What Is the Main Idea?
Malnutrition is a very common problem for people who have cancer, even before diagnosis. It can lead to loss of weight and muscle mass, and generally worse results throughout their cancer journey (to cure or end of life). Malnutrition is frequently underrecognized and therefore also undertreated. This is despite it being known that cancer is a complex disease requiring a mixed type of medical and social care that includes support for nutrition.
An international group of healthcare providers (experts in cancer, nutrition, exercise, and general medicine) participated in a virtual scientific roundtable to discuss gaps and opportunities in cancer nutrition care. The panel wrote the open-access review article “Examining Guidelines and New Evidence in Oncology Nutrition: a Position Paper on Gaps and Opportunities in Multimodal Approaches to Improve Patient Care”, published in the journal Kompass Nutrition & Dietetics. The authors aimed to raise awareness of nutritional care for people with cancer and summarize information on assessment and treatment.
What Else Can You Learn?
You will learn that nutrition and weight goals are not just about having healthy amounts of body fat, but also about having healthy muscles. Linked to this, you will read about the importance of exercise during cancer care.
What Is Malnutrition?
Malnutrition is undernutrition, or not having enough nutrients (energy and protein) required for healthy body function. It can result from poor intake or poor uptake of nutrients, or both. Intake refers to getting nutrients into the body, for example, through eating and drinking. Uptake refers to how the body uses and stores the nutrients once they are inside the body. Approximately 7 out of 10 people with cancer develop malnutrition. It is more common and more severe among older people with cancer, and those with stomach, head and neck, and lung cancers.
What Does Malnutrition Lead to?
Malnutrition can cause loss of muscle (called low muscle mass or myopenia), and loss of weight (called cachexia).
Low muscle mass is a central feature of cancer, affecting 4 out of 10 people. Malnutrition, low levels of physical activity, general cancer effects and cancer treatment can all contribute to low muscle mass.
Cachexia is unintentional weight loss and is also known as cancer-associated malnutrition. It affects up to 8 out of 10 people with cancer. It is characterized by loss of appetite and general body inflammation, which create the wrong balance between energy and protein, leading to dangerous weight loss and muscle wasting. Cachexia can be with or without fat loss, and is not a good type of weight loss. Therefore, if it happens to people with a too-high weight before cancer diagnosis this is just as big a problem as it is for people of a healthy or too-low weight. Cachexia cannot be fully reversed by standard nutrition treatments and can worsen with cancer treatment.
How Do Low Muscle Mass and Cachexia Cause Problems for Cancer Care?
These conditions can occur once cancer starts but before it is diagnosed, as well as during or after treatment. If untreated, they are associated with reduced daily life physical ability, reduced quality of life, reduced ability to tolerate cancer medicines (and therefore receive effective treatment), increased risk of complications with surgical treatment, and reduced survival.
In addition, they strain healthcare and economic resources, extending hospital length of stay and increasing the risk of unplanned hospital stays.
What Did the Panel of Experts Recommend?
- Firstly, the panel stressed the importance of healthcare workers from all professions working together for nutrition care in people with cancer (multidisciplinary care). They reported the need to build nutrition care in every layer and stage of cancer care, making it something that all healthcare professionals are involved with. The paper gives examples of scientific studies that show a positive connection between multidisciplinary nutrition care and better cancer care outcomes.
- Secondly, the panel of experts listed principles for nutritional care during cancer treatment. These covered the importance of testing for problems and how best to treat identified problems.
How Do We Test for Malnutrition and Low Muscle Mass?
When? Throughout the cancer care journey. All clinical nutrition societies and several cancer societies recommend screening for malnutrition risk at diagnosis and during and after treatment.
How? Body measurements can be made and compared during the cancer journey. Several scientific assessments are available; however, many have not been fully explored in terms of how they work for people with cancer. Scientists and researchers are currently working on developing assessments that are directly suitable for people with cancer.
How Is Malnutrition Treated?
As soon as a problem is detected, even if it is small, the cancer care team should give additional energy and protein to improve nutrition and prevent serious problems. The cancer care team should use the person’s weight to calculate how much to prescribe. Additional nutrition can be through eating or drinking special supplements, through feeding tubes that go direct to the stomach or bowel, or infusions that go directly into the blood. Each individual should also receive education and advice, according to their specific situation.
The paper gives examples of scientific studies that show that nutrition therapy improves things such as a person’s weight status, ability to tolerate cancer treatment, and survival of cancer.
Why Is Exercise Also Important?
Exercise during cancer treatments preserves or improves a person’s fitness, muscle mass and strength. In turn, this preserves or improves quality of life during cancer treatment and treatment results. Exercise includes general fitness as well as muscle strength training. In fact, exercise recommendations for most people with cancer are similar to those for healthy adults. Of course, care must be taken to support the additional energy needs of those with malnutrition or who have some particular cancers or conditions (for example, bone cancer). Specifically, it has been found that exercise before cancer surgery or a course of cancer medicine is safe and actually helps to improve results.
For people with cancer, the experts recommend:
- 150 minutes per week of moderate to vigorous fitness exercise (more than 2 hours, but not all in one session).
- At least two sessions a week of muscle strength training.
Take-Home Message
People with cancer, and healthcare professionals treating people with cancer, should at every stage of the cancer journey be considering nutrition and checking for problems. It is best to prevent nutrition problems, or treat them early, rather than deal with complications at a later stage. Because nutrition has an impact on muscle health, it is important for people with cancer to carry out regular fitness and muscle strength training. Worldwide, societies are building nutrition care principles into their standard cancer care recommendations and treatment plans.
Note: The authors of this paper make a declaration about honoraria, paid consultancy, and/or funding received from companies. Two of the authors are employed by a company focusing on nutrition. It is normal for authors to declare this in case it might be perceived as a conflict of interest.
What Is the Main Idea?
Antibiotic medicines help to fight infection in the body; however, some people can be allergic to them. This is often found out during childhood when a child first takes an antibiotic medicine. The type of antibiotics most likely to result in an allergic reaction are beta-lactam (BL) antibiotics. If a child is allergic to BL antibiotics, it is important to discover this so that they can take a different type of medicine.
A small number of children experience a mild problem with their skin after taking a BL antibiotic – a mild skin reaction. An even smaller number of children have a more severe reaction, requiring treatment from a doctor. However, these reactions don’t always mean a child is allergic. A skin reaction can also be caused by the infection or other reasons. Many children are therefore misdiagnosed, or mislabeled as having an allergy when they don’t.
The authors of the research article “Risk Factors of Challenge-Proven Beta-Lactam Allergy in Children with Immediate and Non-Immediate Mild Cutaneous Reactions”, published in the journal International Archives of Allergy and Immunology, aimed to find out more about what a BL antibiotic allergy is like, and what clues there might be that a child will be allergic to BL antibiotics.
What Else Can You Learn?
You can learn about different types of allergy testing and also why it is important to prescribe the correct antibiotic.
What Are Beta-Lactam Antibiotics?
Antibiotics are medicines used to treat infections caused by bacteria. They do not help infections caused by viruses. One type of BL antibiotic is called penicillin, and other types are called cephalosporins. BL antibiotics are the medicine given the most to children and are also the most common cause of medicine reactions in children.
What Are Skin Reactions?
A skin reaction is a problem with the skin such as itchiness, a rash or swelling. It can be caused by different things:
- Allergy to a BL antibiotic.
- Result of an infection (from bacteria or a virus).
- A combined situation where an infection can be from a virus, and the virus can interact with medicine to cause a skin reaction.
Why Is It Important to Be Sure about an Allergy Diagnosis?
Parents/caregivers may notice that their child has a skin reaction at the time of being unwell with an infection and being given BL antibiotics. Then, whenever the child needs antibiotics in the future, they may mention this to the doctor, and it is incorrectly noted in the child’s medical records as an allergy.
The next time the child is sick, even though they may not have an allergy to BL antibiotics, the doctor may choose to give the child an alternative antibiotic.
However, alternative antibiotics may not be as specific for treating an infection, meaning they can be less effective. This results in a cycle of poorer health and higher medical costs, both for the child and, on a larger scale, the general community.
Therefore, the authors report it is essential to know if a child really is allergic to BL antibiotics.
How Do You Confirm Allergy?
A suspected allergy can be tested for by finding out about the child’s medical history and completing some medical tests. These tests usually involve giving a small amount of the substance and seeing how the body reacts. This can be by putting some on the skin (a skin prick test (SPT) or intradermal test (IDT)) or eating some (oral challenge test (OCT)). For BL antibiotic allergy, the best test is an OCT. Recent research recommends that if a child has already had a mild skin reaction, it is sensible to complete an OCT.
How Did the Authors Test for the Allergy?
The authors tested 214 children who had experienced mild skin reactions after taking BL antibiotics. They carried out both skin tests and an OCT on all the children and observed the reactions.
What Were the Results of the Allergy Tests?
It was discovered that 23 of the 214 children (10.7%) had a BL allergy. In other words, the remaining 191 children did not have an allergy, even though they had a skin reaction at the time of taking the BL antibiotics.
How Did the Authors Examine the Risk Factors?
The authors then wanted to try and find out whether they could predict the allergy in ways that would avoid doing the testing. They examined the nature of the reactions, such as whether they happened immediately or non-immediately, and the type of reaction, such as rash, itchiness, or something severe that made the child unwell. They also recorded information on family history of allergy, the child’s gender, and the child’s personal health history.
They used statistical methods to work out what might be a risk factor. This included comparing the children with proven BL allergy to the children who had a mild skin reaction but no allergy. The only factor that made the children with a BL allergy stand out was if they also had confirmed allergies to other medication. The other factors were the same for children with and without BL allergy.
What Did This Study Show?
In this study, BL allergy was confirmed in 10.7% of children who described a mild skin reaction related to BL antibiotics. This means that the true rate of BL allergy resulting in a mild skin reaction is lower than that reported by parents. It also means that BL allergy is often wrongly diagnosed when only a child’s skin reaction type and timing is used to make a decision.
In other words, mild skin reactions in children with suspected BL allergy are likely to be due to viral infections or a combined situation where a virus can interact with medicine to cause a skin reaction. Therefore, an allergy test is required to be sure about – and mostly likely rule out – BL allergy.
Take-Home Message
If a child has a skin reaction after taking BL antibiotics, it is likely that they are not allergic to the antibiotic. They need to have an allergy test to be sure. However, if the child already has confirmed allergies to other medications, this increases the chance that they may also be allergic to BL antibiotics.
Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.
Bathing in the Blue Lagoon in Iceland
The Blue Lagoon is a man-made geothermal outdoor pool near Grindavik, Iceland. Constructed as a cooling basin for a nearby geothermal power plant, about 35% of the lagoon water is warm freshwater and the remaining 65% is seawater. Soon after the power plant was opened in 1976, lake bathers with a skin condition called psoriasis reported that the water was helping their symptoms. These observations have since been confirmed in clinical studies and it is now generally accepted that bathing in the Blue Lagoon is beneficial for people with psoriasis.
Why Does Bathing in the Blue Lagoon Help Skin Problems?
The lake has a high silica content, a moderate temperature of 37 °C, a salinity (saltiness) of 2.7%, and a unique geothermal microbial ecosystem. In summertime the lake is full of algae known as Cyanobacterium (C.) aponinum. Studies have shown that extracts prepared from the algae can regulate the biological functions of human skin cells such as epidermal keratinocytes (which form 90% of our top-layer skin cells) and dermal fibroblasts (found in a deeper skin layer). Both the silica from the lake and the algae extracts induced expression of genes relevant to the formation of the keratinocytes and fibroblasts.
It has also been proposed that the algae can have a positive impact on skin conditions caused by immune system problems. The algae can stimulate and regulate the immune system cells, which regulate inflammation responses and thus help an inflammatory skin condition.
Why Might Bathing in the Blue Lagoon Help Skin Pigmentation Specifically?
Skin pigmentation is determined by the amount of a substance in the skin called melanin. Melanin is produced by cells in the skin called melanocytes. The melanocytes then transfer the melanin to the keratinocytes (the cells in the top skin layer) where it is used to protect them from UV damage. Sun exposure and inflammation results in more production of melanin; thus, uneven skin pigmentation can develop in response to these damaging factors. Since studies have already shown that Blue Lagoon bathing can affect both keratinocytes and inflammation, it was a logical step for the researchers to explore the impact on skin pigmentation.
How Did the Researchers Test These Anecdotal Reports?
Effect of Algae Extract on Melanin Production
The researchers first tested the effect of algae extract on melanin production in a laboratory setting. They did this to see if it was worth carrying out a more complicated trial with humans.
To do this, they exposed human melanocyte cells to different strengths of the algae extract. They then tested the cell samples to see how much melanin-producing activity they had. The authors describe this experiment in detail, explaining the substances (known as markers) they were looking for and why presence of these markers indicate melanin-producing activity.
The researchers found that the algae significantly decreased the presence of these markers, which meant that the algae was likely having an effect on reducing the production of melanin in the cells.
Effects of the Blue Lagoon Water on Humans with Uneven Skin Pigmentation
The researchers conducted a clinical trial to assess the effects of the Blue Lagoon water on humans with uneven skin pigmentation. The algae extract and Blue Lagoon minerals were formed into a cream (active cream), and another cream was made without algae extract (inactive). 50 participants applied both creams, one on each side of the face, twice a day for 12 weeks (which is a common time period for cosmetic skin studies). The skin was assessed before, during and after the 12-week period using specialist imaging.
The authors describe the study as having many scientific features. These included it being single-center (in one location only), randomized (random allocation of participants and treatment), double-blind (neither the researchers nor the study subjects knew which cream was active or inactive; this was only available through encryption), vehicle-controlled (use of a cream to apply the algae) and intra-individual (both active and inactive cream tested on each participant).
Photographs and other images of the skin were taken and compared. A specialist assessment of the photos was carried out so that there was a quantitative (number-based) score for the comparisons.
What Were the Results of the Cream Trial?
There was a reduction of skin pigment spots where the active cream was applied, but not where the inactive cream was applied. In fact, the authors observed an increase of spots where the inactive cream was applied. They suggest that this means that the use of the active cream might also prevent the formation of new pigment spots.
Should I Book a Holiday to the Blue Lagoon If I Have Skin Pigmentation?
Although there is a Blue Lagoon spa resort which you can enjoy for relaxation, there are several reasons to be cautious about these results and thus not get your hopes up for an effect on uneven skin pigmentation.
- Firstly, the authors point out that the study had inclusion criteria meaning that it was carried out on mainly women aged older than 60 years with either East Asian (Japanese, Chinese, Korean) or Caucasian background. Therefore, the results may not be relevant to those of other ages, sex, or skin classification.
- Also, the authors did not include people taking medications that affect the skin, or those with current skin health problems (aside from the uneven pigmentation).
- Finally, since the study period was 12 weeks, it is not possible to determine whether skin pigmentation may change as a result of the yearly seasons. The authors state that more studies are required.
Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available. Furthermore, some of the authors of this paper make a declaration about funding, consultancy work, and being employed by a company conducting research. It is normal for authors to declare this in case it might be perceived as a conflict of interest.
What Is the Main Idea?
What’s it like inside your nose? Is snot good? How does our nose protect us from getting sick or having an allergic reaction? It’s all to do with the inside lining: the epithelial barrier.
The authors of the open-access review article “Epithelial Barrier in the Nasal Mucosa, Related Risk Factors and Diseases”, published in the journal International Archives of Allergy and Immunology, aimed to give a detailed overview of what’s inside our nose—including snot—and how it works to protect us from disease and allergens.
What Else Can You Learn?
The authors also briefly report on some new treatments that might be able to help our nose fight allergies and sinusitis.
What Is the Nasal Epithelial Barrier?
An epithelial barrier is a lining of cells that separates and protects our body from our environment. When the epithelial barrier doesn’t work properly, it exposes us to disease. Simply speaking, our skin is an epithelial barrier on the outside of our body. But we also have epithelial barriers inside our body. They are a little bit different to skin (yet still linings of sort) and are in our digestive, our reproductive and our nose/respiratory systems. This paper focuses on the nasal (nose) epithelial barrier.
But first, let’s examine the four features of the nasal epithelial barrier, as described by the authors. These four features work together to form the nose’s protection against external risk factors and the body’s immune response.
The Physical Barrier
A physical barrier is created from cells touching cells, dividing the internal and external environment. These are called cell junctions, which the authors describe in detail, alongside some other cell functions. They are important for protection against allergens, disease and other irritants. The junctions are in charge of immune surveillance and prevent the invasion of foreign particles into lower, deeper layers of the barrier lining.
The Chemical Barrier
This is where snot plays a role! Snot, or mucus, is a chemical barrier. Mucus is the main component in the chemical barrier. It protects the nasal epithelium from drying, preserves the local wetness, and humidifies the inhaled air. It is the first place where inhaled allergens and germs will land. The mucus traps them and prevents their invasion. Mucus can exchange molecules, transfer, and remove foreign particles, cleaning as it goes and forming a mucosal protective layer. It works alongside cilia, which are tiny protrusions from the epithelial cells that beat in a coordinated manner, conveying mucus to drainage sites such as the nostril or throat. When there is an infection or allergic response, the normal structure and function of the cilia are altered, thus weakening this clearance function.
The Immune Barrier
An immune barrier is formed with molecules called immunoglobulins (Igs) and antimicrobial proteins and peptides (AMPs). These are given out by cells in the nasal lining. The authors describe the detailed role that Igs play in immune response and in suppressing inflammation and allergic reactions. This is a frontline defense mechanism of the respiratory tract. Defense molecules, including AMPs, don’t just inhibit inflammation but also promote repair of the epithelial lining. They are also a first-line response for the body’s immune system because they have antibacterial effects: They inhibit bacterial multiplication and capture and kill germs.
The Microbiological Barrier
The microbiological barrier is the microbiota that colonize the nasal mucosa. Microbiota are often known as “good” bacteria. The microbiota play a protective and regulatory role in the mucosal immune system. They are usually grown in infancy and continuously remodeled by environmental exposure as an infant grows up. When the microbiota move beneath the epithelium, the immune system is stimulated, and the inflammatory process is promoted, thus helping protect and defend.
What Can Cause Problems with the Epithelial Barrier?
Allergens Containing Proteases
Protease-containing allergens include house dust mites, pollen, pet dander, insects, and fungi. It is known that they can induce immune reactions and break down the epithelial barriers.
Bacteria
Although good bacteria (the microbiota) are needed for a healthy epithelium, some other bacteria can have a damaging effect on the physical and chemical barriers.
Viruses
Viral infections cause impairment to the physical barrier and increase the permeability of the epithelial cells, allowing germs to enter the body. Human rhinovirus (HRV) infection is one of the most common viral infections in the nasal mucosa.
Particulate Matter and Diesel Exhaust Particles
Numerous studies have confirmed that these substances are connected to the prevalence of nasal diseases. These particles can undermine the integrity of the physical barrier and also affect the chemical barrier.
Cigarette Smoke
This compromises the physical, chemical, and immune barriers of the nasal epithelium, stimulating and exacerbating the nasal mucosal immune response.
Inflammatory Cytokines
Inflammatory cytokines are signaling proteins produced during immune reactions. They can further induce and exacerbate damage to the epithelial barrier. For example, by impairing cell junctions.
Approaches for Restoring Epithelial Barrier in Nasal Diseases
The epithelial barrier is the first line of defense against disease. The most common problems caused by issues with the nasal epithelial barrier are allergic rhinitis (AR) and what is commonly known as sinusitis (chronic rhinosinusitis (CRS)).
AR is a chronic, noninfectious inflammatory disease and essentially a hypersensitivity reaction, primarily caused by environmental allergens that disrupt the epithelial barrier. After repeated exposure to the same allergen, many allergic chemical mediators (histamine, prostaglandin, etc.) are produced, which induce a range of nasal allergic symptoms such as sneezing, nasal itching, and a watery nose. Recently, it was found that people with AR tend to develop CRS.
Restoring the epithelial barrier could result in improvement of both AR and CRS symptoms. However, the research is only just beginning. Most studies have limited participants and variable methods. In addition, current studies have not yet sought the ideal dose and timing for treatment, or whether there are adverse effects.
There is still a lot of unclear information on the processes (pathways) that lead to epithelial problems. Some studies have confirmed that drugs with histone deacetylase (HDAC) inhibitors can restore the nasal epithelial physical and chemical barriers. Corticosteroid drugs have also been shown to have a positive effect on the physical barrier. Also, natural plant products have a protective and repairing effect. For the microbiological barrier, there is increasing evidence suggesting that nasal administration of probiotics such as Lactobacilli can have a protective effect.
Take-Home Message
Although there are still deficiencies and challenges to overcome in the future, restoring the epithelial barrier may be a promising strategy for the development of nasal disease therapies.
What Is the Main Idea?
Multiple sclerosis (MS) is a common neurological disorder which, among other things, causes problems with muscle control. This leads to difficulties in movement, balance, and walking. Although there are some medications for multiple sclerosis, these do not help so much with the muscle problems, and can also have side effects which outweigh any benefit. However, as an alternative to medications, there is evidence that neuro-rehabilitation techniques can also help the muscle symptoms.
The authors of the open-access research article “The Effects of Neuromodulators on Spasticity, Balance, and Gait in Patients with MS: A Systematic Review and Meta-Analysis Study”, published in the journal European Neurology, aimed to systematically assess the research that has investigated neuro-rehabilitation techniques, to determine the benefits.
What Else Can You Learn?
The authors briefly describe some of the neuroanatomy and disease processes for multiple sclerosis. However, this is only in the context of neuro-rehabilitation techniques.
Tell Me More about the Symptoms of Multiple Sclerosis
The most common symptoms of MS are postural and balance problems, gait (walking) and movement difficulties, spasticity, and fatigue. These symptoms reduce independence, increase the risk of falls, and decrease the quality of life.
MS results in these symptoms because it is a disease that affects the nervous system controlling the muscles. Nerve fibers in the brain and body are usually surrounded by a protective sheath, known as the myelin sheath. In MS, the body’s immune system damages this sheath, or the cells that produce and maintain it. When the sheath is damaged, messages cannot be passed along the nerves, hence leading to muscle control problems. The term sclerosis means scarring, because multiple areas of scarring form where the nerve sheath has been damaged.
What Is Spasticity?
Spasticity is a term used to describe muscles that have high tone (are tight) or are contracted. It can affect the postural and limb muscles as well as speaking and eating muscles. It is not possible for a person to voluntarily control spasticity, as it is caused by problems with the brain and nerves that control the muscles. Normal muscle control means that we can voluntarily and involuntarily tighten and relax our muscles to move our body. But muscles with spasticity cannot be fully relaxed, meaning that a person cannot move their body in a typical way, if at all. The exact level of spasticity can vary, depending on other factors. Severe spasticity can be painful, energy-consuming, and result in permanent problems with joint stiffness and muscle weakness.
How Is Spasticity Treated?
There is evidence that the MS damage to the nerve pathways leads to spasticity. Specifically, damage to a pathway known as the corticospinal tract can lead to hyper-excitability of the messages that tell muscles to contract, and thus to spasticity. There are devices that can control – or modulate – this neuro-excitability, called neuromodulators.
How Do Neuromodulators Work?
Neuromodulator devices are used for treatment of many different neurological conditions. They work by stimulating or activating the nerve cells in the brain with small amounts of electric signals. The signals are sent through electrodes placed on the skin from a battery-powered device. They can have a lasting effect, even after the device is switched off and the electrodes removed. In terms of treatment for MS, the authors of this paper were interested in two types of neuromodulators: transcranial direct-current stimulation (tDCS) and transcranial magnetic stimulation (TMS).
How Did the Authors Carry Out Their Research?
The authors carried out a systematic review and meta-analysis. They searched research databases for all research on MS and neuromodulators. There are international guidelines for how to do this in the best way: such as using key search words to find suitable papers and using logical processes to categorize the different types of research. The authors selected only the best and most relevant research, using international guidelines and statistical methods to compare the research. They ended up with sufficient information from seven studies.
What Were the Results of the Review and Analysis?
Of the final seven studies, four studies used the tDCS technique and three studies used the TMS technique.
With so few studies, the authors briefly described each study and stated that it was difficult to compare them due to their differing number of treatment sessions (i.e., one treatment session or multiple sessions). However, their statistical methods helped them to conclude the following:
- For impact on balance and gait (walking): A single session of tDCS technique neuromodulator treatment definitely does not help but multiple sessions of tDCS have led to lasting changes and improvements.
- For impact on spasticity: Multiple sessions of the TMS technique were helpful in decreasing spasticity.
Take-Home Message
With so few studies, the authors report that further studies are required before it is possible to have a definite result on the specific effects of neuromodulators and different neuromodulator treatment strategies. However, they remain hopeful: Where they identified that multiple treatment sessions can help, they believe that further studies on the use of multiple treatment sessions could only strengthen this conclusion.
Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.
What Is the Main Idea?
Psoriasis is an inflammatory skin problem from which more than 125 million people worldwide suffer. Over the past 20 years, researchers have tested different medicines for the treatment of psoriasis. However, there has not yet been an overall examination combining all the test results. The authors of the research article “Effect of Different Types of Hypoglycemic Medications on Psoriasis: An Analysis of Current Evidence”, published in the journal Dermatology, aimed to find out whether a specific type of medicine can help psoriasis by carrying out an overall review of past research.
What Else Can You Learn?
Psoriasis and its treatment are connected to the symptoms and treatment of diabetes mellitus and cardiovascular conditions.
What Is Psoriasis?
Psoriasis is a problem with the skin, caused by over-production of the skin cells that sit on the very outside of the skin (keratinocytes). The skin becomes thick and scaly (known as plaque), silvery-red in color, and can have pinpoint bleeding (known as Auspitz’s sign). It most often affects the elbow, but can happen in any part of the skin, including the nails, palms and soles, and genitalia. Known fully as psoriasis vulgaris, it is a chronic, recurring, multisystem, inflammatory disease. This means that it lasts longer than a few weeks, can come and go in severity, and affects many parts of the body due to an underlying inflammation problem (in the case of psoriasis this inflammation leads to the skin cell over-production).
What Are Hypoglycemic Medications?
In people with psoriasis these medications help improve the body’s metabolism, which is how it processes glucose and lipid (sugar and fat). If the body’s metabolism doesn’t work properly, the body can become hypoglycemic (known as hypoglycemia) and, amongst other things, inflammation and immunity processes are affected.
What Is Diabetes Mellitus and How Is It Connected to Psoriasis?
Hypoglycemia is also a symptom of diabetes. Psoriasis is connected with diabetes because diabetes is more common in people with psoriasis. Known fully as diabetes mellitus (DM), it is a metabolic disease that can damage the blood vessels, nerves, eyes, and kidneys, leading to serious complications and possible death. Most people with diabetes have type 2 (T2DM), which must be treated with changes to diet and exercise and also, like psoriasis, medicines that help hypoglycemia.
Unfortunately, for people with psoriasis, the risk of T2DM and also cardiovascular problems increases as the disease worsens. Therefore, psoriasis researchers are focusing on treatments that help the body’s metabolism, reduce inflammation, and improve immunity.
How Is Psoriasis Treated?
Both external medicines (such as creams and oils) and medicines taken by mouth have been used to treat psoriasis. However, they have not been very helpful. In the past 20 years, there have been many tests using hypoglycemic medicines. The authors reviewed all the tests using these medicines, to see how effective they can be. This has never been done before.
How Do Researchers Compare so Many Different Tests?
The authors carried out a systematic review and meta-analysis. They searched research databases for all research on hypoglycemic medicines and psoriasis. There are international guidelines for how to do this in the best way: such as using key search words to find suitable papers and using logical processes to categorize the different types of research.
The authors selected only the best and most relevant research, using the international guidelines and statistical methods to compare the research. This resulted in information on 223 patients within 14 studies, described in 18 papers.
How Did They Measure the Treatment Efficacy?
The authors identified different ways to measure whether a hypoglycemic medicine helped psoriasis. The first was that some studies used specialist scoring systems for skin symptoms. These were the psoriasis area and severity index (PASI) score, and dermatology life quality index (DLQI) score. The authors could then take these scores and use formulas to work out whether a treatment helped or not.
The next two methods the authors used were chosen in order to account for the interaction between psoriasis, diabetes and cardiovascular problems (inflammation, immunity and metabolism problems). They looked for scores that represented metabolic health and cardiovascular health. These included information on waist circumference, body mass index (BMI), levels of cholesterol and blood pressure. As for the skin symptom scores, by using these measurements and applying statistical methods the authors could then determine how effective a treatment was.
What Did the Authors Find?
The authors found that all the hypoglycemic medications studied could reduce psoriasis to varying degrees. They also found that the hypoglycemic medications could reduce some of the signs of poor metabolic and cardiovascular health (e.g., waist circumference, cholesterol, and blood pressure).
It is worth noting that none of the included studies involved patients taking a different type of medicine often used to treatment psoriasis, known as biologics. The authors mention that further studies could explore taking a combination of medicines.
Take-Home Message
The authors were excited to see that the use of hypoglycemic medicines may help the treatment of psoriasis alongside symptoms of diabetes or cardiovascular diseases. However, they reported that it is very important that people with psoriasis do not rely just on medicines, but instead also change their diet and exercise.
Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.
What Is the Main Idea?
When a person undergoes non-emergency major surgery, existing or new blood problems such as unusual clotting or too much bleeding can be life-threatening. However, blood problems can usually be detected before surgery, and the medical team can plan treatment to prevent or counteract a complication. This process is known as “patient blood management” (PBM). The PBM process has been successfully used for surgery and is now being applied to other areas of medical care, such as pregnancy and birth. The authors of the open-access review article “Patient Blood Management in Pregnancy”, published in the journal Transfusion Medicine and Hemotherapy, aimed to review and describe treatment protocols for blood problems during pregnancy, birth and the post-birth period.
What Else Can You Learn?
The authors write within the context of pregnancy, birth and the post-birth period. However, their descriptions can help you understand blood problems outside of this context, as the causes and treatments can be similar.
Why Is Patient Blood Management Relevant to Pregnancy and Birth?
Up to 40% of pregnant woman experience the blood problem of anemia and iron deficiency. This can lead to the mother feeling unwell and to serious pregnancy complications. It is also connected to poor post-birth health for both mothers and babies.
Severe bleeding during and after childbirth is called postpartum hemorrhage (PPH). This life-threatening emergency accounts for up to one-third of birth-related deaths in both developing and developed countries. Women who survive can have permanent reproductive disability. Furthermore, the number of at-risk mothers continues to rise (due to reasons such as increased use of Caesarean delivery, effects of fertility treatment and increased age of mothers).
What Are the Stages of Patient Blood Management during Pregnancy and Birth?
PBM is a multidisciplinary and individualized treatment approach:
- Firstly, during early pregnancy for at-risk mothers, early screening and treatment of anemia and iron deficiency occurs.
- Secondly, during delivery, steps to minimize blood loss are taken.
- Thirdly, in the event of anticipated or unexpected high blood loss, a blood transfusion of either donor or the mother’s salvaged blood can be used.
What Is Iron Deficiency Anemia and How Is a Pregnant Woman Treated?
Anemia in pregnancy is a blood condition where there are not enough red blood cells, or not enough hemoglobin inside the red blood cells. Hemoglobin is a protein inside red blood cells that helps them work properly. The leading cause of anemia during and after pregnancy is iron deficiency.
A pregnant woman with iron deficiency anemia may experience fatigue, weakness or dizziness. It also affects thermoregulation, immune function, neurologic function, and enzymatic function, which is why it can place a woman at-risk of complications during pregnancy and birth. Additionally, it can affect the unborn baby’s growth and development.
Iron levels can be tested with a blood test. The authors discussed expected test results for pregnant women (different to non-pregnant women). They also reported the following treatment options that are safe for pregnancy:
- Iron tablets are the gold standard for mild to moderate iron deficiency anemia but take a few weeks for full results. Unfortunately, there can be gastrointestinal side effects. However, these can be helped by taking tablets on alternate days.
- If tablets do not help, then after the second trimester iron can be given with an intravenous drip. This is also an option for anemia that requires rapid normalization.
- A third option is to give recombinant erythropoietin (rhEPO). This medication stimulates the production of red blood cells. However, it requires the presence of enough iron in the blood before it can work; therefore is often given alongside an iron drip (see above). This combination can be the best treatment for severe anemia or when a woman does not want to receive a blood transfusion.
How Can Blood Loss during Pregnancy and Birth Be Minimized?
Some bleeding and blood loss during and after birth is normal. However, too much (more than 500 ml) is classified as post-partum hemorrhage (PPH) and can be life-threatening. There are four leading causes of PPH: uterine atony, trauma, placental disorders and blood clotting defects. These are known as the four Ts: tone, trauma, tissue and thrombin. More than one cause can happen together, and treatment also addresses several causes simultaneously.
The authors list medications, delivery techniques, surgical options and diagnostic tests to reduce bleeding. Although they cannot describe everything in detail, they stress the importance of professionals working together, following a sequence of treatment protocols. The authors highlight a high-quality research trial where the medication tranexamic acid (TXA) was identified as significantly reducing the number of women who die from PPH. This is given as soon as bleeding starts and at further time stages according to a planned protocol. They also report on how the use of some quick-result blood tests is connected with better outcomes, because they enable individualized treatment.
What Is a Blood Transfusion?
If a person loses too much blood, they may need their blood replacing. An allogenic blood transfusion uses blood from a donor. An autologous blood transfusion uses the patient’s own blood and is known as cell salvage. The authors report on the use of cell salvage within the context of birth and specifically Caesarean delivery. They describe safety reviews that identified cell salvage as a safe option so long as steps such as filtering the blood from amniotic fluid were carried out. Cell salvage also results in healthier mothers post-birth and shorter hospital stay.
Take-Home Message
Pregnancy and birth result in normal changes to the blood. Iron deficiency anemia, although potentially serious, can often be easily treated with tablets. However, sometimes the blood changes can put a mother or baby at high risk of complications. If a woman is assessed as high-risk in early pregnancy, then her healthcare providers can follow a protocol of prevention and treatment. There are many treatment options that can be individualized to the mother and baby, including medication, birth techniques, surgical techniques and blood tests. Using all of these preventative and treatment options together, in a collaborative and individualized way, gives mothers and babies the best chance of survival and optimal post-birth health.
Note: The authors of this paper make a declaration about grants, research support, consulting fees, lecture fees, etc. received from pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest.
What Is the Main Idea?
Acute mesenteric ischemia (AMI) is an emergency problem with the bowel that can often be life-threatening. If a person becomes unwell with AMI, they and their doctor must make quick decisions about treatment. To help make these choices, it is important that the sick person knows as much as possible about their survival chances, and what their life might be like after treatment. However, there is very little information about quality of life for survivors of AMI. The authors of the open-access research article “Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors”, published in the journal Visceral Medicine, aimed to find out more.
What Else Can You Learn?
Quality of life after recovery can be affected not just by a disease or its treatment but by how healthy the person is prior to becoming ill or receiving treatment.
What Is Acute Mesenteric Ischemia (AMI)?
Acute mesenteric ischemia (AMI) mostly affects the elderly population and is caused by poor blood flow in the bowel, which leads to inflammation, pain, infection, and permanent damage. Parts of the bowel can die, becoming gangrenous and resulting in a life-threatening situation. Usually, emergency surgery is required, but successful recovery is difficult to predict and many people do not survive long after surgery.
What Is Quality of Life?
Quality of life (QoL) is a term used to describe a person’s satisfaction with their life. Each person views different life aspects positively and negatively. Examples of areas that can affect QoL are physical and psychological health, productivity, spirituality, independence, and relationships.
Measuring QoL is a very common way to understand how a disease or treatment affects a person, and can be used to guide decisions about a treatment. A high QoL score means that a person experiences a high QoL.
Until now, QoL for people who have had AMI and survived up to 4 years after surgery has not been investigated.
How Might Quality of Life Be Affected for a Survivor of Acute Mesenteric Ischemia?
After surgery for AMI, a person may not be able to eat or digest food. They may need to be “fed” through a tube connected to a vein, or they may have had a stoma fitted, which is a tube leading from the stomach or bowel to a waste collection bag outside the body. The researchers thought that these changes might result in lower QoL for long-term survivors.
How Did the Researchers Investigate Their Idea?
Quality of life can be measured in various ways. In this paper the authors used a questionnaire called the EQ-5D, to assess QoL in long-term survivors of AMI. There were questions on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The scoring system is designed to reflect a person’s age and gender, particularly important since the people they assessed were in the elderly range, the typical age range for AMI.
Then, the researchers compared the survivors’ scores with the scores from people with a similar life situation but who had not had AMI.
Finally, rather than just look at QoL after survival, the authors took a step further. They also looked at health problems the patients had prior to becoming ill with AMI such as diabetes, heart and kidney problems, or use of medicines such as blood thinners. They used statistical methods to assess if there was a connection between these preexisting health problems and the level of QoL.
What Did This Study Show?
It is the first time that information on QoL for survivors of AMI up to 4 years after surgery has been reported.
- Firstly, the researchers found that long-term survivors did have a lower QoL score than people with a similar life situation but who have not had AMI. However, this was for different reasons than what the researchers expected. The lower QoL could not have been due to complications because none of the long-term survivors had these complications.
- Secondly, the researchers found that long-term survivors had fewer preexisting health problems than those who did not survive.
The researchers connected these two findings to conclude that survival and long-term QoL is affected by a combination of preexisting health problems rather than one single factor such as age or post-surgery complications.
Take-Home Message
When making treatment decisions for AMI and informing about the possible outcome, a person’s preexisting health should be considered an important factor affecting survival and QoL after recovery.
