Categories : Lab Tests and ImagingTags :

New Technique Enhances Clarity of Photoacoustic Imaging in Dark Skin

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In photoacoustic imaging, laser light is pulsed through the skin into tissues, which release ultrasound signals with which the internal structure can be imaged. This works well for people with light skin but has trouble getting clear pictures from patients with darker skin. A Johns Hopkins University-led team found a way to deliver clear pictures of internal anatomy, regardless of skin tone. Their technique is described in the journal Photoacoustics.

In experiments the new imaging technique produced significantly sharper images for all people – and excelled with darker skin tones. It produced much clearer images of arteries running through the forearms of all participants, compared to standard imaging methods where it was nearly impossible to distinguish the arteries in darker-skinned individuals.

“When you’re imaging through skin with light, it’s kind of like the elephant in the room that there are important biases and challenges for people with darker skin compared to those with lighter skin tones,” said co-senior author Muyinatu “Bisi” Bell, Associate Professor at Johns Hopkins. “Our work demonstrates that equitable imaging technology is possible.”

“We show not only there is a problem with current methods but, more importantly, what we can do to reduce this bias,” Bell said.

The findings advance a 2020 report that showed pulse oximeters, which measure oxygen rates in the blood, have higher error rates in Black patients.

“There were patients with darker skin tones who were basically being sent home to die because the sensor wasn’t calibrated toward their skin tone,” Bell said.

Bell’s team created a new algorithm to process information from photoacoustic imaging, a method that combines ultrasound and light waves to render medical images. Body tissue absorbing this light expands, producing subtle sound waves that ultrasound devices turn into images of blood vessels, tumours, and other internal structures. But in people with darker skin tones, melanin absorbs more of this light, which yields cluttered or noisy signals for ultrasound machines.

The team was able to filter the unwanted signals from images of darker skin, in the way a camera filter sharpens a blurry picture, to provide more accurate details about the location and presence of internal biological structures.

The researchers are now working to apply the new findings to breast cancer imaging, since blood vessels can accumulate in and around tumours. Bell believes the work will improve surgical navigation as well as medical diagnostics.

“We’re aiming to mitigate, and ideally eliminate, bias in imaging technologies by considering a wider diversity of people, whether it’s skin tones, breast densities, body mass indexes – these are currently outliers for standard imaging techniques,” Bell said. “Our goal is to maximise the capabilities of our imaging systems for a wider range of our patient population.”

Source: John Hopkins University

Categories : Healthcare Politics and Regulations Medical IndustryTags :

Only with Both the Private and Public Sectors Working Together Will NHI Succeed

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For National Health Insurance to succeed in South Africa, a meaningful collaboration needs to take place between private and public health care so as to speed up the implementation of the initiative and overcome major obstacles.

This was the opinion of the five panellists who on the first day of the Hospital Association of South Africa conference in Cape Town spoke of how best the NHI could be rolled out by calling on private health care for assistance.

“’It’s fundamental to the economic growth that we so desperately need in South Africa, and a productive nation needs access to health care. So we do need to address the inequalities, we need to address the gap and do not need to preserve the status quo,” said Professor Roseanne Harris, of Discovery Health.

But a concern she raised is the risk of the introduction of a single funding model reliant on taxes, and the introduction of a monopoly market.

“And one of the implications of the bill is centralisation (of health care). There is a need for planning to ensure that it won’t have an unintended consequence of impacting service delivery and impacting on the rights of the healthcare personnel,” she added.

Harris said that both the private sector and public sector needed to go through a consultative process and that sustainable critical milestones needed to be put in place to hold the process to account.

Another panellist at the event Dr Simon Strachan of the South African Private Practitioners Forum (SAPPF), pointed out that the COVID pandemic showed how public and private health care could collaborate successfully.  Here service agreements between the two entities were met and were focused solely on fighting the pandemic.

“So to create the way forward, what we need to be able to do is to have a very clear understanding of what it is we’re trying to achieve, that there is robust trust, and that there is a groundwork for sustainable collaboration,” he explained.

An urgent need for this collaboration he said was the recent introduction of Section 33 of the NHI bill, which in its present form would have health care professionals working for the state at a fee the state sets, with benefits not included.

A second issue he said was the need for a successful funding model that will be acceptable to all South Africans.

Economist Nicola Theron of FTI consulting told the audience that structures already in place and used in the private sector could make for a smoother transition for the NHI. In particular when it comes to issues like the pricing of medicines.

“We are now at a point with the current NHI that there are talks about the lowest possible price at a reasonable return for healthcare providers. There is no indication of what return means,” she said.

“But what we have is an existing system of pricing which has been developed over time, and which should form the basis of pricing going forward,” said Theron.

By not getting the pricing right could lead to investment leaving South Africa, she warned.  She suggested in turn that it would be a better model to have multiple buyers that will stimulate competition.

Dr Ali Hamdulay, CEO, Metropolitan Health, said that a way forward would be to implement the suggestions that came out of the Health Marketing Inquiry that took a hard look at both the public and private health care systems, outlining the problems with both.

“So effectively by addressing the recommendations of the Health Market Inquiry  you’re actually foster an environment of culture and direction to work towards universal health care,” said Hamdulay.

Barry Childs, of Insight Actuaries, said that while fundraising mechanisms in the public sector needed to be improved, the introduction of the NHI offers a great opportunity to reform the healthcare system.

“As much as we talk about the need for reform of the private sector side, there’s been no meaningful reform of the public sector for many decades. And the NHI is a wonderful opportunity for them to introduce some better, more responsive financing mechanisms.” he said.

But for NHI to ultimately provide the services it promises, Childs said South Africa’s economy needed to improve, and more jobs to be created.

Source: Hospitals Association of South Africa

Categories : AddictionTags :

Fathers’ Parental Leave may Protect against Hospitalisation for Alcohol Consumption

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Source: CC0

Fathers who have been on parental leave have a significantly reduced risk of being hospitalised due to alcohol consumption. This is shown by a study published in Addiction from researchers at the Department of Public Health Sciences, Stockholm University.

The aim of the study was to assess whether fathers’ parental leave influences alcohol-related morbidity and mortality. In order to try to find out if that is the case, the researchers have investigated the effects of parental leave policy that was implemented in Sweden in 1995. The policy encouraged fathers to use parental leave by reserving 30 days of leave for their use alone and resulted in the proportion of fathers using parental leave increasing from 43% to 75%.

“Our findings were pretty remarkable considering the severity of the studied outcome. Although alcohol-related hospitalizations were rather uncommon, we found that after the policy was implemented there was a 34% decrease in these hospitalizations among fathers in the two years after birth, as well as smaller decreases up to 8 and 18 years after birth,” says Helena Honkaniemi, researcher at the Department of Public Health Sciences, Stockholm University.

“Most changes were found among hospitalisations for alcohol intoxication and alcohol-related mental and behavioural disorders. Additional analyses evaluating actual changes in parental leave use from before to after the policy suggest that these health consequences could be explained by the increase in fathers’ parental leave use, rather than other underlying trends,” says Helena Honkaniemi.

However, no changes were found for alcohol-related mortality.

Co-author Associate Professor Sol Juárez believes that the results of the study could be useful for policymakers.

“Policymakers should consider that fathers’ parental leave not only promotes more gender-equal participation in childcare, but can also reduce alcohol-related harms,” Juárez says.

The study “Alcohol-related morbidity and mortality by fathers’ parental leave: A quasi-experimental study in Sweden” draws on Swedish register data of all fathers of singleton children born from January 1992 to December 1997, three years before and after the policy was implemented.

Source: Stockholm University

Categories : NeurologyTags :

Goalies Really are Wired Differently to Other Soccer Players

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In soccer, goalkeepers have a unique role: they must be ready to make split-second decisions based on incomplete information to stop their opponents from scoring a goal. Now researchers reporting in Current Biology on have some of the first solid scientific evidence that goalkeepers show fundamental differences in the way they perceive the world and process multi-sensory information.

“Unlike other football players, goalkeepers are required to make thousands of very fast decisions based on limited or incomplete sensory information,” says Michael Quinn, the study’s first author at Dublin City University who is also a retired professional goalkeeper and son of former Irish international Niall Quinn. “This led us to predict that goalkeepers would possess an enhanced capacity to combine information from the different senses, and this hypothesis was confirmed by our results.”

“While many football players and fans worldwide will be familiar with the idea that goalkeepers are just ‘different’ from the rest of us, this study may actually be the first time that we have proven scientific evidence to back up this claim,” says David McGovern, the study’s lead investigator also from Dublin City University.

Based on his own history as a professional goalkeeper, Quinn already had a feeling that goalkeepers experience the world in a distinctive way. In his final year working on a psychology degree, he wanted to put this notion to the test.

To do it, the researchers enlisted 60 volunteers, including professional goalkeepers, professional outfield players, and age-matched controls who don’t play soccer. They decided to look for differences among the three groups in what’s known as temporal binding windows – that is, the time window within which signals from the different senses are likely to be perceptually fused or integrated.

In each trial, participants were presented with one or two images (visual stimuli) on a screen. Those images could be presented along with one, two, or no beeps (auditory stimuli). Those stimuli were presented with different amounts of time in between.

In these tests, trials with one flash and two beeps generally led to the mistaken perception of two flashes, providing evidence that the auditory and visual stimuli have been integrated. This mistaken perception declines as the amount of time between stimuli increases, allowing researchers to measure the width of a person’s temporal binding window, with a narrower temporal binding window indicating more efficient multisensory processing.

their tests showed that goalkeepers had marked differences in their multisensory processing ability. More specifically, goalkeepers had a narrower temporal binding window relative to outfielders and non-soccer players, indicating a more precise and speedy estimation of the timing of audiovisual cues.

The test results revealed another difference too. Goalkeepers didn’t show as much interaction between the visual and auditory information. The finding suggests that the goalies had a greater tendency to separate sensory signals. In other words, they integrated the flashes and beeps to a lesser degree.

“We propose that these differences stem from the idiosyncratic nature of the goalkeeping position that puts a premium on the ability of goalkeepers to make quick decisions, often based on partial or incomplete sensory information,” the researchers write.

They speculate that the tendency to segregate sensory information stems from goalies need to make quick decisions based on visual and auditory information coming in at different times. For example, goalkeepers watch how a ball is moving in the air and also make use of the sound of the ball being kicked. But the relationship between those cues in time will depend on where the outfielder making the shot is on the field. After repeated exposure to those scenarios, goalkeepers may start to process sensory cues separately rather than combining them.

The researchers say they hope to explore other questions in future studies, including whether players with other highly specialised positions, such as strikers and centre-backs, may also show perceptual differences. They’re also curious to know which comes first. “Could the narrower temporal binding window observed in goalkeepers stem from the rigorous training regimens that goalkeepers engage in from an early age?” McGovern asks. “Or could it be that these differences in multisensory processing reflect an inherent, natural ability that draws young players to the goalkeeping position? Further research that tracks the developmental trajectory of aspiring goalkeepers will be required to tease between these possibilities.”

Source: Cell Press via MedicalXpress

Categories : Neurology New Compounds and TreatmentsTags :

A New Drug Could Provide Hope in Treatment-resistant Epilepsy

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In cases where standard therapies fail, an in-development drug called XEN1101 reduces seizure frequency by more than 50% in some patients and in some cases eliminates them, according to a new study published in JAMA Neurology. Unlike several treatments that must be started at low doses and slowly ramped up, the new drug can safety be taken at its most effective dose from the start, the authors say.

Focal seizures, the most common type seen in epilepsy, occur when nerve cells in a particular brain region send out a sudden, excessive burst of electrical signals. Along with seizures, this uncontrolled activity can lead to abnormal behaviour, periods of lost awareness, and mood changes. While many available therapies control or reduce seizures, they fail to stop seizures in about one-third of patients and may cause harsh side effects, experts say.

Led by researchers at NYU Grossman School of Medicine, a new clinical trial found that patients who added XEN1101 to their current antiseizure treatments saw a 33% to 53% drop in monthly seizures, depending on their dose. By contrast, those given a placebo had on average 18% fewer seizures during the treatment phase of the trial, which lasted eight weeks. Most patients then volunteered to extend the trial, with about 18% of those treated with the new drug remaining entirely seizure free after six months, and about 11% having no seizures after a year or longer.

“Our findings show that XEN1101 may offer a swift, safe, and effective way to treat focal epilepsy,” said study lead author, neurologist Jacqueline French, MD. “These promising results offer hope for those who have struggled for decades to get their symptoms under control.”

French, a professor in the Department of Neurology at NYU Langone Health, notes that XEN1101 was well tolerated by the study participants, who reported side effects similar to other antiseizure treatments, including dizziness, nausea, and fatigue, and the majority felt well enough to continue the regimen. Another benefit of the drug, she adds, is that it takes more than a week to break down, so levels in the brain remain consistent over time. This steadiness allows the treatment to be started at full strength and helps to avoid dramatic spikes that worsen side effects, and dips that allow seizures to return. This lengthy breakdown time also allows for a “grace period” if a dose is accidently skipped or taken late.

XEN1101 is part of a class of chemicals called potassium-channel openers, which avert seizures by boosting the flow of potassium out of nerves, stopping them from firing. French notes that while other drugs of this kind have been explored for epilepsy patients in the past, such treatments were taken out of use because the compounds were later found to gradually build up in the skin and eyes, prompting safety concerns, the researchers say.

Meanwhile, XEN1101 combines the effectiveness of potassium-channel openers with the safety of more traditional drugs, says French, who is also a member of NYU Langone’s Comprehensive Epilepsy Center.

For the study, which included 285 men and women with epilepsy and ran from January 2019 to September 2021, the research team recruited adults with epilepsy who had already tried and stopped taking an average of six drugs that failed to treat their focal seizures. Patients in the trial had to have experienced at least four episodes a month despite ongoing treatment to qualify. The patients were randomly provided either a daily oral capsule of XEN1101 (in 10mg, 20mg, or 25mg doses) or placebo.

Among the results, the trial revealed no signs of dangerous side effects such as heart problems, allergic reactions, or concerning skin discolourations. However, French says that the research team plans to expand the number of patients exposed to the drug and monitor for potential issues that could arise in the long term, or include specific groups of people, such as pregnant women. In addition, the team also intends to explore XEN1101 for other types of seizures, including those that broadly affect the brain at the same time (generalised seizures).

“Our study highlights the importance of finding as many therapeutic options as possible for those who suffer from seizures,” says French. “Since everyone responds differently, treating epilepsy cannot be a one-size-fits-all approach.”

Source: NYU Langone Health / NYU Grossman School of Medicine

Categories : NeurologyTags :

Review Re-evaluates Biomarker for Imaging Neuroinflammation

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Neuroinflammation can lead to serious neurological or psychiatric diseases, for which there is presently one biomarker available for medical imaging to visualise cerebral inflammation. Trouble is, it has been unclear how to interpret this biomarker. Researchers have now found that a large quantity of this protein indicates a large quantity of inflammatory cells, but its presence is not a sign of their overactivation. These results, published in Nature Communications, pave the way for optimal observation of neuroinflammatory processes with other potential biomarkers, and a re-evaluation of prior research.

In the brain, microglial cells play an important role in inflammation and its potential overactivation. They can be ”activated” when dysfunction occurs, phagocytise pathological cells or proteins and even produce protective substances. Currently, in medical imaging, only one marker can be used to locate and measure microglia non-invasively and in vivo: the TSPO protein, which is present in these cells. This protein can be observed by Positron Emission Tomography (PET), a common imaging technique.

A TSPO of insight

”Hundreds of studies have used PET scans of this protein to explore and quantify microglia. However, no study has succeeded in precisely interpreting the significance of its quantity in the context of an inflammatory reaction,” explains Stergios Tsartsalis, senior clinical associate in the Department of Psychiatry at the UNIGE Faculty of Medicine. Together with other researchers, Stergios Tsartsalis sought to determine if a large quantity of TSPO correspond to a large quantity of inflammatory cells, and whether it is a sign of their overactivation.

The international research team worked on the brains of mouse models of Alzheimer’s disease, amyotrophic lateral sclerosis and multiple sclerosis, and on post-mortem brain samples from patients affected by the same diseases. ”We discovered that a high density of TSPO protein is indeed an indicator of a high density of microglia. On the other hand, the observation of TSPO does not allow us to say whether or not the inflammatory cells are overactivated,” explains the UNIGE researcher, co-first author of the study.

Re-reading the past, optimising the future

This discovery highlights the value of medical imaging of TSPO: it makes it possible to identify cases where the neuroinflammatory disease is linked to a deregulation in the number of glial cells. In addition, the scientists have identified two markers of the state of microglia activation in humans – the LCP2 and TFEC proteins – setting the stage for new medical imaging approaches.

”These results represent a further step towards understanding the role of microglia in neuroinflammation. They will help to optimise the focus of future studies and also to review the conclusions of previous research,” enthuses Stergios Tsartsalis.

Source: Université de Genève

Categories : Mental Health NeurologyTags :

We may now Know the Reason why SSRIs Take so Long to Kick in

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Source: CC0

Selective serotonin reuptake inhibitors (SSRIs) normally take a few weeks before any improvements manifest, but the reasons why it takes so long have remained unclear since their first introduction 50 years ago. Now, new research provides the first human evidence that this is due to physical changes in the brain, which leads to greater brain plasticity developing over the first few weeks of SSRI intake. This may also begin to explain one of the mechanisms of how antidepressants work.

This work is presented at the ECNP conference in Barcelona, and also has been accepted in a peer-reviewed journal.

Clinician have long been puzzled as to why SSRIs take a relatively long time before having an effect. Researchers in Copenhagen, Innsbruck, and University of Cambridge have undertaken a randomised, double-blind placebo-controlled study in a group of healthy volunteers which shows a gradual difference in how many nerve cell connections (synapses) the brain cells have between those taking the antidepressants and a control group, depending on how long the treatment lasts.

In the study, 17 volunteers were given a 20mg daily dose of the SSRI escitalopram, with 15 volunteers given a placebo. Between three and five weeks after starting the trial, their brains were scanned with a PET (Positron Emission Tomography) scanner, which showed the amount of synaptic vesicle glycoprotein 2A in the brain: this is an indicator of the presence of synapses, so the more of the protein is found in an area, the more synapses are present in that area (ie, greater synaptic density). These scans showed significant between-group differences in how the synapse density evolved over time.

Researcher Professor Gitte Knudsen (of Copenhagen University Hospital) said:

“We found that with those taking the SSRI, over time there was a gradual increase in synapses in the neocortex and the hippocampus of the brain, compared to those taking placebo. We did not see any effect in those taking placebo.”

The neocortex, which takes up around half of the brain’s volume, deals with higher functions, such as sensory perception, emotion, and cognition. The hippocampus, which is found deep in the brain, handles functions of memory and learning.

Professor Knudsen continued, “This points towards two main conclusions. Firstly, it indicates that SSRIs increase synaptic density in the brain areas critically involved in depression. This would go some way to indicating that the synaptic density in the brain may be involved in how these antidepressants function, which would give us a target for developing novel drugs against depression. The second point is that our data suggest that synapses build up over a period of weeks, which would explain why the effects of these drugs take time to kick in.

Commenting, Professor David Nutt (Imperial College, London) said “The delay in therapeutic action of antidepressants has been a puzzle to psychiatrists ever since they were first discerned over 50 years ago. So these new data in humans that uses cutting edge brain imaging to demonstrate an increase in brain connections developing over the period that the depression lifts are very exciting.  Also they provide more evidence enhancing serotonin function in the brain can have enduring health benefits.”

This is an independent comment, Professor Nutt was not involved in this work..

Source: EurekAlert!

Categories : Exercise Mental HealthTags :

Can Running Beat Antidepressants as a Treatment for Depression?

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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, with health benefits for those assigned to running.

Professor Brenda Penninx from Vrije University, Amsterdam, presented the work at the ECNP conference in Barcelona (after recent publication in the Journal of Affective Disorders). Prof Penninx said, “We wanted to compare how exercise or antidepressants affect your general health, not just your mental health.”  

The 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.

The researchers studied 141 patients with depression and/or anxiety. They were offered a choice of treatment; SSRI antidepressants for 16 weeks, or group-based running therapy for 16 weeks. 45 chose antidepressants, with 96 participating in running. The members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.

Professor Penninx said, “This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group.”

Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviours. In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness and participate in a group activity.  

The antidepressant group took the SSRI Escitalopram for 16 weeks. The running group aimed for two to three closely supervised 45-minute group sessions per week (over 16 weeks). The adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.

At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.

“Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation’,” Prox Benninix said.

Physical activity is a good option, but antidepressants still have a role

Prof Benninx noted that it is not a case of one or the other when it comes to treating depression. “It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant. We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behaviour will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution.”

She added: “Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good – and maybe even better – choice for some of our patients.  

“In addition, let’s also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health.”

Source: EurekAlert!

Categories : COVID Diseases, Syndromes and ConditionsTags :

Not Just ‘Long COVID’: Researchers Find ‘Long Colds’

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A new study from Queen Mary University of London, published in The Lancet’s EClinicalMedicine, has found that people may experience long-term symptoms, termed ‘long colds’, after non-COVID acute respiratory infections.

The ‘long cold’s’ most common symptoms included coughing, stomach pain, and diarrhoea more than four weeks after the initial infection. While the severity of an illness appears to be a key driver of risk of long-term symptoms, just why some people suffer extended symptoms while others do not is a focus of further research.

The findings suggest that there may be long-lasting health impacts following non-COVID acute respiratory infections such as colds, influenza, or pneumonia, that are currently going unrecognised. However, the researchers do not yet have evidence suggesting that the symptoms have the same severity or duration as long COVID.

The research compared the prevalence and severity of long-term symptoms after an episode of COVID versus an episode of another acute respiratory infection that tested negative for COVID. Those recovering from COVID were more likely to experience light-headedness or dizziness and problems with taste and smell compared to those who had a non-COVID respiratory infection.

While long COVID is now a recognised condition, there have been few studies comparing long-term symptoms following SARS-CoV-2 coronavirus infection versus other respiratory infections.

The study is the latest output from COVIDENCE UK, Queen Mary University of London’s national study of COVID, launched back in 2020 and still in follow-up, with over 19 000 participants enrolled. This study analysed data from 10 171 UK adults, with responses collected via questionnaires and statistical analysis carried out to identify symptom clusters.

Giulia Vivaldi, researcher on COVIDENCE UK from Queen Mary University of London and the lead author of the study, said: “Our findings shine a light not only on the impact of long COVID on people’s lives, but also other respiratory infections. A lack of awareness – or even the lack of a common term – prevents both reporting and diagnosis of these conditions.

“As research into long COVID continues, we need to take the opportunity to investigate and consider the lasting effects of other acute respiratory infections.

“These ‘long’ infections are so difficult to diagnose and treat primarily because of a lack of diagnostic tests and there being so many possible symptoms. There have been more than 200 investigated for long COVID alone.”

Source: Queen Mary University of London

Categories : Cancer PaediatricsTags :

Cannabis for Children’s Cancer Symptoms Lacks Hard Evidence

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Credit: National Cancer Institute

For the management of children’s cancer symptoms, cannabis products have increased in popularity, but questions remain over their efficacy and safety. A recent review of published studies to date shows a lack of evidence to determine the dosing, safety, and efficacy of medical marijuana or cannabis-containing products for managing symptoms experienced by children with cancer. The analysis is published online in CANCER, a peer-reviewed journal of the American Cancer Society.

Although great strides have been made in treatments for childhood cancer, even leading to cures for many patients, many children still suffer from symptoms such as pain, anxiety, and weight loss related to cancer and its treatment. Over the last decade, cannabis products, both synthetic cannabinoids and natural phytocannabinoids, have gained popularity with patients and families for managing such symptoms, but paediatric oncologists are cautious to authorise cannabis for their patients given the limited data to inform dosing, product selection, and safety monitoring.

To provide insights for clinicians and parents, and to inform an upcoming clinical trial, a team led by Lauren E. Kelly, PhD, associate professor of pharmacology and therapeutics in the Rady Faculty of Health Sciences at the University of Manitoba, searched the medical literature to summarise existing knowledge about the potential benefits and harms of cannabis products in children with cancer.

The investigators identified 19 unique studies with a total of 1927 participants with cancer: eight retrospective chart reviews, seven randomised controlled trials, two open‐label studies, and two case reports. The products studied included medical-grade cannabinoids (such as the prescription drug nabilone), synthetic cannabinoids, and unspecified cannabis herbal extracts. Products were most commonly used to manage chemotherapy‐induced nausea and vomiting.

In the randomised controlled trials, patients who used cannabinoids were more likely to experience drowsiness, feeling high, dizziness, and dry mouth. Also, trial participants who received cannabinoids were almost four times more likely to drop from the study due to adverse events, compared with the control group who received placebo. Across all included studies, no serious cannabis‐related adverse events were reported.

Dr Kelly and her colleagues noted that most studies did not adequately describe the types, dosing, frequencies, and routes of administration of cannabis products, and outcomes were mixed and were reported in different ways. Therefore, researchers should develop standards for reporting cannabis exposures, cannabis‐related effects, and patient outcomes.

“It was difficult to measure benefit across studies, given a range of different outcomes and study designs; however, in interventional studies with active control groups, cannabinoids performed better in managing nausea and vomiting. Data are lacking on cannabinoids’ effects on pain, mood, sleep, and health-related quality of life,” said Dr Kelly. “Given that some children report benefits and some children experience adverse events, it is critical that more rigorous studies evaluating the effects of cannabinoids on children with cancer are conducted and shared with parents, patients, and the health care community.”

This literature review informed the design of a three-arm tolerability trial later this year.

Source: Wiley