Category: Diseases, Syndromes and Conditions

Categories : Diseases, Syndromes and ConditionsTags :

Glycerine’s Surprising Effectiveness in Psoriasis

On By ModernMedia
Photo by Daria Nepriakhina on Unsplash

Patients with psoriasis have often reported that glycerine, common in many skin lotions, is effective at combatting their psoriasis and there is now objective evidence to support their reports.

Researchers found that whether applied topically or ingested in drinking water, glycerine, or glycerol, helps calm the classic scaly, red, raised and itchy patches in their psoriasis model, Dr. Wendy Bollag, cell physiologist and skin researcher at the Medical College of Georgia and Charlie Norwood VA Medical Center and her colleagues report in the International Journal of Molecular Sciences.

The studies also provide more evidence of the different ways glycerine enables the healthy maturation of skin cells through four stages that result in a smooth, protective skin layer. Psoriasis is an immune-mediated problem that typically surfaces in young adults in which skin cells instead multiply rapidly, piling up into inflamed patches.

“We have experimental data now to show what these patients with psoriasis are reporting,” said  Dr Bollag, who nearly 20 years ago first reported that glycerine, a natural alcohol and water attractor known to help the skin look better, also safely helped it function better by helping skin cells mature properly.

Dr Bollag’s early report led to many anecdotal reports from individuals and their reports ultimately led to the newly published study.

Topically, glycerine is known to have a soothing, emollient effect. But once glycerine enters skin cells through the aquaporin 3 channel, the enzyme phospholipase-D-2 converts it to the lipid phosphatidylglycerol. Phosphatidylglycerol ultimately regulates the function of keratinocytes and suppresses inflammation in the skin. Dr Bollag and team previously reported that topical application of phosphatidylglycerol reduced inflammation and raised skin patches in a mouse model of psoriasis. 

For this study, they focused on its glycerin precursor, which was either applied topically or fed to mice with induced psoriasis. Either way, glycerine helped reduce development of the characteristic skin lesions, showing that glycerin works in more than one way to improve the skin condition.

Glycerine worked as an emollient even in mice lacking phospholipase-D-2. It also seems to block hydrogen peroxide in the aquaporin 3 channel. At low levels, hydrogen peroxide is a cell signaling molecule, but at high levels results in destructive oxidative stress, possibly leading to psoriasis.
Topical glycerine reduced the levels of hydrogen peroxide entering skin cells. When they added glycerin and hydrogen peroxide at the same time directly to skin cells, they found that glycerin protected against the oxidative stress from hydrogen peroxide.

“Glycerol is basically outcompeting the hydrogen peroxide in getting in there and preventing it from being able to enter and increase oxidative stress,” Dr Bollag said. Glycerine could also help by maintaining the skin’s water permeability barrier.

On the other hand, when glycerin was ingested by the mice missing the phospholipase- D-2,  it simply did not work, Dr Bollag said, which confirmed their earlier findings that internally anyway, glycerine pairs with the enzyme to produce the signal essential to skin cell maturation.

Some of their other most recent work is detailing more about how phosphatidylglycerol decreases inflammation.

Dr Bollag would like next steps to also include clinical trials with dermatologists and patients and is working to find a formulation scientist who can make what she thinks will be the optimal combination: glycerin and phosphatidylglycerol in the same topical cream.

The addition of phosphatidylglyerol itself, rather than just the glycerine that makes it, is essentially a backup since there is some evidence that in psoriasis the essential conversion of glycerin to phosphatidylglycerol is not optimal. Dr Bollag’s lab and others have shown reduced levels of aquaporin 3 in psoriasis, which likely means less phosphatidylgycerol, so making more glycerine available could somewhat help raise the availability of this key lipid.

She suspects that this sort of two-punch combination, could help keep early signs of psoriasis at bay and, with more advanced disease, use existing psoriasis treatments to get the skin condition under control then start applying glycerin to help keep it that way.

While its exact cause is unclear, psoriasis is an immune-mediated condition and patients have higher levels of inflammation, as well as too many skin cells being produced then maturing abnormally. The heightened inflammation also puts them at increased risk for problems like heart disease.

Biologics used to treat psoriasis work different ways to stem this overactive immune response but in addition to their high cost, can put the patient at risk for problems like serious infections and cancer. The only side effect she has seen in about 20 years of working with glycerine and the clinical and cosmetic use already out there, is sticky-feeling skin.

Source: MedicalXpress

Categories : Diseases, Syndromes and ConditionsTags :

HIV Drugs Could Stop Macular Degeneration

On By ModernMedia
Photo by Victor Freita on Pexels

A new study has found that there is a buildup of damaging DNA in the eyes of patients with geographic atrophy, an untreatable, poorly understood form of age-related macular degeneration that leads to blindness. Based on this, the researchers believe it may be possible to treat the condition with HIV drugs, or even simpler ones.

Dr Jayakrishna Ambati and colleagues had previously discovered that the harmful DNA, known as Alu cDNA, was manufactured in the cytoplasm. This represents the first time toxic Alu cDNA accumulation has been confirmed in patients in any disease.

“Although we’ve known that geographic atrophy expands over time, we didn’t know how or why,” said Dr Ambati, of UVA’s Department of Ophthalmology and Center for Advanced Vision Science. “Our finding in human eyes that the levels of toxic Alu cDNA are highest at the leading edge of the geographic atrophy lesion provides strong evidence that it is responsible for this expansion over time that leads to vision loss.”

Geographic atrophy is an advanced form of age-related macular degeneration, which ultimately destroys vital cells in the retina, resulting in blindness.

Dr Ambati, a leading expert in macular degeneration, and colleagues found that this destruction is brought about by the buildup of Alu DNA. As Alu DNA accumulates in the eye, it triggers harmful inflammation via the inflammasome. The researchers discovered the mechanism involving a previously unknown structural facet of Alu that triggers the immune response that destroys the retinal cells.

HIV drugs called nucleoside reverse transcriptase inhibitors, or NRTIs, could treat this; tests in lab mice suggest these drugs, or safer derivatives known as Kamuvudines, could block the harmful inflammation and protect against retinal cell death.

“Over the last two decades, dozens of clinical trials for geographic atrophy that have targeted other pathways have failed,” Dr Ambati said. “These findings from patient eyes provide a strong impetus for a new direction.”

Dr Ambati says his latest findings support clinical trials testing the drugs in patients with macular degeneration. A prior study of health insurance databases with over 100 million patients found that people taking NRTIs were almost 40% less likely to develop dry macular degeneration.

“Our findings from human eyes show that these toxic molecules, which activate the inflammasome, are most abundant precisely in the area of greatest disease activity,” Dr  Ambati said. “We are very hopeful that a clinical trial of Kamuvudines will be launched soon in geographic atrophy so that we can potentially offer a treatment for this devastating condition.” 

The findings were published in Science Advances.

Source: University of Virginia

Categories : Diseases, Syndromes and ConditionsTags :

Basic Toothbrush Still Tops for Gingivitis Prevention

On By ModernMedia
Photo by Diana Polekhina on Unsplash

In a review of evidence for dental hygiene techniques, only a few were able to provide additional protection against gingivitis and periodontitis beyond brushing one’s teeth with a basic toothbrush.

The paper was published in the Journal of the International Academy of Periodontology and examines the effectiveness of various oral hygiene devices.

At the moment, all other oral hygiene interventions are only supported by insufficient evidence, said principal investigator Frank Scannapieco, DMD, PhD, professor of oral biology in the UB School of Dental Medicine. The findings, he said, will help identify best practices for preventing gum disease.

“Patients can be confident that the oral care tools and practices supported by research, as described in the paper, will prevent the initiation and progression of periodontal disease, if they are performed regularly and properly,” said Prof Scannapieco.

The list of proven techniques includes: basic toothbrush; interdental brush; water pick; chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC) and essential oil (Listerine) mouth rinses.
Tooth brushing is the cornerstone of daily oral hygiene and is a reliable way to control dental plaque, said Scannapieco. Interdental brushes and water picks also performed better than other interdental oral hygiene devices at reducing gingivitis, and both should be used in combination with daily tooth brushing to prevent gum disease.

Mouth rinses based on CHX, CPC, and essential oils (such as Listerine) were proven to be effective at significantly reducing plaque and gingivitis.

While not effective at fighting gingivitis, toothpicks were useful for monitoring gum health, said Prof Scannapieco. By gently prodding the gums with a toothpick and monitoring for bleeding, patients could detect signs of gum disease.

While triclosan toothpastes and mouth rinses significantly reduced plaque and gingivitis, the compound is linked to cancer development and reproductive defects, and has been removed from most toothpastes in the US.
Unfortunately for those who invested in one, electric-powered toothbrushes are no more effective at reducing plaque and gingivitis than a basic toothbrush,  the researchers found. And little evidence has been published in support of dental floss – the mainstay of interdental cleaning – to reduce plaque and gingivitis. However, Prof Scannapieco said that flossing is still necessary:
“While there are few studies available that specifically examined toothbrushes or floss alone, both are still essential. Floss is especially useful to remove interdental plaque for people who have tight space between their teeth. Floss also likely reduces the risk for cavities that from between the teeth.”
Evidence was lacking for mouthwashes based on tea tree oil, green tea, anti-inflammatory agents, hydrogen peroxide, sodium benzoate, stannous fluoride, hexetidine or delmopinol reduced gingivitis.

Though promising as a preventive strategy against gum disease, the effectiveness of probiotics was unproven. There was also little evidence for dietary supplements improving gum health. The investigators also found insufficient evidence that professional plaque removal (known as scaling, the process of removing plaque with a scraper) prevents gum disease.

Source: University at Buffalo

Categories : Diseases, Syndromes and ConditionsTags :

Diabetes Linked to Tuberculosis Risk

On By ModernMedia
Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause tuberculosis. Credit: National Institute of Allergy and Infectious Diseases, National Institutes of Health

Diabetes status may play a role in the risk for developing tuberculosis, suggests a new study reported in JAMA Network Open.

Diabetes and tuberculosis are two major problems for South Africa; an estimated 15% of the population 25 and over have type 2 diabetes, and the burden of tuberculosis was 774 per 100k population in 2012.

In the population-based study from Korea, adults with diabetes had a 48% greater risk for developing tuberculosis compared with adults without diabetes.

This increased tuberculosis risk also appeared to be tied to the duration of diabetes, with risk increasing the longer the person had diabetes:

  • New-onset diabetes: aHR 1.32 (95% CI 1.23-1.42)
  • Diabetes duration less than 5 years: aHR 1.45 (95% CI 1.36-1.54)
  • Diabetes duration 5 or more years: aHR 1.57 (95% CI 1.48-1.66)

The tuberculosis risk also seemed to be dependent on blood glucose levels. Individuals with impaired fasting glucose only, that is, blood glucose levels of 100-125 mg/dL but no diabetes diagnosis, did not appear to have an elevated risk of contracting tuberculosis.

However, those with new-onset diabetes in the highest decile of fasting blood glucose levels (202 mg/dL or higher) had a 79% greater risk for tuberculosis than those with lower glucose levels (fasting plasma glucose of 126-128 mg/dL).

The researchers noted that a previous study looking at this association found about a 2.2-fold increased risk of tuberculosis in patients with diabetes, including those with a fasting plasma glucose level over 130 mg/dL.

“Diabetes appears to be associated with increased risk of lower respiratory tract infection, including TB [tuberculosis], and to have a profound adverse effect on TB treatment outcomes,” the researchers explained. “Even though TB is more associated with other immunosuppressive states, such as human immunodeficiency virus infection, because of the greater numbers, diabetes remains an important factor associated with TB incidence at the population level.”

For the cohort study, the researchers drew upon data from the Korean National Health Insurance System database. Only patients without a history of tuberculosis were included. Besides a history of tuberculosis, other exclusion criteria included diagnoses of anaemia, cancer, and end-stage renal disease.

Individuals who had diabetes the longest tended to be older, have obesity, and possess more comorbidities like chronic kidney disease, chronic obstructive pulmonary disease, ischaemic heart disease, stroke, and dyslipidaemia.

During a median follow-up of about 8 years, 0.6% of the cohort were identified.

A study limitation was that fasting plasma glucose levels were only monitored once at baseline, and that changes in glucose level after treatment was over were not taken into consideration.

“Nevertheless, it is likely that patients whose diabetes status progressed as a result of poor glucose control during the follow-up duration would have a higher risk of TB,” the researchers wrote.

The link with tuberculosis was stronger in male patients, they noted: “The exact mechanism for this phenomenon is not fully explainable — testosterone could be a reason.”

Source: MedPage Today

Categories : Diseases, Syndromes and Conditions UncategorizedTags :

Diabetes Drug Could Halve Glaucoma Risk

On By ModernMedia
Source: Pixabay CC0

GLP-1R agonists, a popular class of diabetes drugs, may also have a protective effect against glaucoma in diabetic patients, according to a new study published in the British Journal of Ophthalmology.

The researchers examined retrospective data of 1961 diabetic patients who were new users of this class of drugs and matched them to 4371 unexposed control subjects. After 150 days on average, 10 patients in the medicated group were newly diagnosed with glaucoma (0.5%) compared to 58 patients (1.3%) in the control group. These results indicate that GLP-1 receptor agonists could halve a diabetic patient’s risk of developing glaucoma.

The findings are supported by a Penn Medicine study from 2020, which found that GLP-1R agonists reduced neuroinflammation and prevented retinal ganglion cell death in mice. This class of drugs has also shown similarly protective effects against Alzheimer’s and Parkinson’s diseases in animal models, and clinical trials are underway to test the medications against neurodegenerative diseases in humans.

Glaucoma is the second leading cause of blindness worldwide, and people with diabetes are twice as likely to develop the condition.

“It was very encouraging to see that a popular diabetes medication could significantly reduce the risk of developing glaucoma, and our study suggests that these medications warrant further study in this patient population,” said Qi N. Cui, MD, PhD, with Brian VanderBeek, MD, MPH, both assistant professors of Ophthalmology at Penn.

Source: EurekAlert!

Categories : Diseases, Syndromes and ConditionsTags :

Discovery of Cell Type Linked to Skin Conditions

On By ModernMedia
Source: NCI on Unsplash

Researchers have found a cell type in human skin that contributes to inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis (PSO). Their study findings were published in the Journal of Experimental Medicine. The team hails from A*STAR’s Singapore Immunology Network (SIgN).

Chronic inflammatory skin diseases such as AD and PSO are characterised by the presence of an activated T cell subtype which secretes pro-inflammatory cytokines in the skin. This immune dysregulation mediated by T cells is central to the pathogenesis of a wide range of inflammatory skin diseases. Thus, understanding the factors modulating T cell priming and activation in healthy and diseased skin is key to developing effective treatments for these diseases.

Recently, a single-cell RNA sequencing (RNA-seq) approach has been used to analyse immune cells in human skin, including dendritic cells (DCs) and macrophages, which are cells that can T cell activation. To tease out the role of DCs and macrophages in chronic inflammatory skin diseases, the team used a combination of complex approaches to yield an unbiased profile/ landscape of DCs and macrophages, and to describe their distinct molecular signatures and proportions in skin lesions of AD and PSO patients.

The researchers found an increase in the proportion of CD14+ DC3s in PSO lesional skin, where they were one of the major cell types co-expressing IL1B and IL23A, two cytokines essential for PSO pathogenesis. This finding suggests that targeting CD14+ DC3 might represent a novel therapeutic option in the treatment of PSO, and demonstrates the potential for the single-cell myeloid cell landscape database to provide important insights into skin biology in health and disease.

Last author Dr Florent Ginhoux, Senior Principal Investigator, SIgN said: “The findings from this study are significant as it will allow the design of new strategies to target or modulate myeloid cell populations for better health outcomes for patients of atopic dermatitis and psoriasis.”

“The roles of antigen-presenting cells in the development of inflammatory skin diseases remain unclear. This study clearly revealed the functions of each antigen-presenting cell subset, which is very informative and valuable to understand the pathogenesis of atopic dermatitis and psoriasis. We expect that this study will lead to the design of new treatment for refractory inflammatory skin diseases.” said Prof Kenji Kabashima, Adjunct Principal Investigator from SIgN and SRIS.

Source: EurekAlert!

Categories : Diseases, Syndromes and ConditionsTags :

Immune System Mutation Found in Tree-man Syndrome

On By ModernMedia
Cryo-electron microscopy structure of the human papillomavirus. Source: Wikimedia Commons CC0

A new study explores why some extremely rare cases of human papilloma virus (HPV) infections cause horn-like growths on the skin, a condition known as tree-man syndrome. 

Infection with HPV is extremely common, with most people catching it at some point and not even being aware of it due to a robust immune response, though some may experience skin or genital warts. Why only a handful of individuals react to it by developing tree-man syndrome was not well understood.

To find out why this strikes a handful and not others, Rockefeller’s Jean-Laurent Casanova examines the genetics of an otherwise healthy patient who contracted a severe case of tree-man syndrome and several family members who exhibited milder reactions to HPV. Casanova’s team identified a mutation that affects one’s reaction to HPV by decreasing the production of CD28, a molecule within the immune system that plays an important role in activating pathogen-fighting T cells.

Given the purported importance of CD28 to the immune system, the scientists were surprised that this CD28-deficient individual was healthy prior to contracting tree-man syndrome. “CD28 is thought of as a pillar of T cell immunity,” says Casanova. “The fact that this patient was otherwise healthy suggests that CD28 is largely redundant in human health. Something else is able to step up to provide protection against other infections.”

The findings, published in Cell, form a small part of Casanova’s larger work, which continues to demonstrate that the severity of  influenza, tuberculosis, COVID, and other diseases, is not solely dependent on the pathogen itself, but on genetics of the host, too.

Source: Rockerfeller University

Categories : Diseases, Syndromes and Conditions PoliticsTags :

Rare Diseases in South Africa: A Neglected Topic

On By ModernMedia
Source: Pixabay/CC0

An article in Spotlight examines the challenges faced by South Africans with rare diseases.

A rare disease is a health condition affecting a small number of people compared with other diseases commonly identified in the population. According to the World Health Organization (WHO), there are between 5000 and 8000 known rare diseases worldwide, affecting an estimated 400 million people.

According to the advocacy group Rare Disease South Africa (RDSA), about 3.6 million people in SA have a rare disease. In South Africa, the ability to diagnose a rare disease is hindered by a lack of capacity and resources, according to research, putting the time to diagnosis for rare diseases in general higher than the estimated 5.5 to 7.5 years in high-income countries.
“There is still low recognition of genetic disorders among specialists. And when they are recognised, testing remains expensive and requires sophisticated levels of training which are relatively limited,” says Prof Karen Fieggen, a medical geneticist at the University of Cape Town (UCT).

According to her, costs, skills, training, and human resource factors are all barriers to effective testing and diagnosis. But she says the rationale to build an effective system is solid.

“We have capable people and expertise to build this system, but until you invest in it, it won’t be big enough to be self-sustaining,” she says.

Prof Fieggen acknowledges that resources are stretched in the public sector, where specialists who carry out genetic testing for rare diseases must meet the needs of a larger part of the population. However, she notes, “there’s no guarantee you’re better off in the private sector”.

“There are very few genetic referral options, and none of the medical geneticists are kept in work full time,” she says. In Cape Town, for example, she says that all patients seeking genetic testing had to come to the private sector until recently. “We have the capacity to train seven specialists a year, but posts aren’t available for them to take,” she says.

At one per 4.5 million population, available medical geneticists in the public healthcare sector fall far short of the 21 per 2 million recommended by the WHO. These services are also spread unevenly through the country. The country’s heavy burden of HIV and TB is partly responsible for this lack of coverage.

While healthcare training must focus on these public health needs, Prof Fieggen says rare diseases need a sensible approach. “It doesn’t help to throw huge resources at something that will have minimal management impact,” she says. “But the way in which rare diseases have been relatively ignored isn’t constructive.”

Helping the recognition of rare diseases and referral pathways in physician training may make a difference. “One thing that could be instilled in training is to recognise that if things are atypical in their presentation, there should be a discussion with a referral centre,” says Associate Professor Ian Ross, a senior consultant endocrinologist at UCT and Groote Schuur Hospital.

Only 2.5-5% of rare diseases have approved treatments, some of which are prohibitively expensive.

The most expensive drug in the world is Zolgensma (generic name onasemnogene abeparvovec), a once-off treatment costing a mind-blowing USD $2.1 million (R 30m). Used to treat inherited spinal muscular atrophy, where infants with the condition are unlikely to see their second birthday. However, even this is available through the UK’s National Health Service, which struck a deal to bring prices down.

Du Plessis says these drugs are not on the essential medicines list because of the small group of patients they would serve. “The essential medicines list is dedicated to treatments that are procured in large numbers. Rare diseases will never be mass-market drugs.”

Such drugs can be purchased by hospital pharmacists so they can be available at a certain hospital, making for a haphazard situation.
To help address this inequality, RDSA held a Rare Disease Symposium on 25 August, inviting feedback on a draft policy framework from various medical sector and political stakeholders.

The framework has a definition for rare disease in SA, namely a condition affecting one in 2000 people or fewer. It also recommends including rare diseases in the NHI benefit package. The NHI bill also includes a Benefits Advisory Committee, which will determine what diseases get coverage,

However, Dr Nicolas Crisp, Acting Director General for Health, said that the NHI would not ring-fence funding. As medical insurance will be done away with, it will be crucial to secure funding for those extremely expensive drugs unaffordable to the private sector.

Source: Spotlight

Categories : Diseases, Syndromes and Conditions Medical IndustryTags :

Review Looks at The Evidence for Cannabis in Paediatric Epilepsies

On By ModernMedia
Photo by Crystalweed Cannabis on Unsplash

A review published in Developmental Medicine & Child Neurology investigates the knowledge base of cannabis-based medicinal products in paediatric epilepsies, highlighting areas in need of additional research.

Following reports in the media of children with epilepsies apparently deriving benefits from medical marijuana (or cannabis-based medicinal products) accessed abroad, the UK government allowed clinicians to prescribe these products. A previous review found that there was some benefit in certain drug-resistant epilepsies in children.

In the review, the authors also looked at the prescribing environment surrounding these products. They found that the major obstacle to prescribing is a lack of quality evidence for efficacy and safety.
The authors stress that unlicensed cannabis-based medicinal products should not circumvent the usual regulatory requirements before being prescribed. They are also concerned that children with epilepsy are at risk of being exploited as a “Trojan horse” for the cannabis industry, with widespread acceptance of medicinal cannabis accelerating the wider legalisation of marijuana and opening up a highly lucrative commercial market.

Source: News-Medical.Net

Categories : Diseases, Syndromes and Conditions General InterestTags :

September 7 is the First World Field Epidemiology Day

On By ModernMedia
Photo by Kyle Glenn on Unsplash

In honour of field epidemiologists across the globe, the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) has declared 7 September 2021 #WorldFieldEpidemiologyDay.

This day, the first of its kind, is aimed at recognising and raising awareness of the invaluable role Field Epidemiologists play.

As health systems face increasingly complex threats, training workers in field epidemiology is even more important.. The NICD, a division of the National Health Laboratory Service, embarked on a joint collaboration more than 15-years ago in establishing the South African Field Epidemiology Training Programme (SAFETP).  To date the program has trained 98 epidemiologists with the majority located in the public service in South Africa.

Field Epidemiologists, or ‘disease detectives’ are considered the cornerstone of public health preparedness and response. They undertake arduous, time-consuming tasks that include contact tracing, case investigations, community engagement, data collection and analysis.

One such ‘disease detective’ is Alain Musaka Abera, whose team was deployed to Equateur province in the DRC in response to an outbreak of Ebola virus disease (EVD). “The health zone of Ingende had already reported seven confirmed cases, including two deaths in the community,” said Abera, describing his work. “I had to set up the different pillars of epidemiological surveillance (management of alerts, active research, investigation, follow-up of contacts) and, at the same time, support coordination of the response in the health zone.

“The task was tough; the means of transport insufficient; communication almost non-existent. It was necessary to travel long distances in the forest on motorcycles that sometimes broke down and to cross the river in a canoe to search for and investigate suspects. It took courage, determination, and will to face these constraints.”

Source: NICD