therapy (CBT) can be especially helpful for those living with fibromyalgia.  The research—conducted by a team from Harvard, Norway, and Pittsburgh—included 114 participants and found that CBT was better at helping to reduce catastrophic thinking related to the disease.  This was compared to people using educational materials alone.

 

Common drug may help manage osteoarthritis symptoms and pain: A recent studyTrusted Source published in The LancetTrusted Source examined how well the drug methotrexate may help treat hand osteoarthritis.  The study found that participants who received methotrexate over six months had moderate pain improvement.  The results indicate that methotrexate, which is helpful in treating other types of arthritis such as psoriatic or rheumatoid arthritis, may benefit people with hand osteoarthritis and inflammation.

 

Immersive virtual reality seems to ease cancer patients’ pain and distress: Immersive virtual reality—digital technology that allows a person to experience being physically present in a non-physical world—seems to ease the pain and distress felt by patients with cancer, suggests a pooled data analysis of the available evidence published in BMJ Supportive & Palliative Care. 

 

Opioid limits didn’t change surgery patients’ experience, study shows: Five-day limit from Michigan’s largest insurance company didn’t lead to increases in patients’ pain levels or decrease in satisfaction after common surgical procedures. JAMA Health Forum 

 

Neanderthal gene variants associated with greater pain sensitivity: People who carry three gene variants that have bene inherited from Neanderthals are more sensitive to some types of pain, according to a new study co-led by UCL researchers. The findings, published in Communications Biology, are the latest findings to show how past interbreeding with Neanderthals has influenced the genetics of modern humans. 

 

Empowering minoritized patients with chronic back and other musculoskeletal pain to receive the care they need: COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) is one of the first studies to test and evaluate equipping Black adults who have chronic pain with tools to facilitate autonomy and control over their own care. Through six telephonic coaching sessions over 12 weeks, the randomized controlled trial provided 125 Black veterans with tools focused on increasing knowledge and confidence to self-manage their pain and on optimizing communication of their needs, preferences and desires to their physicians. An additional 125 Black veterans participated in the study’s control group and did not receive coaching. Average age of participants in both arms of the study was 61 years, and 83 percent were male. The researchers found that the coaching produced significant improvement in patient activation (having the knowledge and confidence to manage their health and healthcare), which has been linked in other research to better treatment adherence, more positive experiences with healthcare, and better quality of life. In addition, patients who received the coaching experienced increased confidence in expressing themselves and communicating their pain-related goals to their clinicians. This improvement remained or improved after coaching ended. “Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics" is published in the peer-reviewed journal Pain.

 


COMPLEMENTARY AND ALTERNATIVE MEDICINE

Cardiovascular Disease Risk Higher for People with Cannabis Use Disorder: A study just published in the journal AddictionTrusted Source reports that Canadian adults with cannabis use disorder (also known as “marijuana use disorder”) appear to have about a 60% greater risk of having their first major cardiovascular event like a stroke or heart attack when compared to those without the disorder.

 

Medicine without Meds: Revolutionizing healthcare with digital solutions: A new book by researchers from the Yong Loo Lin School of Medicine, National University of Singapore describes digital solutions as a new way to help patients manage symptoms for pain, diabetes, hypertension, cancer and more. Some patients with sleep disorders, back pain, diabetes, cancer, and attention-deficit/hyperactivity disorder are benefitting from digital health interventions that use software programmes, often delivered through mobile apps or web-based platforms, to treat, manage, or prevent a medical condition. Designed to provide therapeutic benefits and backed by clinical evidence, these digital interventions often complement traditional healthcare approaches.

 

Yoga improves quality of life, cardiovascular function in heart failure patients: A new study, presented at the American College of Cardiology Asia 2023 conference, examines the long-term outcomes of yoga therapy to determine the benefit of adding yoga therapy as a complementary treatment in the management of heart failure. “This study proves that the addition of yoga therapy to standard medical management of heart failure leads to an improvement in left ventricular systolic function and quality of life in heart failure patients. Hence, yoga therapy may improve physical well-being and left ventricular function among heart failure patients on guideline-directed optimal medical therapy.” ACC.org/Asia2023

 


FDA ACTION

• Approved zilucoplan (Zilbrysq, UCB) for the treatment of generalized myasthenia gravis (gMG) in adults who are antiacetylcholine receptor (AChR) antibody positive.

• Approved etrasimod (Velsipity, Pfizer) for treating moderate to severe active ulcerative colitis (UC) in adults

• Approved  pembrolizumab (Keytruda, Merck) with platinum-containing chemotherapy as neoadjuvant treatment, and with continuation of single-agent pembrolizumab as post-surgical adjuvant treatment for resectable (tumors ≥4 cm or node positive) non-small cell lung cancer (NSCLC).

• Approved nivolumab (Opdivo, Bristol-Myers Squibb Company) for the adjuvant treatment of completely resected Stage IIB/C melanoma in patients 12 years and older. 

• Approved encorafenib (Braftovi, Array BioPharma Inc., a wholly owned subsidiary of Pfizer) with binimetinib (Mektovi, Array BioPharma Inc.) for adult patients with metastatic non-small cell lung cancer (NSCLC) with a BRAF V600E mutation, as detected by an FDA-approved test. 

• Announced the creation of a new Digital Health Advisory Committee to help the agency explore the complex, scientific and technical issues related to digital health technologies (DHTs), such as artificial intelligence/machine learning (AI/ML), augmented reality, virtual reality, digital therapeutics, wearables, remote patient monitoring and software.

• approved bosutinib (Bosulif, Pfizer) for pediatric patients 1 year of age and older with chronic phase (CP) Ph+ chronic myelogenous leukemia (CML) that is newly diagnosed (ND) or resistant or intolerant (R/I) to prior therapy. 

• Published the Treating Migraines: Ways to Fight the Pain with Medication Consumer Update.

 

PREVENTION


Exercise

Morning Workouts are Linked to Better Weight Management: A new study finds exercising in the morning appears to show more benefits for keeping the pounds off than working out during other times of the day. Although the question of optimal exercise timing hasn’t yet been solved, the new evidence suggests that working out between 7–9 a.m. is most effective for obesity.  In an observational study, researchers found that people who exercised in the morning had lower BMI and waist circumference, even when they did less exercise overall than people who worked out in the afternoon and evening.  ObesityTrusted Source

 

Walking more than five flights of stairs a day can cut risk of heart disease by 20 percent, study says: Taking at least 50 steps climbing stairs each day could significantly slash your risk of heart disease, according to a new study from Tulane University. The study, published in Atherosclerosis, found that climbing more than five flights of stairs daily could reduce risk of cardiovascular disease by 20%. Atherosclerosis.


A Few Minutes of Physical Activity Can Reduce Your Risk of Heart Attack, Stroke

New research shows that small bouts of physical activity spread throughout the day could reduce the risk of heart attack, stroke and premature death.  The study, recently published in The Lancet Public HealthTrusted Source, found that people may be able to lower their risk of major cardiovascular events through sporadic bursts of movement — lasting just one to three minutes — even if they don’t typically exercise.  The health benefits linked to a few minutes of movements was comparable to those conferred from physical activity lasting five to 10 minutes.

 

Golf, walking and Nordic walking may enhance cognitive function in older adults: Playing a single 18-hole round of golf or completing 6 km of either Nordic walking or regular walking may significantly improve immediate cognitive function in older individuals, according to a recent study published in BMJ Open Sport & Exercise Medicine. 

 

Antidepressants versus running for depression: is there a winner? The first study to compare effects of antidepressants with running exercises for anxiety, depression and overall health shows that they have about the same benefits for mental health – but a 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants lead to a slightly worse physical condition, as has been suggested by previous studies.  However, the drop-out rate was much higher in the group which initially chose exercise. European College of Neuropsychopharmacology  

 


Diet/Nutrition

Swapping Starchy Foods for High Fiber Meals Can Help You Avoid Weight GainNew research published in the British Medical JournalTrusted Sourcehas found that increasing the amount of whole foods, fiber, fruits, and non-starchy vegetables you consume is linked to a decrease in weight gain over time. The study included 136,432 people, all of whom were part of the healthcare field and were defined as being “mid-life” with an average age of 51.6 years old. Researchers found the quality of the carbohydrates you consume has a significant impact on the weight that you gain over long periods.

 

Almonds Are a Great Addition to a Weight Loss Diet:  researchTrusted Source newly published in the journal Obesity suggests that nuts may be a fantastic addition to a weight-loss diet. The study, which was reported to be the largest of its kind, found that people who ate almonds as a part of a calorie-restricted diet lost about 9.3% of their body weight. They also experienced improvements in various measures of cardiometabolic health, such as blood pressure, blood sugar, and lipids.

 

Diet Soda and Ultra-Processed Food May Increase Your Depression Risk:  new researchTrusted Source published in JAMA Network Open has found a link between ultra-processed foods and increased depression risk. In particular, artificial sweeteners were associated with depression.

 

Drinking Dark Tea May Help Control Blood Sugar, Reduce Your Diabetes Risk:  A new study has found that drinking dark tea specifically may reduce your diabetes risk. Drinking dark tea every day may help to mitigate type 2 diabetes risk and progression in adults through better blood sugar control, according to new research shared at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD) in Hamburg. Researchers suggest drinking dark tea increases glucose excretion in urine and improves insulin resistance.

 

Study Finds Unsweetened Coffee is Linked to Weight Loss: study published October 1 in The American Journal of Clinical Nutrition reports that drinking coffee is associated with weight loss. However, there is one catch — it must be drunk unsweetened.

 

Alcohol Use: Cutting Back or Quitting May Reverse Brain Shrinkage: A new study published in Alcohol: Clinical and Experimental ResearchTrusted Source indicates that, for people with alcohol use disorder, even reducing alcohol consumption can be helpful when it comes to brain health.

 

Low-Calorie Mediterranean Diet Can Help You Lose Belly Fat and Reduce Health Risks: As people age, they tend to gain belly fat while also losing muscle. These changes in body composition are linked with metabolic syndrome. However, a reduced-energy Mediterranean diet and increased activity may mitigate this. A Mediterranean-style diet emphasizes a variety of healthy whole foods. Watching portion sizes and limiting higher-calorie foods can help with fat loss. JAMA Network Open new studyTrusted Source

 

Calorie restriction in humans builds strong muscle and stimulates healthy aging genes: Researchers analyzed data from participants in the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE), a study supported by the National Institute on Aging (NIA) that examined whether moderate calorie restriction conveys the same health benefits seen in animal studies. They found that during a two-year span, the goal for participants was to reduce their daily caloric intake by 25%, but the highest the group was able to reach was a 12% reduction. Even so, this slight reduction in calories was enough to activate most of the biological pathways that are important in healthy aging.

 

Two or More Servings of Red Meat Per Week May Significantly Raise Your Type 2 Diabetes Risk: Results from a large observational study suggest that eating just two servings of red meat a week can increase your type 2 diabetes risk. A new study has found that replacing red meat with plant-based protein sources may reduce the risk of type 2 diabetes and provide environmental benefits too. Good plant-based swaps include tofu and tempeh, legumes, nuts and seeds.

 

Researchers discover associations among PTSD, diet, and the gut microbiome: Study suggests that adhering to a Mediterranean diet may alleviate or prevent posttraumatic stress disorder (PTSD) symptoms.  Results are published in Nature Mental Health

 


Sleep

You don’t lose if you snooze: It is often claimed that using the snooze button can have negative effects on sleep and cognitive processes, but there has been no direct evidence to this effect. New research from the Department of Psychology at Stockholm University shows that snoozing may actually support the waking process for regular snoozers. Journal of Sleep Research https://www.eurekalert.org/news-releases/1004066

 

The emotional function of dreams is not the same everywhere: Why do we dream? A product of our brain’s neurophysiology, dreaming is a complex experience that can take on many emotional tones and simulate reality to varying degrees. As a result, there is still no clear answer to this question. A study led by the universities of Geneva (UNIGE) and Toronto, and the Geneva University Hospitals (HUG), compared the dreams of two forager communities, in Tanzania and the Democratic Republic of Congo, with those of individuals living in Europe and North America. It showed that the first two groups produced more threatening, but also more cathartic and socially-oriented dreams than the Western groups. These results, to be read in Scientific Reports, show how strong are the links between the socio-cultural environment and the function of dreams.

 

We can respond to verbal stimuli while sleeping: Sleep is generally defined as a period during which the body and mind are at rest—as if disconnected from the world. However, a new study shows that the frontier between wakefulness and sleep is much more porous than it seems. The researchers have shown that ordinary sleepers can pick up verbal information transmitted by a human voice and respond to it by contracting their facial muscles. This astonishing ability occurs intermittently during almost all stages of sleep—like windows of connection with the outside world were temporarily opened on this occasion. These new findings suggest that it may be possible to develop standardized communication protocols with sleeping individuals to understand better how mental activity changes during sleep. On the horizon: a new tool to access the cognitive processes that underlie both normal and pathological sleep. Nature Neuroscience

 

Perfect storm: Poor sleep quality worsens health problems in obese older people, study shows: Obese older people who sleep badly have less muscle strength and mass in their legs and arms, as well as more body fat and more symptoms of anxiety and depression than those who sleep well, according to a study conducted by researchers at the University of São Paulo (USP) in Brazil. An article on the study is published in the journal Scientific Reports. 

 

Largest ever study on light exposure proves its impact on mental health: The world’s largest study on light exposure and its impact on mental health, with almost 87,000 participants, has found that increased exposure to light at night increases a person’s risk for psychiatric disorders such as anxiety, bipolar and PTSD severity as well as self-harm.  Importantly, the study also found that increasing exposure to daytime light can act like a non-pharmacological means for reducing psychosis risk. In those exposed to high amounts of light at night, the risk of depression increased by 30 per cent – while those who were exposed to high amounts of light during the day reduced their risk of depression by 20 per cent. Similar patterns of results were seen for self-harm behaviour, psychosis, bipolar disorder, Generalised Anxiety Disorder, and PTSD.  These findings indicate that the simple practise of avoiding light at night and seeking brighter light during the day could be an effective, non-pharmacological means of reducing serious mental health issues. Nature Mental Health

 

Losing sleep? It might be time to check your blood pressure: New research shows  that women who struggled with getting enough sleep were at greater risk of developing hypertension, or high blood pressure. Results are published in the journal Hypertension.

 

 


Vitamins/Supplements

Ginger Supplements May Help With Autoimmune Disorders Like Lupus:

Ginger root has a long history as a medicine, particularly as an anti-inflammatory ingredient. New research suggests ginger could be helpful in individuals with certain autoimmune disorders. In a study published this month in the biomedical research journal JCI Insight, researchers found that ginger supplementation affected a biological process in the body known to cause inflammation. The work included positive results in both animal and human studies.

 

B12 deficiency: a hidden trigger of inflammation? A new study has identified a compelling link between vitamin B12 deficiency and chronic inflammation, which is associated with a range of health problems including cardiovascular disease, diabetes, and neurodegenerative disorders.  Published in the Journal of the Science of Food and Agriculture, the research examined the effects of circulating B12 concentration on the levels of two key inflammatory markers in both humans and mice.

 

Patients with AML who received vitamin C/D supplements had fewer complications, but no overall survival benefit seen: Patients with acute myeloid leukemia (AML) who received vitamin C and D supplements while undergoing intensive chemotherapy had lower rates of complications, such as infections, bleeding, and inflammation, when compared with similar, previously treated patients who did not receive these supplements. Moreover, while the study showed no difference in survival between the two groups, a subgroup analysis showed that among patients with a genetic mutation known as NPM1 – found in about one in three patients with AML – the risk of death was nearly 50% lower among those who were taking the supplements. The results published today in the journal Blood Advances. 

 


Other

Work Stress Could Nearly Double Heart Disease Risk for Men: New research suggests that men who are exposed to stressful working conditions and receive low rewards despite their best efforts have nearly twice the risk of heart disease compared to men who do not have these psychosocial stressors. The impact of work stress on women’s heart health was inconclusive, according to the results published on September 19 in the journal Circulation: Cardiovascular Quality and OutcomesTrusted Source

 

Exposure to 'Forever Chemicals' May Contribute to Breast and Ovarian Cancer Risk: A new study has found that people with cancer have significantly higher levels of forever chemicals in their bodies.  The trend was most pronounced among women, particularly those who developed melanoma.  The researchers say exposure to certain chemicals, including per- and poly-fluoroalkyl substances (PFAS),Trusted Source parabens, and phenols, may contribute to hormone-related cancers of the breast, ovary, skin, and uterus. These chemicals, commonly found in plastics and personal care products, have been dubbed “forever chemicals,” as they aren’t easily broken down and can remain in the body for months to years. They have the potential to disrupt hormone function and need to be considered an environmental risk factor for cancer, according to a report, published in the Journal of Exposure Science and Environmental Epidemiology September 18.

 

Healthy Habits That Can Help Reduce Your Depression Risk: In a new studyTrusted Source , identified seven healthy lifestyle factors that are protective against depression. Healthy lifestyle factors include regular exercise, good-quality sleep, and interacting with friends. Of the seven lifestyle factors observed, healthy sleep had the greatest impact on depression risk, decreasing it by 22%.  “Never smoking” and frequent social connection followed, with 20% and 18%, respectively.  Having a healthy diet, consuming alcohol in moderation, regular physical activity, and low-to-moderate sedentary behavior also lowered depression risk.

 

Risk Reduction Program Helps Lower Chance of Heart Attack and Stroke: A new study has found that paying organizations to track cardiac risks in Medicare patients increases patient outcomes while not noticeably increasing spending. That led to a small reduced risk of first-time stroke and heart attack. JAMATrusted Source

 


TREATMENT

Stem Cell Therapy May Help Treat Multiple Sclerosis: A stem cell treatment- hematopoietic stem cell transplantation (aHSCT) - commonly used for blood cancer appears effective in treating one form of MS-relapsing-remitting MS.  The treatment has been available since the 1990s but questions about safety and difficulty have limited its impact New research suggests it is safer and would benefit more people with MS than previously believed. Journal of Neurology Neurosurgery & Psychiatry,

 

Mounjaro Superior to Ozempic for Blood Sugar and Weight Loss: A comparison of two drugs used to treat type 2 diabetes found that tirzepatide (Mounjaro) was superior to semaglutide (Ozempic) at controlling blood sugar (glucose) and promoting weight loss. The meta-analysis of 22 randomized controlled trials is being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in early October.


Experimental nasal spray may offer quick, easy remedy for treating rapid heartbeat: In a new study, etripamil, a rapid- and short-acting investigational medication formulated to be delivered via nasal spray, restored a normal heart rhythm in less than 30 minutes in most users with intermittent rapid heartbeats, sparing them a trip to the emergency room to receive intravenous medication. This new medication is still waiting on approval from the U.S. Food and Drug Administration. Journal of the American Heart Association 

 

Men with metastatic prostate cancer live longer thanks to new drugs: Survival rates for men with metastatic prostate cancer have increased by an average of six months, something which coincides with the gradual introduction of ‘dual treatment’ since 2016. This is according to a register study of all Swedish men diagnosed between 2008 and 2020. The results are published in the medical journal JAMA Network open. Dual treatment means that patients receive both standard hormone therapy (GnRH therapy) and chemotherapy or androgen receptor blockers. 

 

Ozempic, Wegovy Improve Blood Sugar Control and Weight Loss Over 3 Years, Study Finds: According to a new study being presented at the 59th Annual Meeting of The European Association for the Study of Diabetes (EASD), the diabetes drug semaglutide can significantly improve both blood sugar control and weight loss when taken for as long as three years. The researchers said these results apply to adults with type 2 diabetes.  

 

Mounjaro May Be Better than Fast-Acting Insulin for Uncontrolled Type 2 Diabetes: For individuals whose type 2 diabetes is hard to control, physicians may be able to turn to a new treatment. Tirzepatide, commonly known by the brand name Mounjaro, is currently prescribed as a primary treatment for diabetes.  However, a new clinical trial indicates that the medication could also work as an adjunct therapy for individuals who are prescribed both slow-acting insulin and fast-acting insulin at meal times. Results from the trial indicate that tirzepatide, when added to a regimen of slow-acting insulin, was more effective than fast-acting insulin in lowering A1CTrusted Source, aiding in weight loss, and had less incidences of hypoglycemia in people with uncontrolled diabetes. Researchers published those conclusions today in the medical journal JAMATrusted Source based on their findings in the SURPASS-6 randomized clinical trial. The clinical trial was sponsored by Eli Lilly, the pharmaceutical company that developed Mounjaro.

 

No Benefit of Enteric-Coated Aspirin vs Uncoated in Cardio Vascular Disease: Enteric-coated aspirin is not significantly less effective than uncoated aspirin is in preventing death, myocardial infarction (MI), or stroke among patients with cardiovascular disease but is also not significantly safer in terms of bleeding risk, results of a post hoc analysis of data from a randomized clinical trial suggest. This was a post hoc analysis of the 2021 open-label randomized ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness) trial that showed no statistical difference between high-dose (325 mg) and low-dose (81 mg) daily aspirin in death or hospitalization for MI or stroke among 15,076 patients with atherosclerotic cardiovascular disease and no significant difference in major bleeding between doses.


Taking GLP-1 Drugs for Weight Loss Can Lead to Serious GI Symptoms: Glucagon-like peptide-1 receptor agonists commonly called GLP-1 drugs are a class of drugs that includes semaglutide (OzempicWegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro). Common side effects of these drugs include GI issues. In a research letterTrusted Source  in the medical journal JAMA, researchers found strong associations with these complications in users of GLP-1s.

 

New drug shows promise in providing relief for treatment-resistant epilepsy: People with epilepsy who added a new medication, XEN1101, to their treatment routine had seizures reduced by a third to more than 50%. That’s according to a studyTrusted Source published in the journal JAMA Neurology, which noted that some people treated with the drug remained seizure-free during the 8-week treatment period

 

Intermittent Use of Benzodiazepines Is the Safest Option: Intermittent benzodiazepine use significantly reduces the risk for falls, fractures, and mortality in older adults compared with chronic use of these medications, results of a large-scale study show. Research shows that where possible, patients older than 65 years with anxiety or insomnia who are taking benzodiazepines should not stay on these medications continuously. 36th European College of Neuropsychopharmacology (ECNP) Congress.

 

Common High Blood Pressure Drug Amlodipine Is Safe and Effective: Amlodipine, a treatment for high blood pressure, is safe and effective, new research shows.

Earlier research raised concerns about an increased risk of heart failure from taking amlodipine and similar calcium channel blockers. The new study refuted these earlier results and found that amlodipine may decrease the risk of heart failure and and other cardiovascular outcomes. Function

 

A Common Antidepressant May Also Help Relieve IBS Symptoms: New research has found that amitriptyline, a cheap and widely available prescription drug, can improve symptoms of Irritable Bowel Syndrome (IBS). The research presented at UEG Week 2023 found that doses of the drug (commonly used to treat a range of health concerns, including migraine, nerve and back pain, and depression) could also improve IBS.

 

Diabetes Drug Mounjaro Helped People Drop an Average of 64lbs in Recent Study: A new study found that tirzepatide known by its brand name Mounjaro, a glucagon-like peptide-1 (GLP-1) drug used to treat diabetes, can propel weight loss in people who’ve achieved weight loss with healthy lifestyle changes.  The reportTrusted Source, which was conducted by the pharmaceutical company Eli Lilly & Company, also discovered that the weight reduction achieved with Mounjaro improved other cardiometabolic factors, including blood pressure, cholesterol and triglycerides, and blood sugar. Participants who took Mounjaro — in addition to making diet and physical activity changes — lost, on average, 64lbs in roughly 19 months compared to people who took a placebo, according to the study, which published in the journal Nature Medicine Monday.

 

Major study reveals safest way to take Valium and Ativan: More than 60 years after being introduced, doctors have uncovered the first reliable evidence to confirm the belief that taking benzodiazepines such as Valium and Ativan intermittently rather than continuously is associated with fewer side effects and reduced falls, hospitalisations and deaths.  Our results show that changing the way people take benzos from chronic to intermittent could lead, over one year, to 20% fewer hip fractures 33% fewer in men), 7.5% fewer falls requiring hospitalization or emergency visits and a 24% fall in the chance of needing to go into long term care”.European College of Neuropsychopharmacology 

 

Clinical trial demonstrates benefits of solriamfetol for adults with ADHD: Although several medications are approved to treat attention-deficit/hyperactivity disorder (ADHD), some individuals experience limited benefits from the drugs or develop side effects from their use. A recent clinical trial published in the Journal of Clinical Psychiatry  has demonstrated that the drug solriamfetol may be an effective alternative for managing ADHD in adults. Solriamfetol is currently approved in the United States for treating excessive daytime sleepiness in patients with narcolepsy or obstructive sleep apnea. The drug increases the amounts of certain natural substances in the brain—specifically, dopamine and norepinephrine—that control sleep and wakefulness, thus sharing some of the properties of current ADHD medications. 

 

Head-to-Head Study of Common Statins Looks at Effectiveness and Diabetes Risk: The study, published Oct. 18, in The BMJTrusted Source, focused on people with existing coronary artery disease, a type of heart disease caused by the buildup of plaque on the inside of the arteries that supply blood to the heart. Two widely used statins, rosuvastatin and atorvastatin, were equally effective at preventing heart attacks and strokes in people with coronary artery disease. People taking rosuvastatin had a slightly higher risk of developing diabetes or needing cataract surgery, compared to those taking atorvastatin. Experts say the study confirms that the drugs are similarly effective, but some patients may have fewer side effects on one medication.

 

 

OTHER

New Syndrome Identified that Links Heart Disease, Metabolic Disorders, and Kidney Disease: The American Heart Association has released a new advisory regarding a new type of condition related to heart, kidney and metabolic disorders.  Health experts are referring to this as cardiovascular-kidney-metabolic (CKM) syndrome. The advisory includes updated approaches to screening, stages and treatment. CirculationTrusted Source 

 

EMA Warns That Omega-3-Acid Ethyl Esters May Cause AF: In its September meeting, the safety committee (Pharmacovigilance Risk Assessment Committee [PRAC]) of the European Medicines Agency (EMA) confirmed that atrial fibrillation will now be included as a common side effect in the Summary of Product Characteristics for medicinal products containing omega-3-acid ethyl esters. Should atrial fibrillation develop, intake of the medication must be stopped permanently. Omega-3-acid ethyl esters are used to treat hypertriglyceridemia if lifestyle changes, particularly those related to nutrition, have not been sufficient to lower the blood triglyceride level. Hypertriglyceridemia is a risk factor for coronary heart disease

 

Saturday, October 14, 2023

Life with Chronic Conditions: Use of Expired Medications


Whether it’s over the counter medications, or prescriptions, they all have expiration dates on them. Does that mean it’s dangerous or not effective to use after the expiration date?

 Understand what the expiration date means:  The expiration date is not the date that the drug stops being effective or potentially becomes toxic. It is a date, required by law, that the manufacturer can guarantee greater than 90% original potency of the medication.

 

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. The Shelf Life Extension Program (SLEP).  With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date. ..Medical authorities state if expired medicine is safe to take, even those that expired years ago. A rare exception to this may be tetracycline, but the report on this is controversial among researchers. It's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. Placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many years. Drug Expiration Dates — Do They Mean Anything? 

 

More on  SLEP.  A total of 122 drugs were studied representing 3,005 lots. Based on testing and stability assessment, 88% of the lots were extended at least 1 year beyond their original expiration date for an average extension of 66 months, but the additional stability period was highly variable. Several antibiotics were studied, including ciprofloxacin (mean extension, 55 months), amoxicillin (mean extension, 23 months), and doxycycline (mean extension, 50 months).

 

A study of albuterol found that  almost all lots of albuterol maintained > 90% of product (73%-103%), many years past their expiration date. 

 

Bottom Line: If your medication expired a few years ago,  and it's important that your drug is absolutely 100% effective, you might want to consider buying a new bottle. For questions about drug safety, expiration dates etc. talk to your pharmacist.

Saturday, October 7, 2023

Life with Chronic Conditions: Hyperbaric Oxygen Therapy (HBOT)


Recently, I was talking to a woman in her late 70s, who had suffered a serious concussion while ice skating last winter. She said she found immediate relief by going for regularly treatments with hyperbaric oxygen therapy (HBOT). For about 4 months she went 2-3 times a week. Currently she goes approximately once a month as she finds it helpful for memory. 

 Just before talking to her, I had read two research articles on HBOT for traumatic Brain Injury (TBI) and fibromyalgia caused by TBI. As a result,  I thought a post on HBOT might be useful as this medical treatment is used for various chronic conditions, and in recent years, there has been a proliferation of HBOT offered by clinics, chiropractors, naturopaths and alternative care providers. 

 

Talk to your provider before undergoing any type of new or alternative treatment.  

 

WHAT IS HBOT: If you are not familiar with HBOT, it’s a form of treatment in which the patient stays in special chambers where the pressure is higher than the atmospheric pressure at sea level, and breathe 100% oxygen. The increased air pressure in the chamber helps the lungs collect more oxygen. Getting more oxygen to the tissues that need it can help the body heal and fight certain infections. This video is 5 years old but it’s a helpful overview of HBOT 


 

WHO BENEFITS FROM HBOT: As of July 2021, the FDA has cleared hyperbaric chambers for the following disorders:

• Air and gas bubbles in blood vessels

• Anemia (severe anemia when blood transfusions cannot be used)

• Burns (severe and large burns treated at a specialized burn center)

• Carbon monoxide poisoning

• Crush injury

• Decompression sickness (diving risk)

• Gas gangrene

• Hearing loss (complete hearing loss that occurs suddenly and without any known cause)

• Infection of the skin and bone (severe)

• Radiation injury

• Skin graft flap at risk of tissue death

• Vision loss (when sudden and painless in one eye due to blockage of blood flow)

• Wounds (non-healing, diabetic foot ulcers)

HBOT is being heavily studied in Israel, and is being used for a number of conditions beyond what the FDA has approved to date. For diseases like Lyme, and TBI doctors use it as an off-label course of treatment. 

While it may not yet have FDA approval, there are a number of studies underway that appear to show effectiveness of HBOT in the treatment of various conditions including:  traumatic brain injury ; Lyme-particularly neurological Lyme,  Long Covid;  Fibromyalgia caused by head injury; veterans with PTSD; Alzheimer’s Disease 

ARE THERE RISKS? HBOT is generally safe, and serious complications are rare. Because of the increased pressure and increased concentration of the oxygen during HBOT, potential risks include: Ear and sinus pain; Middle ear injuries, including tympanic membrane rupture; Temporary vision changes; Lung collapse (rare).

 

CLAUSTROPHOBIA: Because chambers are enclosed, people who suffer from claustrophobia, fear of confined spaces, may be concerned how they’ll react. Many chambers are designed with this concern and most allow you to see outside.  Hyperbaric physicians can prescribe medication that will relax you and make your treatment less stressful.

 

HOW LONG IS THE TREATMENT?: Each person differs based on the condition they are being treated for. The average treatment lasts about one-two hours and the number of sessions is condition dependent. Treatments are generally scheduled Monday-Friday. 

 

DOES INSURANCE COVER IT? Medicare has approved coverage for HBOT therapy for conditions which have FDA approval.  Most private insurance companies follow Medicare’s guidelines, including Medicaid. Conditions not approved by the FDA, see list above, or “off-label” are generally not covered by insurance. Check with your insurance before undergoing treatment as the out of pocket costs could be quite high. 

 

If your treatment would not be covered, check to see if there are sliding scale fees or other services that could help with costs. Lyme Disease.org offers Lyme Treatment Grants. Check out if there are clinical trials you could participate in at clinicaltrials.gov

 

Veterans should check the VA’s Center for Compassionate Innovation as the VA does provide HBOT for some off label conditions, including PTSD. 

 

 

ARE THERE DIFFERENT TYPES OF HBOT?: The woman I spoke with had her treatments at a private office in Brattleboro, VT receiving  “mild hyperbaric oxygen therapy” (mHBOT) in what is referred to as a “soft chamber.” The difference between mHBOT and HBOT is that mHBOT uses lower concentration and pressure than HBOT to deliver oxygen. There has been limited research done on the effectiveness of mHBOT compared to HBOT though the mild form has become very popular with athletes and various celebrities have soft chambers in their home. 

 

NEXT STEPS: If you’d like to learn more about HBOT for your specific chronic condition:

• Talk to your health provider. 

• Check with the organization that specializes in your condition, e.g. The American Diabetic Association. 

• If you do decide to try it, look for a qualified HBOT technician or center, up-to-date equipment, with knowledge of using HBOT to treat someone with your condition. 

 

RESOURCES

• Undersea & Hyberbaric Medical Society  They provide a list of chambers that meet their accreditation. 

• Mayo Clinic HBOT