Certain ADHD medications may increase heart disease risk

Using certain ADHD medications may be associated with an increased risk of heart disease.

Attention deficit hyperactivity disorder (ADHD) is a developmental condition that may make it harder for people to stay focused and make impulsive behaviors more likely.

Some people with ADHD may benefit from taking medications that help with such behaviors.

However, research is ongoing about these medications’ potential risks and benefits.

A recent study found that people taking ADHD medication long-term may be more at risk for cardiovascular disease.

ADHD is a neurodevelopmental disorder that can interfere with everyday life. People with ADHD may take certain medications to help with work and school performance and ultimately improve their quality of life.

A new case-control study published in JAMA Psychiatry looked at how long-term use of ADHD medication influenced risks for cardiovascular disease.

In their data collection from over 278,000 participants, the researchers found that individuals taking ADHD medication are at a higher risk for cardiovascular disease, particularly hypertension and arterial disease.

The study points to the critical need for physicians to carefully weigh the potential risks and benefits of people taking ADHD medications to help control specific symptoms.

Different medications for ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. It has subtypes, and doctors are not entirely sure of the precise cause of ADHD.

The CDC estimates that 9.8% of children between the ages of three and seventeen have ever been diagnosed with ADHD in the United States. Children with ADHD may also have other conditions, such as autism spectrum disorder or anxiety.

ADHD can involve several behavioral components. Someone with ADHD may have difficulty in paying attention, act without thinking, and find it hard to sit still. The specifics can vary from person to person.

Treatment for ADHD can involve the use of certain medications that can help improve some behaviors and symptoms. Common medications include stimulants and non-stimulants. Sometimes, someone with ADHD may be on more than one medication to help with ADHD symptoms.

Researchers in the current study wrote that “[p]harmacological therapy, including both stimulants and nonstimulants, is recommended as the first-line treatment for ADHD in many countries. The use of ADHD medication has increased greatly in both children and adults during the past decades.”

Research is ongoing about the potential long-term effects of ADHD medication use. Gathering more data in this area can help doctors make informed decisions when prescribing ADHD medications.

First years of taking ADHD meds may be crucial

This case-control study was conducted in Sweden. Researchers included 278,027 participants. Participants were ages 6–64 and had either received an ADHD diagnosis or were taking ADHD medication.

They looked at the timeframe of ADHD medication use, up to 14 years, and the incidence of several cardiovascular diseases, such as abnormal heart rhythms, heart failure, high blood pressure, and arterial disease. The researchers collected data via the National Inpatient Register, which records diagnoses, and the Swedish Prescribed Drug Register, which records data on dispensed medications.

In their analysis, they found that individuals taking ADHD medication were at a higher risk for cardiovascular disease, particularly within the first three cumulative years of taking ADHD medication.

After this, the associated risk remained more stable. Researchers found similar results among men and women and among children and adults.

Researchers further found that participants taking ADHD medication were particularly at risk for high blood pressure and arterial disease. However, the risk related to several other cardiovascular diseases was not statistically significant.

Dr. Keith C. Ferdinand, professor of medicine at the Tulane University School of Medicine, who was not involved in the study, noted to Medical News Today:

“This well-done, long term study did not did not observe any statistically significant increased risk for arrhythmias, heart failure, ischemic heart disease, thromboembolic disease, or cerebrovascular disease and should inform the public that these life threatening conditions were not clearly revealed as a driver of risks. Hence, it is reasonable to understand the real possibility of increased risk of hypertension and arterial disease, especially associated with stimulant medication use without suggesting that all ADHD medications, even used briefly, should always be avoided.”

Stimulant vs. non-stimulant medication for ADHD

The results also suggest that the risk for cardiovascular disease may be higher when taking stimulants rather than non-stimulants. The research points to the importance of weighing the risks and benefits of taking ADHD medication long-term.

Study authors Dr. Le Zhang and Dr. Zheng Chang explained to MNT:

“This longitudinal observational study found long-term exposure to ADHD medications was associated with an increased risk of CVDs [cardiovascular diseases], especially hypertension and arterial disease.”

“Clinicians should be vigilant in monitoring signs and symptoms of cardiovascular diseases, particularly among those receiving higher doses [of ADHD medications]. Treatment decisions, as always, should be based on careful[ly] weighing potential benefits and risks at individual patient level, rather than simple one-size-fits-all recommendations.”

— Study authors Dr. Le Zhang and Dr. Zheng Chang

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No causal link yet

This research does have certain limitations. First, it cannot prove that ADHD medication causes any cardiovascular disease problems.

It also only included individuals from one country, which could indicate the need for more diverse studies in the future. Future research can also have larger sample sizes.

Researchers note that there’s the possibility that there could have been some cases of cardiovascular disease that doctors had not diagnosed. They also note that there could have been exposure misclassification if participants did not take their medications the way medical professionals prescribed.

There is also the possibility of residual confounding, and results could have been affected by time-varying confounders. The research also did not look at the risk for cardiovascular disease among individuals who already had cardiovascular disease.

Study authors Dr. Le Zhang and Dr. Zheng Chang explained some components of future research to MNT:

“The current study did not examine the risk of CVD among individuals with pre-existing CVD. Further research needs to be done to examine the potential risks among individuals with pre-existing CVD. Individuals with pre-existing CVD represent a distinct clinical group that requires careful monitoring; thus, evaluating the risk among them necessitates a different study design that carefully considers the potential impact of prior knowledge and periodic monitoring.”

https://www.medicalnewstoday.com/articles/certain-adhd-medications-may-increase-heart-disease-risk

Certain migraine medications may be more effective than ibuprofen

Experts say a number of medications can be helpful in dealing with migraine pain

Researchers are reporting that triptans are the most effective medications for treating migraine attacks.

Ergots and antiemetics were found to be the second most effective medications. The scientists stress that there are many different effective options for treating migraine attacks. Triptans sold under brand names such as Imitrex, Zomig, Maxalt are the most effective in treating migraine attacks, according to a study published today in the online issue of Neurology.

Other classes of medications, such as ergots and anti-emetics, were found to be two to three times more effective than ibuprofen, which is sold under brand names such as Advil and Motrin.

Researchers looked at 25 medications among seven drug classes to determine which were most effective at treating migraine attacks compared to ibuprofen.

The scientists collected data over six years on more than 4.7 million treatment attempts by nearly 300,000 people via a smartphone app. The app collected information based on user input, frequency, triggers, symptoms, medication, and medication effectiveness.

What drugs are most effective to treat migraine

The researchers reported the top three classes of drugs were:

Triptans

Ergots (Migranal, Trudhesa, Cafergot, Ergomar, Ergostat)

Anti-emetics (Reglan, Compro)

The participants reported ibuprofen to be effective 42% of the time.

“Ibuprofen is often underdosed in order to limit side effects like stomach irritation, and that underdosing increases the risk of recurrence,” said Dr. Noah Rosen, the vice chair of neurology at Northwell Health in New York who was not involved in the study.

“Additionally, the half-life of the drug is quite short — that is how long the medication stays active in your body,” Rosen told Medical News Today. “Other comparable medications like naproxen stay in the system much longer, preventing the recurrence of the headache. While ibuprofen has moderate benefit, particularly for individuals with less frequent events or concurrent neck pain or jaw pain, there are other more specific choices that can have a greater likelihood of response as well as less likelihood the headache will return.”

According to the study, the top three medications were:

Eletriptan (6 times more effective than ibuprofen)

Zolmitriptan (5.5 times more effective than ibuprofen)

Sumatriptan (5 times more effective than ibuprofen)

The participants indicated that eletriptan was helpful 78% of the time, zolmitriptan was helpful 74% of the time, and sumatriptan was helpful 72% of the time.

Other potential medications for migraine

The researchers also looked at other groups of medication, such as acetaminophen (Tylenol) and other nonsteroidal anti-inflammatory drugs (NSAIDs). The NSAIDs other than ibuprofen were 94% more effective. A common combination of acetaminophen, aspirin, and caffeine was 69% more effective than ibuprofen.

Acetaminophen alone was helpful 37% of the time, compared to 42% for ibuprofen.

The scientists looked at other NSAIDs, which they reported were all more effective than ibuprofen:

Ketorolac (Toradol) was helpful 62% of the time

Indomethacin (Tivorbex) was helpful 57% of the time

Diclofenac (Flector, Cambia, Zipsor) was helpful 56% of the time

“I am not surprised by these results,” said Dr. Medhat Mikhael,a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California. “Triptans and ergots are very effective at treating migraines, which are caused by vasodilation of the arteries. These medications constrict the arteries, relieving the pain.”

“Ibuprofen treats inflammation. It is good for arthritis and other inflammatory conditions,” Mikhael, who was not involved in the study, told Medical News Today. “Ibuprofen might drop the pain level of a migraine down, but it usually doesn’t get rid of it. Another problem with ibuprofen is how quickly it leaves your system. It might start relieving symptoms and then two hours later the pain returns.”

The authors note that there are many treatment options available for relieving migraine.

“For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition,” said Dr. Chia-Chun Chiang, a study author and neurologist at the Mayo Clinic in Rochester, Minnesota, and a member of the American Academy of Neurology.

The researchers reported that a limitation of their study is that the results were user-reported and could be influenced by any number of factors, including a user’s expectations of the medication.

Another limitation is that there are newer migraine medications, gepants (ubrogepant, atogepant, and rimegepant) and ditans (Lasmiditan), that were not included in the research because there was only limited data on them at the time of the study.

What is migraine?

Migraine is a neurological condition or syndrome, not just a headache, according to UC Davis Health.

Headaches are a key symptom but not always present during a migraine. The headache pain is caused by nerve-controlled inflammation of the dura, or the membrane between the brain and the skull.

It is characterized by recurrent attacks of moderate to sever throbbing and pulsating pain on one side of the head, according to the National Institute of Neurological Disorders and Stroke.

“Migraine is more than just bad head pain,” Rosen noted. “It is the associated symptoms that often sets it apart. Throbbing one-sided pain that lasts anywhere from 2 to 24 hours in a stereotyped fashion is classic of a migraine. Typically, these worsen with movement and are moderate to severe in intensity. These events are either associated with light and sound sensitivity or nausea and vomiting. Many people may have other associated symptoms such as prodromal or post-dromal states (that is before or after the actual head pain) that consist of things like behavioral changes, yawning, food cravings and change in level of energy.”

Migraine is most common in adult women and can be connected to changes in hormones.

https://www.medicalnewstoday.com/articles/certain-migraine-medications-may-be-more-effective-than-ibuprofen

China respiratory illness: What’s the H9N2 avian flu outbreak there all about?

A subtype of avian flu virus needs to be watched for mutations.

Avian flu primarily affects birds with a high prevalence in poultry such as chickens and turkeys and can easily jump to humans. Avian flu primarily affects birds with a high prevalence in poultry such as chickens and turkeys and can easily jump to humans.

Ever since the outbreak of a mysterious respiratory illness that’s affecting children in northern China, authorities there have been talking about a cocktail of viruses that are breaking out again after pandemic restrictions. One of the viruses in circulation is H9N2, a subtype of the Influenza A virus. It primarily affects birds with a high prevalence in poultry such as chickens and turkeys and can easily jump to humans. It is highly transmissible and while it is known to cause mild illness, sometimes it manifests as a severe infection that can result in complications.

Why is H9N2 under the scanner?

A new study from researchers in China and Nottingham has discovered that a subtype of avian flu virus, endemic in poultry farms in China, is undergoing mutational changes, which could increase the risk of the disease being passed on to humans.

Researchers also say that the findings raise concerns of a potential epidemic or pandemic in the making and that concerted research is necessary to closely monitor such viruses in poultry and humans. This has raised some concern given that the coronavirus mutation resulted in a pandemic. However, at the moment there has been no confirmation of a new strain and there is no need to panic.

https://indianexpress.com/article/health-wellness/china-respiratory-illness-whats-the-h9n2-avian-flu-outbreak-there-all-about-9048145/

How to know if you have weak bones? Signs and symptoms of bone conditions other than osteoporosis

Your bones may lose density and become fragile as you age. Here are two conditions that can weaken your bones apart from osteoporosis. Know signs and symptoms.

As we age and body processes slow down, our bones bear the brunt of the loss of bone density and dwindling nutrient absorpotion. As a result by the time you reach 40s, your bones may start showing signs of wear and tear as they start to lose calcium, minerals and density.

As you get older, the strength of the bone tissue may start to decrease. Bone is a living tissue and is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bones is exceeded by the loss of old bone. In this condition, you may experience back pain, a stooped posture, loss of height and a bone that's broken easily. However, your bone health may deteriorate even without osteoporosis. In fact, your bones may weaken even without symptoms, and this is not detected until you go for a bone mineral density test (BMD). (See pics: 8 tips to maintain your bone and muscle health as you age)

Your bone health may deteriorate even without osteoporosis. In fact, your bones may weaken even without symptoms, and this is not detected until you go for a bone mineral density test (BMD).

 Weak bones due to osteopenia or osteomalacia

The two conditions that can weaken your bones apart from osteoporosis are osteopenia and osteomalacia. They may or may not show up symptoms.

"Not everyone with osteopenia develops osteoporosis, but it can happen. Upto 70% of individuals with osteomalacia have low bone density, which could be categorized as osteoporosis. Osteopenia is a loss of bone mineral density (BMD). Lower BMD indicates bones are weaker than usual. Osteomalacia means 'soft bones.' Osteomalacia is a disease that weakens bones and can cause them to break more easily. It is a disorder of decreased mineralization, which results in bone breaking down faster than it can re-form," says Dr Amite Pankaj Aggarwal, Director & HOD, Department of Orthopaedics & Joint Replacement Surgery, Fortis Hospital Shalimar Bagh.

Dr Aggarwal suggests a bone density test to determine whether you have osteopenia or osteoporosis. He however adds that it cannot determine osteomalacia.

Symptoms of osteopenia and osteomalacia

Osteopenia usually causes no symptoms. When osteopenia does cause symptoms, they may include localized bone pain and weakness in an area of a previous bone fracture.

The most common symptoms of osteomalacia as explained by Dr Aggarwal are:

Pain in the bones and hips

Bone fractures

Muscle weakness. Patients can also have difficulty walking.

How to diagnose osteopenia

"To check for osteopenia the main way to determine your bone density is to have a painless, non-invasive test called dual-energy x-ray absorptiometry (DXA) that measures the mineral content of bone," says the expert.

Some things can make bone loss happen more quickly, leading to osteopenia are:

Medical conditions such as hyperthyroidism.

Medications for cancer, heartburn, high blood pressure and seizures.

Hormonal changes.

Poor nutrition, especially a diet too low in calcium or vitamin D.

Surgery on the gastrointestinal system, which can affect the body’s ability to absorb needed nutrients and minerals.

Unhealthy lifestyle choices, such as smoking, drinking too much alcohol or caffeine, and not exercising.

Treatment

Treatment involves simple strategies to keep your bones as healthy and strong as possible and prevent progression to osteoporosis:

Calcium treatment

Exercise

Healthy diet.

Supplements for Vitamin D deficiency and exposure to the sun to help your body absorb vitamin D.

"Osteomalacia develops most commonly due to vitamin D deficiency, or less frequently, due to a digestive or kidney disorder. Vitamin D is essential for calcium absorption and for maintaining bone health.

These disorders can interfere with the body’s ability to absorb vitamins patients who have osteomalacia can take vitamin D, calcium or phosphate supplements, depending on the individual case. For instance, people with intestinal malabsorption may need to take larger quantities of Vitamin D and calcium," concludes Dr Aggarwal.

https://www.hindustantimes.com/lifestyle/health/how-to-know-if-you-have-weak-bones-signs-and-symptoms-of-bone-conditions-other-than-osteoporosis-101701153543307.html

Not just a smokers' disease: Breaking the lung cancer stigma

Lung cancer is the second most common form of cancer worldwide, leading to around 20% of cancer-related deaths. We know that smoking can cause lung cancer, but it is less known that 15–20% of cases occur in nonsmokers. Many of these are due to a nonhereditary gene mutation that develops later in life, causing a type of lung cancer called EGFR positive (EGFR+). Medical News Today spoke to a survivor of EGFR+ lung cancer, and investigated the latest developments in lung cancer research and treatment.

Not everyone who receives a lung cancer diagnosis used to be a smoker. Header design by MNT; photography by Rankin for the See through the symptoms campaign, courtesy of EGFR+ UK.

Smoking tobacco can cause lung cancer — this is an undisputed fact. Cancer Research UK — a United Kingdom nonprofit organization — reports that 72% of lung cancer cases, and 86% of lung cancer deaths, are caused by smoking.

In the United States, the Centers for Disease Control and Prevention (CDC)Trusted Source state that up to 90% of lung cancer deaths are associated with smoking. Giving up smoking or, better still, never starting to smoke, greatly reduces the risk of lung cancer.

However, not all lung cancer cases can be linked to smoking. And, as the number of smoking-related lung cancers starts to decrease, non-smoking-related lung cancer cases are on the rise.

First, what is lung cancer?

CancerTrusted Source is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. Lung cancer is any cancer that affects the trachea (windpipe), bronchi (airways), or lung tissue.

The two main types of lung cancer are small cell lung cancer (SCLC), and non small cell lung cancer (NSCLC). NSCLC makes up the majority — around 80%–85% — of lung cancers.

NSCLC can be divided into 3 main typesTrusted Source:

adenocarcinoma, which starts in the mucus cells lining the airways

squamous cell carcinoma, which tends to grow near the centre of the lungs and starts in the flat cells that cover the airway surface large cell carcinoma, where cells appear larger than typical cells when examined under a microscope.

Overall, in the U.S., the estimated 5-year survival rate for NSCLC is 28%, meaning that of people with NSCLC, 28% are likely to be alive 5 years after diagnosis. However, survival rates are improvingTrusted Source all the time.

Historically, lung cancer has affected more men than women. Smoking peaked among women in the U.S. in the 1960s, so as these women aged, their rates of lung cancer increased. In recent years, there has been a concerning rise in lung cancer in younger women.

What is EGFR+ lung cancer?

EGFR+ lung cancer is a form of lung cancer, usually an adenocarcinoma, that is not caused by smoking, but by a mutation in epidermal growth factor receptorTrusted Source (EGFR) — a protein involved in the growth and division of healthy cells. The mutation causes the gene to constantly tell cells to divide, leading to malignanciesTrusted Source, or cancer.

The American Lung Association (ALA) states that EGFR+ mutation occurs in around 10–15% of lung cancers in the U.S.

The most common EGFR mutations are EGFR 19 deletion — where part of the gene is missing — and EGFR L858R point mutation — where one nucleotideTrusted Source (small unit of DNATrusted Source) is altered. Less common is the Exon 20 insertion mutation, which causes between 4 and 10%Trusted Source of EGFR+ lung cancer cases.

This type of lung cancer is more common in women than men. It is also more likely to be diagnosed in younger people and people who have never smoked, or who have been light smokers at some stage of their life, than in heavy smokers.

So it could be, in part, responsible for the increases being seen.

Lung cancer in nonsmokers

Many people with lung cancer face harmful stigma about their presumed lifestyles. Collage design by MNT; photography by Rankin for the See through the symptoms campaign, courtesy of EGFR+ UK.

Prof. Robert Rintoul, a professor of thoracic oncology in the Department of Oncology at the University of Cambridge, U.K., and honorary consultant respiratory physician at the Royal Papworth Hospital NHS Foundation Trust in Cambridge, told Medical News Today:

“Because many EGFR+ are never smokers or light smokers, they are not thinking of lung cancer when they develop symptoms. ‘Oh it can’t be anything serious, I have never smoked.’

Therefore often such patients present with more advanced, higher stage disease when they do come to light. Currently around 15% of all the lung cancers we diagnose (regardless of EGFR status) are never smokers — lung cancer is no longer a disease of smokers.”

According to the CDC, up to 20%Trusted Source of lung cancer cases in the U.S. are diagnosed in nonsmokers. Prof. Rintoul advised that everyone, regardless of whether they have ever smoked, should be aware of possible symptoms, which include:

persistent cough (more than 3 weeks)

recurrent chest infections

coughing blood

losing weight

unexplained tiredness

chest pain

unexplained breathlessness.

However, Dr. Gini Harrison, psychologist and research trustee at EGFR+ UK, and EGFR+ survivor, cautioned that not everyone, particularly with EGFR+ lung cancer, has these typical symptoms.

“I was 40. I had my son in February 2021, and almost immediately, I started getting really bad shoulder pain. That was it. That was my only symptom. No breathing issues, no wheezing, nothing. My GP [primary care practitioner] said it was probably tendonitis due to poor breastfeeding posture,” she told us.

“And,” she added, “many of us only present with musculoskeletal symptoms — such as back, chest or shoulder pain — at diagnosis.”

Partly because of these atypical symptoms, it was 9 months before her cancer was diagnosed.

Does stigma lead to a lack of research?

Lung cancer research suffers from a lack of funding. Although the most common cancer in men and the second most common cancer in women, it receives some of the lowest investmentTrusted Source compared to the overall burden of diseaseof any cancer.

It causes 11.4% of cancer cases and 18% of cancer deaths globally, but lung cancer research received only 5.3% of the total investment in cancer research between 2016 and 2020.

Could this be due to the stigma associated to lung cancer? That may be a contributing factor, seeing that around 80-90%Trusted Source of people who die from lung cancer have a history of smoking, and this lifestyle choice is often blamed for the cancer.

But Dr. Harrison is adamant that this viewpoint needs to change:

“We need to raise awareness that lung cancer can happen to anyone with lungs, regardless of smoking status. Breaking this stigma would mean more visibility, more fundraising, more support, more money for research, more knowledge… which ultimately should lead to better and earlier detection of symptoms, better treatments and better survival outcomes.”

Early lung cancer diagnosis is vital

The earlier lung cancer is diagnosed, the better the prognosis. According to the American Cancer SocietyTrusted Source, those diagnosed when NSCLC is at an early, or localized, stage have a 65% chance of surviving for 5 years.

However, if the cancer has spread to other parts of the body before it is diagnosed, only 9% of those people are likely to live for another 5 years.

Nevertheless, the outlook for those with all types of lung cancer is improving, as Dr. Harrison explained.

“These days, with targeted therapies, people are living way longer than they used to. When you get diagnosed, you Google the statistics and the ones you see are horrendous — that’s terrifying. But those statistics are massively out of date. They haven’t taken into account the targeted therapies,” she pointed out.

Treatment options and targeted therapies for lung cancer

The treatments for NSCLC depend on the stage of the cancer.

A cancer that is detected early may be entirely removed by surgeryTrusted Source, photodynamic therapyTrusted Source (PDT), laser therapyTrusted Source, or brachytherapyTrusted Source (internal radiation), without any need for follow-up therapies. The later the cancer is diagnosed, and the further it has spread, the more intensive the therapy that is needed.

Later stages of lung cancer may be treated using surgery followed by radiation therapyTrusted Source, immunotherapyTrusted Source (medications that help the immune system fight the cancer), and/or chemotherapyTrusted Source. The tumors will be tested for gene mutationsTrusted Source so that therapy can be targeted.

EGFR+ lung cancer is also treated with a group of drugs called tyrosine kinase inhibitorsTrusted Source, or TKIs, which inhibit the enzymes that activate proteins such as EGFR.

There are five approved TKIs for treating EGFR+ lung cancer:

Tarceva (erlotinib)

Gilotrif (afatanib)

Iressa (gefitinib)

Vizimpro (dacomitinib)

Tagrisso (osimertinib).

These medications can greatly improve the survival and quality of life of NSCLC patients with EGFR mutations. However, their efficacy can be affected by other gene mutations, and tumors can become resistant to them.

According to EGFR+ UK, how long the drugs are effective varies from patient to patient. If the cancer becomes resistant, it will start to grow or spread, and doctors will then carry out genetic tests to see what mutation has occurred. Often, they will then try a different TKI, which many people will respond well to, chemotherapy or radiation therapy.

For Dr. Harrison, genetic testing showed that her cancer was Exon 20, which does not respond to TKIs. “When I was diagnosed, there were no targeted treatments for Exon 20, so they decided on chemo radiation because it was quite local.”

Having undergone several months of chemo and radiotherapy, she now has no evidence of cancer, although she does have some lasting effects: “What has happened is the top of my lung has collapsed, as a result of the radiation, and my ribs just keep breaking, but it’s not cancer!”

New developments and research breakthroughs

Despite funding shortages, there have been some recent breakthroughs in EGFR+ lung cancer research.

One studyTrusted Source earlier in 2023 found that CD70, a gene that promotes cell survival and invasiveness, and has been implicated in the development of other cancers —such as glioblastoma, the most common type of brain tumor — could be a therapeutic target for people with resistant EGFR+ lung cancer.

Another study has suggested that a vaccine may prevent the development of common EGFR mutation-driven lung tumors, by activating immune cells, but this research is in its early stages.

Targeted, combined therapies seem to be the most promising route, as Dr. Elene Mariamidze, from Todua Clinic, in Tbilisi, Georgia, argued at the ESMO Congress 2023:

“We are entering an era of personalised medicine in NSCLC where we are using combinations of novel, targeted agents, and it will be essential to know the whole mutational burden of each patient at diagnosis so we can properly plan the most effective and least toxic approach. The future of lung cancer care lies in finding the right combination of targeted treatment, or chemotherapy with immunotherapy for each patient.”

Marcia K. Horn, juris doctor, president and CEO of the International Cancer Advocacy Network, and executive director of the Exon 20 Group, told MNT that there is new hope for those with the rarer Exon 20 mutation EGFR+ cancer.

“Our patients and care partners who are members of the Exon 20 Group were overjoyed at the PAPILLON clinical trial data announced at Madrid’s recent ESMO Congress,” she said.

“What the PAPILLON data means is that we now have a new first-line therapy for EGFR exon 20 insertion-mutated patients of amivantamab plus the chemo doublet of pemetrexed/ALIMTA plus carboplatin. I cannot overstate the importance of having such a transformative first-line therapy available for our patient population,” she added.

Can lung cancer become a controlled illness?

According to EGFR+ UK, the goal is for EGFR mutant lung cancer to become a chronic, controlled illness that people will be able to live for many years.

However, as Dr. Harrison told MNT, the care a person gets depends on where they live: “There are new breakthroughs happening all of the time, but while there are many clinical trials sited in the U.S…. very few have sites in the U.K., and we have much worse access to drugs over here.”

“Disparity of care is enormous, both within the U.K. and between different countries. It’s horribly frustrating,” she added. “Patient advocacy is so important. Our role in the charity is helping patients navigate and informing them, giving them the power to be advocates for themselves.”

But the outlook is improving. “These days, people are living much longer. I know someone who is alive 34 years after diagnosis,” Dr. Harrison told us.

“The longer I do this, the more people I meet who are living 10 years and beyond. It was less than 1% when I Googled it. I think things are shifting.”

https://www.medicalnewstoday.com/articles/things-you-may-not-know-about-egfr-positive-lung-cancer

What can we expect from health talks at COP28? | Explained

How has health figured in previous COPs? What are the expected health-related outcomes of the COP28? What challenges do experts foresee?

The story so far: On December 3, the global health landscape is expected to reach a turning point. For the first time in 28 years of climate change negotiations, the climate-health nexus will take centre stage at the United Nations Conference of Parties (COP28) summit in UAE. The ‘groundbreaking Health Day at COP28’, as President-Designate Dr. Sultan Al Jaber put it, is expected to pose two questions: how public health can become resilient to climate change, and who will finance this transformation.

Growing evidence has highlighted the profound ways in which climate crises erode socioeconomic and environmental conditions. Unabated greenhouse gas emissions are triggering extreme weather events, air pollution, food insecurity, water scarcity and population displacement — which, in turn, alter the trajectory of vector-borne diseases and endanger public health infrastructures. And this chain of climate-related health events is not unfolding evenly around the world: Africa, Asia, South and Central America, and small island developing states, which have contributed the least to climate change, are bearing the brunt. In India, particulate air pollution is said to be the ‘greatest threat to human health’, and heat-related deaths may kill an additional 10 lakh people annually by 2090, according to data from the Lancet Countdown and the Climate Vulnerable Forum. If countries fail to meet emission targets set under the Paris Agreement, climate change-related events will cause at least 34 lakh deaths per year, by the end of this century.

https://www.thehindu.com/sci-tech/energy-and-environment/what-can-we-we-expect-from-health-talks-at-cop28-explained/article67524052.ece

Mysterious pneumonia outbreak in China; symptoms to prevention tips, all you want to know

Mysterious pneumonia outbreak in China has led to rise in hospitalisations in the country and is being attributed to the immunity debt created by lockdowns.

A mysterious pneumonia outbreak in China has led to a massive spike in hospital admissions in the country. According to the state-owned China National Radio, the Beijing children’s hospital is seeing an average of 7,000 patients per day, which has overwhelmed the healthcare system in the country. According to reports, the infection that's mostly affecting children is causing lung inflammation and high fever in the affected individuals but other respiratory symptoms like cough are missing. Experts say the surge in cases of this 'undiagnosed pneumonia' could be due to a phenomenon called 'immunity debt' after lifting of lockdown restrictions in the peak season of respiratory illnesses. Experts suspect this mystery influenza-like illness found in Beijing and Liaoning Province of China could be due to pre-existing viruses like RSV, bacteria or atypical bacteria like Mycoplasma etc.

China has reported an outbreak of mysterious influenza-like illness mostly among children recently. Children are presenting with high-grade fever without any other symptoms and further radiological investigations have revealed lung lesions.

"China has reported an outbreak of mysterious influenza-like illness mostly among children recently. Children are presenting with high-grade fever without any other symptoms and further radiological investigations have revealed lung lesions. Some patients have been hospitalised for further management. There are numerous viruses such as Adenovirus, influenza virus, enterovirus, rhinovirus, RSV and Covid virus which can cause such symptoms. Important thing to be noted is that all viral infections do not necessarily cause the full spectrum of symptoms which we associate with common flu. Common symptoms of any viral infection are fever, with or without chills. There may be associated running nose, cough, SOB, vomiting and loose motions but it is not always necessary for additional symptoms to be there, says Dr Tushar Tayal, Consultant-- Internal Medicine at CK Birla Hospital Gurugram.

"Recently, there has been a rise in pneumonia cases among children, particularly in certain areas of northern China, prompting concerns reminiscent of the events in November and December 2019. However, there is some relief as per a report from the World Health Organization (WHO). The Chinese government has clarified that these cases are attributed to known pathogens such as bacteria and viruses, including the influenza virus, respiratory syncytial virus, some COVID cases, and some mycoplasma cases. Given that the incidence of pneumonia typically increases during winter, it is hoped that this surge is seasonal. According to the WHO report, the Chinese government has identified the causes of these pneumonia cases, ruling out the presence of any new viruses or bacteria. Consequently, there is no immediate risk of the situation spreading globally or reaching India. While there is a sense of reassurance, it is important to remain cautious," says Dr Sushila Kataria, Senior Director, Internal Medicine, Medanta, Gurugram.

"According to WHO, in their November 13 press meeting, China's National Health Commission officials reported alarmingly large number of cases of respiratory diseases in the country. These infections are likely due to respiratory illnesses like influenza, mycoplasma pneumoniae (a common bacterial infection which typically affects younger children), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). This surge in childhood infections is being linked to co-incidence between lifting of lockdown restrictions and the start of winter, when such respiratory infections are more prevalent. On 21 November, media and ProMED (part of the International Society for Infectious Diseases) reported clusters of undiagnosed pneumonia in children in northern China. It is unclear if these cases are associated with the overall increase in respiratory infections previously reported by Chinese authorities, or separate events. Since mid-October, northern China has reported an increase in influenza-like illness compared to the same period in the previous three years, says Dr. Gurmeet Singh Chabbra, Director-Pulmonary, Marengo Asia Hospitals Faridabad.

What are the symptoms of this mysterious pneumonia?

"Pneumonia is a lung infection affecting one or both lungs leading to the filling of air sacs (alveoli) with fluid or pus caused by bacteria, viruses like RSV- respiratory syncytial virus, Adenovirus, Influenza, Rhinovirus, COVID and bacteria like Mycoplasma pneumonia. It is diagnosed based on symptoms like cough, breathing difficulty, fever additive symptoms like loose stool and vomiting in children and chest X-ray. Recently, there has been an upsurge of influenza-like illness cases in children from Beijing and Liaoning Province of China, named 'mysterious pneumonia', because definite cause is still under investigation. It could be any of the pre-existing viruses like RSV, bacteria or atypical bacteria like Mycoplasma etc. This 'mysterious pneumonia' presents with high-grade fever and abnormal chest radiograph with no or minimal cough," says Dr Dhirendra Pratap Singh, Consultant, PICU, Amrita Hospital, Faridabad.

"RSV (Respiratory Syncytial Virus) and mycoplasma pneumonia are thought to be the causes of this illness. They're usually called atypical pneumonia. Symptoms of this type of pneumonia are not as strong and include fever, headache, extreme tiredness, a cough that doesn't produce much phlegm, a sore throat, and a runny nose. This is why it's sometimes called 'walking pneumonia.' In contrast, regular bacterial pneumonia can make a person very sick with high temperatures, low blood pressure, and trouble breathing. The reason for this difference is that the germs causing these types of pneumonia are different. To prevent the quick spread of any infection, it's important to keep hands clean, avoid public transport and crowded places if you have symptoms, and get prompt medical attention for early diagnosis and the right antibiotics for a speedy recovery," says Dr Rupkatha Sen, Chief Intensivist, SRV Hospitals - Chembur.

"The symptoms associated with this pneumonia include fever; however, notably, there is an absence of cough or breathlessness. This divergence from typical respiratory infections adds to the mystery surrounding the illness. The healthcare authorities are diligently investigating these cases, aiming to identify the responsible pathogen and establish effective management strategies. As the situation unfolds, continuous monitoring and research efforts are essential to comprehend the nature of this pneumonia and implement appropriate public health measures," says Dr Rajesh Chawla, Senior consultant, pulmonology and critical care, Indraprastha Apollo Hospital

Why classic symptoms of pneumonia may be missing in China outbreak?

All symptoms of classical pneumonia may not manifest in every child depending upon age, co-existing comorbidity and cause of infection, says Singh.

"This pneumonia outbreak can be attributed to 'immunity debt'- after lifting off of China’s lengthy lockdown in this peak season of respiratory illness which has drastically reduced immunity to respiratory bugs that is usually achieved by exposure. China reported a surge of Mycoplasma pneumonia or 'walking pneumonia', which, although usually presents itself as harmless, can also lead to challenges in respiration in some patients. It’s treated with macrolide antibiotics although macrolide resistance is increasing due to unnecessary misuse during any cold cough episode by the general population. It’s too early to comment on whether undiagnosed pneumonia is a new pandemic or an upsurge of existing infection until more information is available," says Dr Singh.

"Possibly, withdrawal of restrictions after a prolonged period of lock down, exposed the Chinese population to number of respiratory infections. Having not been exposed to such respiratory infections since long, probably caused waning of their immunity to cope up with these infections, though some infections like mycoplasma pneumoniae and antigenically variable corona viruses themselves do not give prolonged immunity. Though lack of symptoms like cough is being reported, children are suffering from high fever and lung inflammation. Usually, such winter related infections have symptoms like sore throat, nasal discharge, sneezing, body ache, headache, chills with fever, cough which is usually dry, breathlessness, wheeze, confusion etc," says Dr Chhabra.

"The absence of a cough or other classic respiratory symptoms in this pneumonia, despite the presence of fever in children, raises intriguing questions about the nature of the causative organism. It's important to note that fever is a symptom commonly associated with various infections, and different bacteria or viruses may manifest with distinct sets of symptoms. The possibility that the responsible organism for this pneumonia may not induce cough is not entirely unusual. Infections can present in diverse ways, and it's not uncommon for individuals to experience infections without displaying certain expected symptoms, such as coughing. This emphasizes the importance of considering a broad range of clinical presentations when investigating infectious diseases," says Dr Chawla.

Preventive measures

Dr Chhabra advises that as a precautionary measure to prevent transmission of such diseases, which spread from person to person by infected respiratory droplets during close contact, it is advisable to follow measures like keeping distance from people who are ill, staying home when ill, getting tested and medical care as needed, wearing masks as appropriate, ensuring good ventilation, regular hand-washing and getting vaccinated.

"Like any communicable disease, personal protective measures will help limit the spread of this too- wearing masks, frequent hand washing, social distancing and staying at home when ill. It is advised to get the recommended vaccination, get tested for the disease and ensure medical care, and good ventilation. Another recommendation would be to not take antibiotics without paediatric consultation," says Dr Singh.

"Preventive measures for the pneumonia spreading in China include adhering to crucial practices such as avoiding unnecessary travel, prioritizing personal hygiene, and maintaining a clean environment. Stressing the significance of frequent handwashing and practicing respiratory hygiene is paramount in minimizing the risk of infection. It's noteworthy that these preventive measures, including vaccination against influenza, play a pivotal role in controlling the spread of respiratory illnesses. Although the situation may not be as prevalent in India, being proactive in adopting these measures remains essential for safeguarding public health," says Dr Chawla.

Should India worry about this mystery pneumonia spread?

"In our own country, there may be an increase in influenza cases during the ongoing pandemic. Therefore, it is advisable to prioritize influenza vaccination and consistently practice cough etiquette to mitigate potential risks. Vigilance remains crucial despite the current understanding of the situation," says Dr Kataria.

"We can assume that the etiological agent causing infection in Chinese children is a virus or some atypical bacteria, and proper research will be needed to find out the culprit organism so that it can be contained and effective strategies implemented. It is too early to say whether the current infection can become a pandemic or not and whether or not this infection will spread to India. WHO is already involved and is looking into the matter and has asked the Chinese govt to look into the matter. What is most important is to keep following personal protection in the form of 3 ply masks, frequent hand sanitization and social distancing," says Dr Tayal.

"As of now, there isn't enough information right now to say that pneumonia outbreak in the northern China can escalate and spread to India. Though we've witnessed this pneumonia spreading in subgroups, we need to remember that this is the winter of the Northern Hemisphere. We have always witnessed increase in the number of cases during winter across the world. When it comes to winter cases, we need to find out what is causing this, and Is there really an actual reason behind the increase in numbers or not. Just reporting for flu cases or pneumonia cases is very common during winter. We really don't know if it's a mysterious pneumonia or regular. We need to have more concrete information before we go ahead and classify it as one, and as of yet there's no objective evidence," says Dr Rahul Pandit, Chairperson of the Critical Care Department at Sir HN Reliance Foundation Hospital, Mumbai.

"This is the first winter of China after lifting up of lockdown restrictions. They are now experiencing a sudden rise in cases of pneumonia which is primarily affecting clusters of children, leading to significant absenteeism in schools. At this point, there is no identified novel virus as the cause, making it premature to speculate about potential additional risks of infection spread that could lead to a pandemic-like situation," says Dr Sen.

https://www.hindustantimes.com/lifestyle/health/mysterious-pneumonia-outbreak-in-china-symptoms-to-prevention-tips-all-you-want-to-know-101700813801240.html

Which foods may increase, and which may lower bowel cancer risk?

White bread and alcohol may contribute to colorectal cancer risk, new research shows.

Colorectal cancer is a common cancer type that can lead to poor health outcomes.

Research is ongoing about risk factors for colorectal cancer and what people can do to decrease risk.

Data from a recent study found that consuming higher amounts of white bread and alcohol was associated with an increased risk for colorectal cancer.

In contrast, they found that higher intakes of fiber, calcium, magnesium, phosphorus, and manganese were associated with a decreased risk for colorectal cancer.

Cancer comes in several types that experts still do not fully understand. While cancer research has come a long way, it is still not always clear why some people develop specific types of cancer.

Colorectal cancer is one cancer type that can be severe and sometimes fatal. Experts are still seeking to understand ways that people can decrease their risk of developing colorectal cancer.

A study published in Nutrients examined the risk for colorectal cancer related to the intake of certain foods and nutrients.

Analyzing data from over 118,000 participants, researchers found that alcohol and white bread intake were associated with a higher risk for colorectal cancer, while consuming higher amounts of fiber and nutrients like calcium was associated with a decreased risk.

More research will help confirm these findings and potentially lead to guidance in clinical practice.

Bowel cancer: Which foods may be protective?

Researchers of this particular study wanted to understand more about how food and nutrient intake contributed to colorectal cancer. They note that certain foods and nutrients carry a risk that people can modify, making it an important area of research.

To conduct their analysis, they used data from the U.K. Biobank, which provides substantial information. They examined the relationship between 139 foods and nutrients and colorectal cancer risk. They also looked at how this risk interacted with genetic susceptibility to colorectal cancer.

Overall, researchers included 118,210 participants and followed participants for an average of almost 13 years. During the follow-up, there were 1,466 cases of colorectal cancer.

Researchers collected data on food consumption via 24-hour dietary questionnaires. All participants in the analysis completed at least two 24-hour online dietary assessments. They excluded participants who already had colorectal cancer at baseline.

They adjusted the analysis based on several covariates, like education level, family history of colorectal cancer, body mass index, and physical activity levels.

Researchers were also able to create polygenic risk scoresTrusted Source for colorectal cancer for participants. Polygenic risk scores help determine someone’s risk for a condition based on their genetics.

They found that participants who developed colorectal cancer were more likely to have certain characteristics. For example, they were more likely to be older, have a higher body mass index (BMI), and engage in lower physical activity levels.

The study also found that white bread and alcohol were both associated with an increased risk for colorectal cancer. However, dietary fiber, calcium, magnesium, phosphorus, and manganese were all associated with a decreased risk for colorectal cancer.

The study did not find evidence that participants’ genetic background influenced risk related to consumption of nutrients.

Rick Miller, a registered dietitian at King Edward VII’s Hospital, London, in the United Kingdom, and principal dietitian at Miller & Everton, not involved in this research, shared his thoughts on the study to Medical News Today:

“An interesting finding was that the authors reported white bread, which could be defined as an ultra-processed food was associated with an elevated colorectal cancer risk, over alcohol. The authors also saw an inverse risk association with dietary fibre intake which was equal with the risk reduction seen with manganese intake.”

Different associations for women

The impact of these risks may be different for men and women.

The study reported that, “[a]mong women, no dietary factor was significantly associated with CRC [colorectal cancer] risk after multiple corrections.”

Dr. Brian Black, a board-certified osteopathic physician specializing in family medicine and emergency medicine, not involved in this study, noted that its findings “[support] existing literature reinforcing the body of evidence that alcohol and white bread are positively associated with colorectal cancer risks.”

“These fit within a broader understanding of the potential adverse effects of diets high in refined carbohydrates and their link to a risk of cancer,” he added.

“This study would support specifically dietary fiber, calcium, magnesium, phosphorus, and manganese intake as important positive factors. This review was a helpful study which supported the current understanding of the dangers associated with refined carbohydrates and the need for a varied diet high in vitamins and minerals. Its questions and aims may lead future research in multicentered trials, including more than one continent, to lead to specific identification of genetic predisposition to colorectal or other cancers.”

– Dr. Brian Black

Study limitations and continued research

Overall, this study adds knowledge about potential risk factors for colorectal cancer. However, its limitations should also be taken into account.

First, it focuses on the European population, meaning the results might not be as applicable to other groups. The authors also note that they were somewhat limited in their ability to look at the independent effects of certain nutrients.

Furthermore, some data were self-reported by participants, which may lead to errors. Researchers note that future studies can help confirm what this study found. It could also further look at the difference between men and women in colorectal cancer risk.

Miller noted that future research could also look at the difference between plant and animal sources of certain nutrients and decreased risk for colorectal cancer.

“The authors also reported that high dietary intake of calcium, magnesium, and phosphorus were associated with lower [colorectal cancer] risk,” he told MNT.

” Dietary sources of these key nutrients are found in many foods both plant (eg. wheatgerm, legumes, nuts, seeds) and animal-based (dairy products, meat and shellfish). However, the relative bioavailability of these micronutrients is lower in plant-based foods and hence it is difficult to draw the conclusion that the CRC risk reduction would be the same between animal versus plant-sources and a further interventional trial would need to be conducted to ascertain this.” – Rick Miller

The impact of colorectal cancer Colorectal cancer includes all cancers of the large intestine and rectum. Colorectal cancer can begin when polyps form on the inner walls of the large intestine or rectum. As noted by the Centers of Disease Control and Prevention (CDC)Trusted Source, “[c]olorectal cancer is a leading cause of cancer death in the United States.”

Doctors can sometimes detect colorectal cancer early when there is a better chance of effective treatment. This is why there is a significant emphasis on early screening for colorectal cancer.

Researchers are also interested in understanding risk factors for colorectal cancer. Risk factorsTrusted Source include increased age, family history of colorectal cancer, eating a diet with minimal fruits and vegetables, and obesity.

When researchers understand more about modifiable risk factors, doctors can better advise patients about healthy lifestyle changes that can help reduce risk.

https://www.medicalnewstoday.com/articles/which-foods-may-increase-and-which-may-lower-bowel-cancer-risk