Day: September 14, 2021

The Nagging Pain of Vaccination Shoulder Injuries

Image source: NCI on Unsplash

Shoulder injury related to vaccine administration (SIRVA) has been documented long before COVID, and most commonly reported after influenza vaccination. The cause is often due to poor administration. 

However, the medical community cautions that currently it’s more of a medicolegal determination rather than a distinct diagnosis. The condition is also plagued by the lack of a solid evidence base, and causality is difficult to pin down.

However, most physicians that MedPage Today interviewed put shoulder injury down to improper injection technique, and that these problems should be taken seriously and treated appropriately. One recent overview noted that SIRVA is a “rare yet increasingly recognised complication of immunisation.”

“We’re certainly not seeing a pandemic of SIRVA” from COVID vaccines, said Dr DJ Kennedy, chair of physical medicine & rehabilitation at Vanderbilt University Medical Center. “It’s really rare and the literature to date is mostly case reports. But I do think it’s possible, absolutely” for vaccine-related shoulder injury to occur.

Dr Laura Keeling, orthopedic surgeon at MedStar Georgetown University Hospital, told MedPage Today that part of the reason SIRVA remains in the medicolegal realm is that it’s “more of a constellation of symptoms and findings” as opposed to a specific diagnosis.

Symptoms can vary depending on where the stray shot landed, resulting in various manifestations such as bursitis, tendonitis, or adhesive capsulitis (aka ‘frozen shoulder’).

Generally, it’s characterised as a “constellation of shoulder pain and reduced range of motion that occurs within 48 hours of vaccination and does not resolve within 1 week,” according to a recent paper co-authored by Dr Keeling. It’s also different from typical post-injection soreness, as the pain is more severe and it can impact mobility and function.

Generally, treatments include anti-inflammatory drugs, corticosteroid injections, and physical therapy. Occasionally surgery is necessary to treat an underlying pathology such as an exacerbated rotator cuff injury. Patients with SIRVA often land in their GP’s office first, and then may be referred to a specialist such as a physiatrist or an orthopedic surgeon.

“It’s the patients who have persistent symptoms who are referred to orthopedic surgeons,” Dr Keeling said. “If physical therapy and injection don’t work, then primary care refers to us.”

Physical medicine & rehabilitation physicians, or physiatrists, also play a large role in treating SIRVA.

“We treat based on a full evaluation including history and physical findings, and imaging if needed,” Dr Kennedy said. “Then we develop a comprehensive rehabilitation plan … that usually involves doing range of motion and strengthening exercises on a daily basis.”

Scott Noren, DDS, an oral surgeon in Ithaca, New York, said after his second COVID shot in early February, he developed shoulder pain: “It went in pretty deep and pretty high,” he told MedPage Today.

An MRI revealed fluid collecting in his joint, as well as adhesive capsulitis, he said. Physical therapy helped improve his range of motion to an extent, but he has lingering pain. It’s difficult to take x-rays and do long procedures as an oral surgeon: “I have pretty good pain even with just normal function now,” he said.

Source: MedPage Today

2-Metre Social Distancing May be Insufficient Indoors

Photo by Paul Wong on Unsplash

A new study found that the two-metre physical distance required to avoid the viral shedding from a person infected with COVID caused by speaking or breathing may be insufficient indoors.

Researchers from the Penn State Department of Architectural Engineering found that indoor distances of two metres may not be enough to sufficiently prevent transmission of airborne aerosols. Their results were published online in Sustainable Cities and Society.

“We set out to explore the airborne transport of virus-laden particles released from infected people in buildings,” said first author Gen Pei, a doctoral student in architectural engineering at Penn State. “We investigated the effects of building ventilation and physical distancing as control strategies for indoor exposure to airborne viruses.”

The researchers looked at three factors: the amount and rate of air ventilated through a space, the indoor airflow pattern associated with different ventilation strategies and the aerosol emission mode of breathing versus talking. They also compared transport of tracer gas, usually used to test leaks in air-tight systems, and human respiratory aerosols ranging in size from one to 10 micrometres, a size that can still carry SARS-CoV-2.

“Our study results reveal that virus-laden particles from an infected person’s talking — without a mask — can quickly travel to another person’s breathing zone within one minute, even with a distance of two meters,” said corresponding author Donghyun Rim, associate professor of architectural engineering. “This trend is pronounced in rooms without sufficient ventilation. The results suggest that physical distance alone is not enough to prevent human exposure to exhaled aerosols and should be implemented with other control strategies such as masking and adequate ventilation.”

Aerosols were found to travel farther and more quickly in rooms with displacement ventilation, where fresh air continuously flows from the floor and pushes old air to an exhaust vent near the ceiling. This is the type of ventilation system installed in most residential homes, and it can result in a human breathing zone concentration of viral aerosols seven times higher than mixed-mode ventilation systems. Many commercial buildings have mixed-mode systems, which bring in outside air to dilute the indoor air and result in better air integration as well as tempered aerosol concentrations, according to the researchers.

“This is one of the surprising results: Airborne infection probability could be much higher for residential environments than office environments,” Prof Rim said. “However, in residential environments, operating mechanical fans and stand-alone air cleaners can help reduce infection probability.”

According to Rim, increasing the ventilation and air mixing rates can effectively reduce the transmission distance and potential accumulation of exhaled aerosols, but ventilation and distance are only two options in an arsenal of protective techniques.

“Airborne infection control strategies such as physical distancing, ventilation and mask wearing should be considered together for a layered control,” Prof Rim said.

The researchers are now applying this analysis technique to other kinds of occupied spaces, such as classrooms and transportation environments. 

Source: Pennsylvania State University

Brain Cholesterol Production Linked to Alzehimer’s

Amyloid plaques and neurons. Source: NIAH

Cholesterol manufactured in the brain appears to play a key role in the development of Alzheimer’s disease, new research indicates.

Scientists found that cholesterol produced by cells called astrocytes is required for controlling the production of amyloid beta, a sticky protein which forms the characteristic plaques in patients with Alzheimer’s. These plaques have been the target of efforts to remove or prevent them  in the hopes that this could treat or prevent Alzheimer’s.

The new findings offer important insights into how and why the plaques form and may explain why genes associated with cholesterol have been linked to increased risk for Alzheimer’s. The results also provide scientists with important direction as they seek to prevent Alzheimer’s.

“This study helps us to understand why genes linked to cholesterol are so important to the development of Alzheimer’s disease,” Heather Ferris, MD, PhD, Researcher, UVA’s Division of Endocrinology and Metabolism. “Our data point to the importance of focusing on the production of cholesterol in astrocytes and the transport to neurons as a way to reduce amyloid beta and prevent plaques from ever being formed.”

The work sheds light on the role of astrocytes in Alzheimer’s disease. Scientists have known that these common brain cells undergo dramatic changes in Alzheimer’s, but they have been uncertain if the cells were suffering from the disease or contributing to it. The new results suggest the latter.

The scientists found that astrocytes help drive the progression of Alzheimer’s by making and distributing cholesterol to brain cells called neurons. This cholesterol buildup increases amyloid beta production and, in turn, fuels plaque accumulation.

Normally, the buildup of amyloid beta is limited because cholesterol is kept quite low in neurons. But in Alzheimer’s, the neurons are no longer able to regulate amyloid beta, leading to plaque formation.
Blocking the astrocytes’ cholesterol manufacturing “robustly” decreased amyloid beta production in lab mice, the researchers reported. While it is presently unknown whether this could be applied in people to prevent plaque formation, the researchers believe that further research is likely to yield important insights that will benefit the battle against Alzheimer’s.

The fact that amyloid beta production is normally tightly controlled suggests an important role in brain cells, the researchers said. Doctors may therefore need to be cautious about blockage or removal of amyloid beta. Additional research into the discovery could shed light on how to prevent the over-production of amyloid beta as a strategy against Alzheimer’s, the researchers believe.

“If we can find strategies to prevent astrocytes from over-producing cholesterol, we might make a real impact on the development of Alzheimer’s disease,” Dr Ferris said. “Once people start having memory problems from Alzheimer’s disease, countless neurons have already died. We hope that targeting cholesterol can prevent that death from ever occurring in the first place.”

Source: University of Virginia Health System

A ‘Fountain of Youth’ for Bone Marrow Stem Cells

Source: National Cancer Institute on Unsplash

Scientists have shown that reduced bone marrow stem cell function with ageing is due to changes in their epigenome, and they were able to reverse these changes in isolated stem cells by adding acetate. This ‘fountain of youth’ for the epigenome could become important for the treatment of diseases such as osteoporosis.

One responsible mechanism for age-related osteoporosis and fracture risk involves the impaired function of the bone-marrow stem cells, which are required for the maintenance of bone integrity. 

For a long time, researchers have looked at epigenetics as a cause of ageing. Epigenetics looks at changes that affect the activity of genes. One of these is changes in proteins called histones, which package and thus control access to DNA. In this study, the researchers investigated the epigenome of mesenchymal stem cells, which are found in bone marrow and can give rise to different types of cells such as cartilage, bone and fat cells.

“We wanted to know why these stem cells produce less material for the development and maintenance of bones as we age, causing more and more fat to accumulate in the bone marrow. To do this, we compared the epigenome of stem cells from young and old mice,” explained Andromachi Pouikli, first author of the study. “We could see that the epigenome changes significantly with age. Genes that are important for bone production are particularly affected.”

The researchers then sought to find out if it was possible to rejuvenate the epigenome of stem cells. To do this, they treated isolated stem cells from mouse bone marrow with a nutrient solution which contained sodium acetate. The cell converts the acetate into a building block that enzymes can attach to histones to increase access to genes, thereby boosting their activity. “This treatment impressively caused the epigenome to rejuvenate, improving stem cell activity and leading to higher production of bone cells,” Pouikli said.

To see if this change could also be responsible for increased fracture risk and osteoporosis with age, the researchers studied human mesenchymal stem cells from hip surgery patients. In elderly patients with osteoporosis, the same epigenetic changes seen with mice were also seen in these human cells.

“Sodium acetate is also available as a food additive, however, it is not advisable to use it in this form against osteoporosis, as our observed effect is very specific to certain cells,” cautioned study leader Peter Tessarz. “However, there are already first experiences with stem cell therapies for osteoporosis. Such a treatment with acetate could also work in such a case. However, we still need to investigate in more detail the effects on the whole organism in order to exclude possible risks and side effects.”

The results were published in the journal Nature Aging.

Source: Max Planck Society

Men’s Sleep Affected by Phases of the Moon

Photo by Mert Kahveci on Unsplash

The phases of the moon may have a far greater effect on men’s sleep than women’s, according to a new study published in Science of the Total Environment.

Prior research has produced somewhat conflicting results on the link between the lunar cycle and sleep, with some reporting an association whereas others did not. There are several possible explanations for these discrepant findings, such as that some of the results were chance findings. However, a number of past studies investigating the link between lunar cycle and human sleep did not account for confounding factors, such as obstructive sleep apnoea and insomnia.

During the waxing period, the amount of illuminated moon surface as seen from Earth increases, and the time the moon appears highest in the sky gradually shifts to late evening hours. In contrast, during the waning period, the illuminated surface decreases and the moment that time the moon is highest gradually shifts to daytime hours.

“We used one-night at-home sleep recordings from 492 women and 360 men. We found that men whose sleep was recorded during nights in the waxing period of the lunar cycle exhibited lower sleep efficiency and increased time awake after sleep onset compared to men whose sleep was measured during nights in the waning period. In contrast, the sleep of women remained largely unaffected by the lunar cycle. Our results were robust to adjustment for chronic sleep problems and obstructive sleep apnea severity,” said Christian Benedict, Associate Professor at Uppsala University’s Department of Neuroscience, and corresponding author of the study.

One mechanism through which the moon may impact sleep is sunlight reflected by the moon around times when people usually go to bed. In addition, a recent study suggests that the male brain may be more responsive to ambient light than that of females.

“Our study, of course, cannot disentangle whether the association of sleep with the lunar cycle was causal or just correlative,” concluded Prof Benedict.

Source: EurekAlert!

Childhood Cancer Survivor Set to Break Barriers in Space

Hayley Arcenaux, seated furthest left, is the Medical Officer for the Inspiration4 flight. She is a survivor of childhood cancer and works as a physician assistant at St Jude’s Children’s Hospital, for which the flight is raising funds and awareness.

The first chartered spaceflight into orbit, scheduled for launch on September 15, will have a crewmember who is both a childhood cancer survivor and physician assistant as part of the crew. 

The three-day long mission aboard a SpaceX Dragon spacecraft was chartered by entrepreneur Jared Isaacman. Dubbed Inspiration4, the flight is in fact also raising money and awareness for St Jude Children’s Hospital, which was given two of the four seats on the spacecraft. The funds raised for the hospital are believed to have exceeded the cost of the flight.

Isaacman offered the first seat to 29 year-old Hayley Arceneux, who works as a physician assistant at St Jude’s and will be the medical officer for the flight. She was also a patient at the very same hospital. At age 10, she was diagnosed with osteosarcoma, the most common primary paediatric bone malignancy. In addition to a dozen rounds of chemotherapy, she had a limb-sparing operation which replaced her knee and inserted a titanium reinforcing rod in her femur. This will make her the first person with a prosthetic in space. Such a medical history would have immediately disqualified her for astronaut selection with any of the government-run space agencies like NASA.

In an interview with The Cut, she described her work as a physician assistant at St Jude’s: “I work inpatient… with leukaemia and lymphoma patients specifically. The majority of them received their cancer diagnoses pretty recently, so a big part of  my role is helping to educate and support families through the beginning of treatment. I help them understand, What is cancer? What does the treatment process look like? What should I expect?

“We also manage the kids while they are in treatment. If they get an infection or if they get a fever, we take that really seriously. So I’ll manage their IV antibiotics or other treatment-related complications that can occur.. I check on patients, assess labs, order tests, update families on the results, order meds for outpatients. It is a lot of coordinating and educating. It’s hard, but it’s the greatest job in the world.”

St Jude’s held an auction for the other crew seat that Isaacman offered. The winning bidder declined the seat and gifted it to data engineer Christopher Sembroski. The final seat was won in an entrepreneurial competition by Dr Sian Proctor, a geologist and pilot who narrowly missed out on being chosen as a NASA astronaut. 

Speaking about the auction, Richard C. Shadyac Jr, president and chief executive of American Lebanese Syrian Associated Charities, which raised fund for St Jude’s, said: “The impact of the Inspiration4 mission has been immeasurable, serving as an incredible platform to educate and engage millions in the movement to find cures and deliver care for childhood cancer and other catastrophic diseases through accelerated research and treatment. The auction is a critical component of the overall campaign as it enables us to reach new audiences and supporters as we work to fulfill our mission.”

So far, $100 million has been raised for St Jude’s.

While in space, the crew will conduct experiments such as examining fluid shifts in zero gravity using ultrasound, as well as other medical experiments including measuring blood glucose levels — in order to help expand space travel to those with diabetes.

A documentary has been made of the crew’s training, and is available to stream on Netflix.