Month: September 2021

Worse Lung Function Linked to Sudden Cardiac Death

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A new study found that people with modest but measurably worse lung function are more likely to suffer sudden cardiac death (SCD).

SCD is death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life. There are often no previous warning signs, and is thought to be responsible for around 20% of all deaths in Europe.

The study was presented at the ERS International Congress by Dr Suneela Zaigham of Lund University. She said: “Although sudden cardiac deaths are common, we don’t know enough about who is at risk in the general population. There are links between lung and heart health, so we wanted to investigate whether measurable differences in lung function could offer clues about the risk of sudden cardiac death.”

The study involved 28 584 middle-aged participants with no known heart problems. All took part in spirometry tests where they were asked to blow into a machine to measure how well their lungs were working. Over the following approximately 40 years, researchers recorded any SCDs (death on the day of a coronary event) or any non-fatal coronary events (coronary events where people survived the first 24 hours)

They found that measurably lower lung function in middle-aged people (one standard deviation lower in the amount of air they could blow out in one second, which equates to around 0.8 litres) was more strongly associated with suffering a SCD (a 23% increase in risk) than a non-fatal coronary event (an 8% increase in risk) later on in life. The pattern of risk remained even in people who had never smoked.

Dr Zaigham said: “We believe this is the first study to directly compare the risk of sudden cardiac death and non-fatal coronary events and their links with lung function in the general population.

“Our findings suggest that testing people’s lungs when they are middle-aged and healthy could help spot those who have a higher risk of sudden cardiac death. This could enable people to take steps to potentially reduce the risk of this devastating event.”

A limitation of the study is that risk questionnaires were administered at the start of the study and these factors could have changed. The researchers next seek to see whether SCD could be prevented by testing lung function as part of current cardiovascular risk assessment. They plan to explore the link between lung function and SCD further to see if heart abnormalities, variable blood pressure or genetic causes are involved.

Source: European Respiratory Society

Bisexual People Have Over Twice the Rates of Lung Diseases

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A new national study found that bisexual Americans had over two times the rates of lung diseases including asthma as heterosexual adults.

The study, published in Annals of the American Thoracic Society, analysed data from 12 209 adults in the National Longitudinal Study of Adolescent to Adult Health. Overall, 29% of bisexual adults reported experiencing lung disease compared to 14% of heterosexual adults. There is consistent evidence that bisexual individuals are at increased risk for negative health outcomes (such as mental health, substance use, and sexual health problems) compared to monosexual (heterosexual and gay/lesbian) individuals.

“Higher levels of discrimination experienced by bisexual people could lead to more stress and lead to inflammation or stress hormones which would worsen asthma,” said lead author, Jason Nagata, MD, assistant professor of paediatrics at the University of California, San Francisco. “Bisexual adults have been shown to have worse health outcomes across a number of physical and mental health domains, and we add to this literature by showing disparities in asthma and other lung diseases.”

Even people who identified as ‘mostly’ heterosexual had higher rates of asthma than those who identified as exclusively heterosexual. Mostly heterosexual individuals may also face discrimination but may not be ‘out’, with access to the social support and communities ‘out’ LGBTQ+ people have available.

“Medical professionals, social workers, and clinicians need to be aware of these sexual orientation disparities in health outcomes,” said co-author Kyle T Ganson, PhD, assistant professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “Providing appropriate and tailored care is needed to address these disparities.”

“Some sexual minorities may be less likely to seek care due to barriers to accessing health care or experiences of discrimination at a clinician’s office. Doctors should offer materials on LGBTQ health, publicise nondiscrimination statements and have inclusive forms for sexual minorities,” Prof Nagata added, “so that they’re not discouraged from seeking care.”

Source: EurekAlert!

In Women, Avocado Consumption Reduces Abdominal Visceral Fat

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An avocado a day could help reduce abdominal visceral fat in women and result in health benefits, researchers wrote in the Journal of Nutrition.

In a randomised study, women who consumed avocado as part of their daily meal experienced a reduction in deeper visceral abdominal fat, though glucose tolerance markers were unchanged.

Study leader Naiman Khan, professor of kinesiology and community health, at University of Illinois Urbana-Champaign said:

“The goal wasn’t weight loss; we were interested in understanding what eating an avocado does to the way individuals store their body fat. The location of fat in the body plays an important role in health,” Prof Khan said.

“In the abdomen, there are two kinds of fat: fat that accumulates right underneath the skin, called subcutaneous fat, and fat that accumulates deeper in the abdomen, known as visceral fat, that surrounds the internal organs. Individuals with a higher proportion of that deeper visceral fat tend to be at a higher risk of developing diabetes. So we were interested in determining whether the ratio of subcutaneous to visceral fat changed with avocado consumption,” he said.

The participants were divided into two groups; one received meals incorporating a fresh avocado, and the other received a meal that had nearly identical ingredients and similar calories but without avocado. At the beginning and end of the trial, the researchers measured participants’ abdominal fat and their glucose tolerance, a measure of metabolism and a marker of diabetes.

Female participants who consumed an avocado a day as part of their meal had a reduction in visceral abdominal fat and experienced a reduction in the ratio of visceral fat to subcutaneous fat, indicating a redistribution of fat away from the organs. However, in males there was no change in fat distribution, and neither males nor females had improvements in glucose tolerance.

“While daily consumption of avocados did not change glucose tolerance, what we learned is that a dietary pattern that includes an avocado every day impacted the way individuals store body fat in a beneficial manner for their health, but the benefits were primarily in females,” Prof Khan said. “It’s important to demonstrate that dietary interventions can modulate fat distribution. Learning that the benefits were only evident in females tells us a little bit about the potential for sex playing a role in dietary intervention responses.”

The next step would be to provide all of the participants’ daily meals and look at additional markers of gut health and physical health for a more complete understanding of metabolic impacts and whether this sex difference persists.

Source: University of Illinois Alabama

Ridhwaan Suliman on Twitter: Graphs, Insight and Empathy

Photo by Tracy le Blanc from Pexels
Photo by Tracy le Blanc from Pexels

The Daily Maverick interviewed Dr Ridhwaan Suliman, a senior researcher at CSIR who has entered the spotlight by posting his concise, easy-to-understand COVID numbers graphs on Twitter.

Trained as a mechanical engineer and with a PhD in applied mathematics, he develops computational tools to model and simulate physical systems and processes. Equations in real-world contexts and how they govern physical systems are the relationships he translates into code. And from the code and modelling he can find solutions to make things work more optimally.

As a boy, he took apart his brothers’ old toys to see how they worked, and he took the same approach with COVID data to make sense of it. He started tracking the data in early 2020, and wanted to contribute in some way amidst all the growing uncertainty.

“When I started seeing the raw numbers that were being fed to us daily I couldn’t quite make sense of it myself because the raw numbers in isolation don’t show what’s happening, actually.”

As he tweeted his analyses, he drew attention for his concise summaries of the situation, and praise for helping people to understand the trends. However, he stresses that this is all unpaid, with nobody else’s agenda and that he is not a medical expert.

https://twitter.com/rid1tweets/status/1434570126091821062
This week’s update from Dr Ridhwaan

“I’m just comfortable with the numbers.” He gratefully turns to the science experts he engages with on Twitter because “there’s so much more to learn”, he says. That, and a lot of background reading, which he readily dives into.

Dr Suliman’s tracking of the data let him identify gaps and to add to the call for open data, better data collection and smarter analysis. This allows for the factoring in of more variables and laying out of better parameters. “Sure, data can be manipulated to fit a certain narrative, but the benefits outweigh the risks,” he says.

Even in the polarising, easily toxic world of Twitter, Dr Suliman’s interactions show a great empathy.

“We’ve all had numerous moments in this pandemic when things have been depressing and that’s probably something that doesn’t come out on Twitter because you’re generally only sharing things when things are hunky-dory, you don’t share when you’re not okay. There have been many times when I’ve just wanted to stop tweeting, but I get drawn back by people who reach out and say ‘you’re helping me’ – and that’s good enough reason to continue.”

Since he first started on Twitter, he has since appeared numerous times on television to explain the data behind COVID numbers.

Despite his newfound fame however, he looks forward to the time when he can travel again.  “I’ll trade the followers any day for our lives to go back to some sense of normality,” he says.

Source: Daily Maverick

Novel Nasal Spray for Migraines Approved by FDA

Impel NeuroPharma announced that the US Food and Drug Administration (FDA) approved TRUDHESA™ (dihydroergotamine mesylate) nasal spray (0.725 mg per spray) for the acute treatment of migraine with or without aura in adults.

The innovative system delivers dihydroergotamine mesylate (DHE) through the vascular-rich upper nasal space, bypasses the gut and potential absorption issues, offering rapid, sustained, and consistent symptom relief without injection or infusion, even when administered hours after a migraine attack starts. 

During the Phase 3, open-label, pivotal safety study, STOP 301, more than 5,650 migraine attacks were treated over 24 or 52 weeks during the study. The primary objective of the study was to assess the safety and tolerability of TRUDHESA. TRUDHESA was generally well tolerated and exploratory efficacy findings showed it provided rapid, sustained, and consistent symptom relief. STOP 301 reported TRUDHESA offered consistent efficacy even when taken late into a migraine attack.

“Many of my patients need more from their migraine treatment, and TRUDHESA offers a non-oral, fast-acting, reliable option that overcomes many current medication challenges,” said Stephanie J. Nahas-Geiger, MD, MSEd, Associate Professor in the Department of Neurology, and Program Director of the Headache Medicine Fellowship Program, Thomas Jefferson University. “Its upper nasal delivery circumvents the GI tract and common phenomena associated with migraine, such as nausea and gastroparesis, that can impact the effectiveness of oral treatments. And, importantly, it is a self-administered, single dose that can be taken anytime during a migraine attack, so patients don’t need to worry about missing the opportunity to benefit from using TRUDHESA within a certain timeframe. I think patients will be very receptive to this treatment, because it pairs the long-proven benefits of DHE with a patient-friendly delivery system.”

There were no serious adverse events were observed in the study, and most adverse events were mild and transient in nature.

In the STOP 301 study, patient-reported efficacy showed that 38% of patients had pain freedom, 66% had pain relief, and 52% had freedom from their most bothersome migraine symptom at two hours after their first dose of TRUDHESA. In 16% of patients, pain relief started as early as 15 minutes. Of patients who were pain free at two hours, 93 percent were still pain free at 24 hours, and 86 percent were still pain free through two days. The great majority of patients (84%) reported that TRUDHESA was easy to use10 and preferred it over their current therapy.

Source: Impel NeuroPharma

Physical Activity, Less Sitting Reduces Risk of Sleep Apnoea

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Higher levels of physical activity and fewer hours sitting still have been linked with a lower risk of sleep apnoea in a new study.

Researchers studied information from three different databases. These databases had collected health information on men and women using tests and questionnaires over several years. In this study, researchers looked at cases of sleep apnoea that had been diagnosed by a doctor, the amount of physical activity a person completed each week and how much time a person sat still while watching TV or working.

Drawing on the database, the study found 8733 cases of sleep apnoea (6652 women, 2081 men). Across all three databases, it was found that higher levels of physical activity were linked to lower levels of sleep apnoea. Fewer hours of sitting while watching TV or while working was also linked with lower levels of sleep apnoea.
The study also noted that there was a strong link between low levels of activity and long hours sitting in women, as well as those who were overweight or obese.

According to its authors, this is the largest study of its kind that looks at the link between sleep apnoea and physical activity and the number of hours sitting down. The findings support the benefits of maintaining an active lifestyle, and avoiding sitting for long periods of time, to help to reduce the risk of sleep apnoea.

Source: European Lung Foundation

Low-level Air Pollution Still Linked to Higher Mortality

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Long-term exposure to air pollution appears to still be linked to higher mortality despite the existence of air quality standards that restrict levels of pollution, suggests a study published online in The BMJ today.

Previous studies have found an association between long term exposure to outdoor air pollution such as those in the form of fine particles in the air (known as particulate matter or PM2.5) and nitrogen dioxide (NO2) and illness or mortality.

While air pollution concentrations have fallen substantially in Europe since the 1990s, it is unclear whether there still is a link between pollution and ill health or death at pollution levels under permitted levels.

Therefore, researchers set out to determine if there was an association between low levels of air pollution concentrations and natural and cause-specific deaths.

Low-level air pollution was defined as concentrations below current limits set by the European Union, US Environmental Protection Agency and the World Health Organization (WHO).

The researchers analysed data on eight groups of people within six European countries. Their study recruited participants in the 1990s or 2000s. Of the 325 367 participants who were followed up over an almost 20-year period, around 14.5% (47 131 people) died during the study period.

An increase of 5 µg/m3 (a concentration measure of particulate matter) in particulate matter (PM2.5) was associated with a 13% increase in natural deaths while the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6%. Associations with PM2.5 and NO2 were largely independent of each other.

Moreover, even at low to very low concentrations, associations with PM2.5, NO2, and black carbon remained significant. For people exposed to pollution levels below the US standard of 12 µg/m3, an increase of 5 µg/m3 in PM2.5 was associated with a 29.6% increase in natural deaths. People exposed to NO2at less than half the current EU standard of 40 µg/m3, a 10 µg/m3 increase in NO2 was associated with a 9.9% increase in natural deaths.

The study also has some limitations, the researchers said, such as the fact that it focused on exposure in 2010 which was towards the end of the follow-up period for most participants and, given falling air pollution, this measure might not exactly reflect the concentrations experienced during follow-up.

However, this was a large study from multiple European groups of people with detailed information provided. As such, the authors concluded: “Our study contributes to the evidence that outdoor air pollution is associated with mortality even at levels below the current European and North American standards and WHO guideline values.

“These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines and standards, and future assessments by the Global Burden of Disease [study].”

Source: The BMJ

MRI and Massage Stones Help Unlock Mystery of Sensory Associations

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By using hot and cold massage stones, scientists have found that the brain’s prefrontal cortex conjures up sensations based on other sensory information, such as feeling warmth when viewing a beach.

Publishing their findings in The Journal of Neuroscience, the researchers investigated patterns of neural activity in the prefrontal cortex as well as the other regions of the brain known to be responsible for processing stimulation from all the senses and discovered significant similarities.

“Whether an individual was directly exposed to warmth, for example, or simply looking at a picture of a sunny scene, we saw the same pattern of neural activity in the prefrontal cortex,” said Dirk Bernhardt-Walther, an associate professor in the department of psychology in the Faculty of Arts & Science, and coauthor of a study published last week in the Journal of Neuroscience describing the findings. “The results suggest that the prefrontal cortex generalizes perceptual experiences that originate from different senses.”

To understand how the human brain processes the torrent of information from the environment, researchers often study the senses in isolation, with much prior work focused on the visual system. Bernhardt-Walther says that while such work is illuminating and important, it is equally important to find out how the brain integrates information from the different senses, and how it uses the information in a task-directed manner. “Understanding the basics of these capabilities provides the foundation for research of disorders of perception,” he said.

Capturing brain activity with functional magnetic resonance imaging (fMRI), the researchers conducted two experiments with the same participants, based on knowing how regions of the brain respond differently depending on the intensity of stimulation.

In the first, the participants viewed images of various scenes, such as beaches, city streets, forests and train stations, and were asked to judge if the scenes were warm or cold and noisy or quiet.

For the second experiment, participants were first handed a series of massage stones that were either heated to 45C or cooled to 9C, and later exposed to a variety of sounds such as birds, people and waves at a beach.

“When we compared the patterns of activity in the prefrontal cortex, we could determine temperature both from the stone experiment and from the experiment with pictures as the neural activity patterns for temperature were so consistent between the two experiments,” said lead author of the study Yaelan Jung, who recently completed her PhD at U of T working with Bernhardt-Walther and is now a postdoctoral researcher at Emory University.

“We could successfully determine whether a participant was holding a warm or a cold stone from patterns of brain activity in the somatosensory cortex, which is the part of the brain that receives and processes sensory information from the entire body – while brain activity in the visual cortex told us if they were looking at an image of a warm or cold scene.”

“Overall, the neural activity patterns in the prefrontal cortex produced by participants viewing the images were the same as those triggered by actual experience of temperature and noise level,” said Dr Jung.

This opens up insights into how the brain processes and represents complex real-world attributes that span multiple senses, even without directly experiencing them.

“In understanding how the human brain integrates information from different senses into higher-level concepts, we may be able to pinpoint the causes of specific inabilities to recognise particular kinds of objects or concepts,” said Bernhardt-Walther.

“Our results might help people with limitations in one sensory modality to compensate with another and reach the same or very similar conceptual representations in their prefrontal cortex, which is essential for making decisions about their environment.”

Source: University of Toronto

HPV Vaccine to Cause Drop in Oropharyngeal Cancers

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Vaccinations against human papillomavirus (HPV), a major cause of oropharyngeal cancers, are expected to yield significant reductions in the rates of these cancers in the US after 2045, according to a new study.

The most common sexually transmitted infectious virus worldwide, HPV infection is often silent, and while most infections clear, some are chronic and can trigger cancers including mouth and throat (oropharyngeal), and cervical cancer as they disrupt DNA and inhibit tumour-suppressor proteins in infected cells. While there is no cure for existing HPV infections, vaccines can prevent new infections. The study appears online in JAMA Oncology.

“We estimate that most of the oropharyngeal cancers from 2018 to 2045 will occur among people who are 55 years and older and have not been vaccinated,” said study lead author Yuehan Zhang, a PhD candidate in the research group of Gypsyamber D’Souza, PhD, professor in the Department of Epidemiology at the Bloomberg School.

“HPV vaccination is going to work to prevent oropharyngeal cancers, but it will take time to see that impact, because these cancers mostly occur in middle age,” Prof D’Souza said.

Oropharyngeal cancer is the most common HPV-related cancer. Vaccination, though effective in prevention, has no effect against established HPV infections or against cells that have been transformed by HPV and are on their way to forming tumours, therefore recommended mainly for the young not yet exposed to sexually transmitted HPV. (People who were adults when the vaccine became available mostly did not receive it and remain at risk for these cancers)

In the new study, researchers at the Johns Hopkins Bloomberg School of Public Health analysed national databases on oropharyngeal cancer cases and HPV vaccinations, and projected the impact of HPV vaccination on the rates of these cancers in different age groups. They estimated that the oropharyngeal cancer rate would nearly halve between 2018 and 2045 among people ages 36–45. However, they also projected that the rate in the overall population would stay about the same from 2018-2045, due to still-rising rates of these cancers in older people, where most of these cancers occur.

The results suggest, though, that by 2045 HPV vaccination will have begun to make a significant impact. “Our projections suggest that by around 2033, nearly 100 cases of oropharyngeal cancer will be prevented each year, but by 2045 that figure will have increased by about ten times,” Zhang said.

Source: Johns Hopkins University Bloomberg School of Public Health

Europe to Return Millions of Locally-filled J&J Vaccines

The European Union has agreed to return millions of COVID vaccines doses partially produced in South Africa back to the African continent.

South Africa’s Aspen Pharmacare operates the plant that is partially producing Johnson & Johnson vaccines, where vaccine substance from Europe is sent to be bottled and shipped.

The plant is supposed to produce 400 million doses for the AU’s African Vaccine Acquisition Trust through 2022, to be purchased by African nations using World Bank financing. Shipments started in August, with 6.4 million doses delivered to countries, but they have been limited due to the manufacturing plant’s production capacity.

The announcement came as Africa struggles to immunise its population against COVID, partly due to a lack of supply resulting from wealthier countries buying up most vaccines, and also from widespread vaccine hesitancy. 

“All the vaccines produced at Aspen will stay in Africa and be distributed to Africa,” said Strive Masiyiwa, special African Union envoy. “This issue has been corrected and corrected in a very positive way.”

The announcement came after a meeting in Berlin between South African President Cyril Ramaphosa and European Commission President Ursula Von der Leyen, he said, adding that the first supplies were expected this month.

“In addition, the Europeans committed to give us 200 million doses before the end of December,” Masiyiwa said at the briefing by the Africa Centres for Disease Control and Prevention.

About 2.93% of people who have been fully immunised against COVID, said Africa CDC director John Nkengasong. The World Health Organization meanwhile warned that eight out of 10 African countries were likely to fall short of the “crucial” goal of vaccinating the most vulnerable 10% of their populations against COVID by the end of the month.

Source: Eyewitness News