Prayer: What Is the Meaning of Prayer – Purpose Fairy https://www.purposefairy.com/9081/what-is-the-meaning-of-prayer/
Day: 01/11/2022
Hyperbaric oxygen safe, effective adjuvant treatment for patients with COVID-19, hypoxemia
Hyperbaric oxygen was safe and effective for treating patients with COVID-19 and severe hypoxemia, according to new findings published in Emergency Medicine Journal.
“Our findings suggest that supplementing oxygen through hyperbaric oxygen treatment contributed to an increased SpO2 in patients with COVID-19 with severe hypoxemia, with no significant adverse effects,”Mariana Cannellotto,MD, from the research department in the Argentine Association of Hyperbaric Medicine and Research in Buenos Aires, and colleagues wrote. “Cases of severe COVID-19 that need mechanical ventilation have a high mortality risk. Therefore, novel therapeutic strategies are needed, and this study offers evidence supporting hyperbaric oxygen treatment.”
The multicenter, open-label, randomized controlled trial enrolled 40 patients (mean age, 55.2 years; 65% men) in Buenos Aires, Argentina, with COVID-19 and severe hypoxemia with an oxygen saturation of 90% or greater despite oxygen supplementation. The study was conducted from July to November 2020. All patients were randomly assigned to receive hyperbaric oxygen in addition to the standard treatment (n = 20) or standard treatment for respiratory symptoms (n = 20) for 7 days. Hyperbaric oxygen treatment was planned for at least five sessions of 90 minutes (1.45 atmosphere absolute) once daily.
Study outcomes included time to normalize oxygen requirement to a pulse oximetry value in ambient air of 93% or more, need for mechanical respiratory assistance, development of acute respiratory distress syndrome and mortality within 30 days.
The study was stopped at interim analysis due to the clinical benefit observed.
The most frequent symptoms observed at admission in the hyperbaric oxygen and standard treatment groups were dyspnea (95% and 90%, respectively), fever (85% and 90%) and odynophagia (50% and 35%).
Mean SpO2 at admission was 85.1%.
Patients who received hyperbaric oxygen underwent an average of 6.2 sessions. The researchers reported a shorter median time to correct hypoxemia among patients who received hyperbaric oxygen compared with standard treatment only (3 days vs. 9 days; P < .01).
Researchers observed higher odds of recovery from hypoxemia among those who received hyperbaric oxygen compared with standard treatment at day 3 (OR = 23.2; 95% CI, 1.6-329.6; P = .001) and at day 5 (OR = 28.5; 95% CI, 1.8-447.4; P < .001).
Hyperbaric oxygen treatment had no significant effect on acute respiratory distress syndrome, mechanical ventilation or mortality within 30 days.
According to a related press release, the researchers had limited ability to assess other outcomes due to early cessation of the study.
“This treatment could be easily available in various settings. Portable hyperbaric chambers offer a fast setup to avoid transferring patients to other hospital areas, attenuating the risk of virus transmission,” the researchers wrote. “In conclusion, our findings support the efficacy of hyperbaric oxygen in the treatment of COVID-19 with severe hypoxemia; larger trials are needed to further confirm the treatment effects on survival.”
Mediterranean named best overall diet for fifth consecutive year
The Mediterranean diet has been named the best overall diet for the fifth year in a row by the editors of U.S. News & World Report.
The Mediterranean diet is one of the most studied diets, and one of the few diets — most of which involve higher fat or lower carbohydrate intake — that demonstrates CVD benefits, according to a U.S. News & World Report press release.
The Mediterranean diet also ranked first in the categories of best diets for healthy eating, easiest diets to follow, best diets for diabetes and best plant-based diets; it tied with best heart-healthy diets for the No. 1 spot.
A panel of 27 experts rated 40 diets in seven categories, including ease of following the plan, its ability to produce short- and long-term weight loss, “nutritional completeness,” safety and potential for preventing diabetes and CVD. The scores enabled the U.S. News & World Report health team to rate diets from one to five (five being the highest score). The cost of a plan or amount of exercise the plan requires were not part of the decision-making process, according to the press release.
“The Mediterranean diet has a lot of what we look for in healthy eating, like lean proteins, whole grains and fruits and vegetables. Overall, the reason why it ends up coming out on top is because it is really not a diet. It is more a lifestyle of eating,” said Fatima Cody Stanford, MD, MPH, MPA, MBA, FAAP, FACP, FAHA, FAMWA, FTOS, a Healio Primary Care Peer Perspective Board Member and one of the U.S. News & World Report panelists.
There are some caveats to the Mediterranean diet, Stanford told Healio.
“The diet is Eurocentric. The constant emphasis on this diet supports the notion that diets that are derived elsewhere are inferior,” she said. “This diet may also be prohibitive, particularly for those with lower socioeconomic status.”
Stanford, who is also a clinician at Harvard Medical School and Massachusetts General Hospital, noted that she did not rank the Atkins, HMR or OPTAVIA diets very high “since they have a potential for containing highly processed foods and are not as sustainable as the Mediterranean, Dash or Flexitarian.”
The top eating plans in each of U.S. News & World Report’s 2022 rankings are:
Best overall diets
1. Mediterranean diet
2. DASH diet (tied)
2. Flexitarian diet (tied)
Best diet plans
1. Mayo Clinic diet (tied)
1. WW, also known as Weight Watchers (tied)
3. Jenny Craig
Best weight-loss diets
1. Flexitarian diet (tied)
1. Volumentrics (tied)
1. WW (tied)
Best fast weight-loss diets
1. Atkins
2. HMR diet (tied)
2. OPTAVIA diet (tied)
Best diets for healthy eating
1. Mediterranean diet
2. DASH diet (tied)
2. Flexitarian diet (tied)
Easiest diets to follow
1. Mediterranean diet
2. Flexitarian diet
3. MIND diet (tied)
3. Fertility diet (tied)
3. WW (tied)
Best diets for diabetes
1. Mediterranean diet
2. Flexitarian diet (tied)
2. vegan diet (tied)
Best heart-healthy diets
1. Mediterranean diet (tied)
1. Ornish diet (tied)
3. DASH diet
Best plant-based diets
1. Mediterranean diet
2. Flexitarian diet
3. vegetarian diet
For the first time, the complete list of rankings also includes intermittent fasting and the Sirtfood diet “to account for the ever-evolving nature of diet and nutrition,” according to the release.
References
2022 Best Diets Methodology. https://health.usnews.com/wellness/food/articles/how-us-news-ranks-best-diets. Published Jan. 4, 2022. Accessed Jan. 4, 2022.
U.S. News Reveals Best Diet Rankings for 2022. https://health.usnews.com/best-diet. Published Jan. 4, 2022. Accessed Jan. 4, 2022.
Which experts reviewed this year’s diets? https://health.usnews.com/best-diet/experts. Published Jan. 4, 2022. Accessed Jan. 4, 2022.
PERSPECTIVE
David S. Seres, MD, ScM, PNS, FASPEN
The U.S. News & World Report article about best diets is a useful guide for consumers, but the reader should be aware of the nuances of such guidance. The guide was based on a detailed survey of a panel of health care practitioners, health writers and people in the media, and some of the top scientists in the field of nutrition. The scientists are certain to understand the science behind nutrition, and the rankings are consistent with current scientific consensuses. Even so, it is important to remember to note that the members of any such panel bring their own personal and scientific biases to this kind of ranking process.
A lot of medical news tends to sound definitive, when in fact, the science is ever-evolving, or misunderstood or inadvertently misrepresented in the reporting. Further, when the medical community changes its recommendations, it has a real negative effect on how people view the credibility of science. Moreover, all of us, scientists, clinicians and writers alike, are subject to the pressures inherent in what we do. If science doesn’t have the answer, am I going to provide an opinion that sounds credible so that you keep asking me what to do? As has been demonstrated in the last 2 years during the COVID-19 pandemic, scientific credibility is at a low enough point that it has been easily politicized, likely resulting in a large number of unnecessary deaths in the pandemic.
It is crucial that the public be better educated on where recommendations are vulnerable to change, which are subject to variability and why. The U.S. News & World Report article is a good start, since the writers have been transparent with their methods and the makeup of the panel, but only if the reader reviews these and strives to understand the nuances.
TB epidemic ‘could flare in near future’
A student recently being attended to by a doctor from Trinity Care Foundation in Karnataka, India.
Speed read
- Tuberculosis crisis could flare in near future if left unchecked
- Boosted immunity essential to end COVID-19 this year
- Climate science must focus on global South
The twin global challenges of COVID-19 and climate change monopolised the news agenda throughout the past year and will undoubtedly remain firmly in the public eye in 2022.
SciDev.Net spoke to a doctor and a scientist from these fields about their expectations for the year ahead and what progress must be made to tackle the parallel crises.
TB and COVID-19
Sushmita Roychowdhury is the director of pulmonology at Fortis Hospital in Kolkata, India. Since the beginning of the global pandemic in 2020, she has treated critically ill patients with COVID-19, helping them recover from the disease.
Roychowdhury believes that the COVID-19 vaccination strategy in India has been a game-changer in the country’s battle against the disease and possibly helped reduce “a wave to a ripple”.
However, she warns that in 2022, rising cases of drug-resistant tuberculosis — due to interruptions to programmes to combat the disease as a result of COVID-19 — is a matter of “real concern”.
Identification, isolation and treatment of TB patients must be achieved as completely as possible, says Roychowdhury. “Otherwise, it is another epidemic volcano waiting to erupt,” she adds.
With the appearance of newer, more rapidly transmissible COVID-19 variants such as Omicron, Roychowdhury hopes for COVID-19 vaccination programmes to be given priority in 2022 and made compulsory for all in India, including children.
“Our only prevention appears to be boosted immunity as a first line of defence to minimise risk of serious disease and for a pandemic to turn into an endemic, so that the world may once more feel safe enough to live in.”
Sushmita Roychowdhury, director of pulmonology, Fortis Hospital, Kolkata, India
She believes the Omicron variant will overshadow all previous variants given its rapid spread, but she is hopeful that the pandemic can end before the year 2022 does. In India, she expects COVID-19 booster doses to be rolled out for vulnerable populations within two months.
“Our only prevention appears to be boosted immunity as a first line of defence to minimise risk of serious disease and for a pandemic to turn into an endemic, so that the world may once more feel safe enough to live in,” Roychowdhury says. Until then, wearing face masks and physical distancing “will need to be our ways of life”, she adds.
‘Look to global South for climate science’
Laura Gallardo Klenner is a meteorologist from the University of Chile whose work focuses on urbanisation as both a problem and a solution to climate change. She expects 2022 will be a year in which climate science will continue to bear fruit.
The member and lead author of the Sixth Assessment Report of the Intergovernmental Panel on Climate Change is optimistic that new knowledge generated through interdisciplinary collaboration and civic participation will allow countries to better face climate change.
“A tremendous change that has been seen in science in less than a decade has been to be able to attribute extreme events to climate change,” she says. “In 2014 it wasn’t possible. Being able to prove this attribution will help society to be better prepared in 2022 and the coming years.”
Klenner believes political and social changes are needed to face the already inevitable effects of climate change in 2022. The impacts of climate change around the world have been so overwhelming and surprising that “there is no other option but to start making decisions much closer to science,” she says.
South African deputy president David Mabuza in December 2021 addressing inter-faith leaders and traditional health practitioners on their active role in demand generation for COVID-19 vaccines and the fight against HIV/AIDS, TB and sexually transmitted infections. Copyright: GCIS, (CC BY-ND 2.0).
“I would expect that [in 2022] all countries will show an immensely greater level of ambition than what we saw in Glasgow [at the COP26 climate summit in November, 2021],” Klenner said.
“The profound changes required to address the crises of today’s world (climate, biodiversity, energy, food security), will not happen without people’s participation.” Wealthy countries must “put the resources in place to enable the needed energy transition” worldwide, she adds.
Finally, scientists must also rise to the challenge, Klenner believes. “Conventional science is no longer enough. Many of us who have had the privilege of studying the world have used the same lenses,” says Klenner.
“Other, new, totally different perspectives are needed. Climate change requires science from the global South, science with other priorities and other languages.”
Dementia cases ‘set to almost triple by 2050’
A study published 6 January in The Lancet Public Health says the increase in dementia is largely due to population growth and ageing. Copyright: WHO/Yoshi Shimizu
Speed read
- Global dementia cases ‘could rise to 153 million by 2050’
- Study predicts huge surge in cases in Sub-Saharan Africa
- Authors call for investments to reduce lifestyle risk factors
The number of adults living with dementia could almost triple within the next three decades unless urgent steps are taken to reduce risk factors such as unhealthy lifestyles, a study has warned.
Dementia is the seventh leading cause of death worldwide, affecting around 57 million people worldwide in 2019 – more than 60 per cent of them in low- and middle-income countries – says the World Health Organization (WHO).
This figure is expected to rise to nearly 153 million by 2050 according to the Global Burden of Disease study by the University of Washington, US, with Africa and the Middle East accounting for the majority of all cases.
The study published 6 January in The Lancet Public Health says the increase is largely due to population growth and ageing, but also identifies smoking, obesity, high blood sugar and low education as key risk factors affecting future trends.
“Investments in interventions to address modifiable risk factors, the scale-up of services and supports to help those affected, and continued prioritisation on research focused on finding effective disease-modifying therapies are needed.”
Emma Nichols, researcher, Institute for Health Metrics and Evaluation (IHME), University of Washington
Emma Nichols, researcher at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and lead author of the study, said an expected surge in Sub-Saharan Africa could put a strain on “health care systems, on family caregivers, and on economies more generally”, as well as those directly affected.
While improvements in global education access is projected to reduce dementia prevalence by 6.2 million cases worldwide by 2050, these gains could be wiped out by anticipated increases in obesity, high blood sugar and smoking which are expected to result in an additional 6.8 million dementia cases, says the study.
“Investments in interventions to address modifiable risk factors, the scale-up of services and supports to help those affected, and continued prioritisation on research focused on finding effective disease-modifying therapies are needed,” said Nichols.
The study covering 204 countries suggests that the greatest increase in prevalence will occur in eastern Sub-Saharan Africa where the number of people living with dementia is expected to climb by 357 per cent from nearly 660,000 in 2019 to more than three million in 2050. Percentage increases could be as high as 473 in Djibouti, 443 in Ethiopia, and 396 in South Sudan.
In North Africa and the Middle East, cases are predicted to grow by 367 per cent from almost three million to nearly 14 million, with large increases in Qatar (1,926 per cent), United Arab Emirates (1,795), and Bahrain (1,048).
By contrast, the smallest increase is expected in the Asia Pacific region where cases are forecast to grow by 53 per cent from 4.8 million in 2019 to 7.4 million in 2050, attributed mainly to improvements in education and lifestyles.
Globally, women are more affected by dementia than men. In 2019, the ratio of women with dementia to that of men was 100 to 69, with this pattern expected to continue over the next 30 years, according to the study.
The authors emphasise the need to implement locally tailored interventions that reduce risk factors, including research into new treatments and other intervention mechanisms to reduce future disease burden.
According to co-author Theo Vos, also from the IHME, low-and middle-Income countries in particular should implement national policies now that can mitigate dementia risk factors for the future.
“Ensuring that structural inequalities in access to health and social care services can be addressed and that services can additionally be adapted to the unprecedented needs of an increasing older population with complex care needs will require considerable planning at both local and national level,” said Vos.
The authors, however, acknowledged that their analysis was limited by lack of high-quality data in several parts of the world, including Sub-Saharan Africa, and by studies using different methodologies and definitions of dementia.https://www.buzzsprout.com/1257893/9240362-witchcraft-stigma-surrounds-dementia?client_source=small_player&iframe=true&referrer=https://www.buzzsprout.com/1257893/9240362-witchcraft-stigma-surrounds-dementia.js?container_id=buzzsprout-player-9240362&player=small
“It is definitely difficult to document and measure dementia in many countries in Sub-Saharan Africa,” said Nichols. “Our estimates make use of all available data and we rely on modeling strategies to generate estimates based on the best evidence that exists.
“Further improvements to systems necessary to detect and document dementia in these settings could lead to improvements in estimates and also improvements in the ability to care for individuals affected.”
Michael Schwarzinger and Carole Dufoui, teaching fellows at the Bordeaux University Hospital in France, who were not part of the study, said the authors were “oversimplifying mechanisms that cause dementia”.
“[They] provide apocalyptic projections that do not factor in advisable changes in lifestyle over the lifetime,” the paid said in a comment linked to the study.
“There is considerable and urgent need to reinforce a public health approach towards dementia to better inform the people and decision makers about appropriate means to delay or avoid these dire projections.”
Can Small Amounts of Olive Oil Keep the Death Away?
Introduction
Olive oil is the cornerstone in the Mediterranean diet, which is also abundant in plant foods. High adherence to the Mediterranean diet has been associated with lower incidence and mortality from cardiovascular disease (CVD) (1) and cancer (2). For CVD, the association with the Mediterranean diet appears most attributable to olive oil, fruit, vegetables, and legumes (1). The PREDIMED (PREvención con DIeta MEDiterránea) randomized clinical trial, which enrolled 7,447 Spanish adults at high cardiovascular risk (3), showed that a Mediterranean diet supplemented with either extra virgin olive oil (the goal was to consume 50 g [approximately 4 tablespoons] or more per day) or mixed nuts significantly decreased the risk of the composite endpoint of cardiovascular death, myocardial infarction, and stroke by about 30% compared with the control diet (advice on a low-fat diet) (3). The associations were mostly driven by a reduction in stroke risk (3), but a post hoc analysis of the PREDIMED trial showed that the Mediterranean diet supplemented with extra virgin olive oil also conferred a reduction in atrial fibrillation risk (4). Even though the PREDIMED trial could not distinguish between the effects of olive oil or nuts from other foods that were recommended for the 2 Mediterranean diet groups, a main difference between those groups and the control group was the increase in extra virgin olive oil and nut consumption in the Mediterranean diet groups (3). In an observational analysis of the PREDIMED study, participants in the highest category of baseline consumption of total olive oil (mean 56.9 g/d) and extra virgin olive oil (mean 34.6 g/d) had a significant reduced risk of total CVD incidence and mortality but not cancer and all-cause mortality compared with those in the lowest category of olive oil consumption (5). Although the evidence is convincing regarding a beneficial role of the Mediterranean diet on CVD risk, data on olive oil consumption specifically in relation to all-cause and cause-specific mortality in populations with a low average olive oil consumption are limited.
In this issue of the Journal, Guasch-Ferré et al (6) report results from a study of olive oil consumption and risk of all-cause and cause-specific mortality in 2 cohorts of >90,000 U.S. women and men. In this well-designed study, with long-term follow-up and repeated measurements of dietary intake and other risk factors for diseases, participants who reported the highest olive oil consumption (>0.5 tablespoon/day or >7 g/d) had 19% lower risk of all-cause mortality, 19% lower risk of CVD mortality, 17% lower risk of cancer mortality, 29% lower risk of neurodegenerative disease mortality, and 18% lower risk of respiratory disease mortality compared with those who never or rarely consumed olive oil after adjustment for known risk factors and other dietary factors. The risk of all-cause mortality and mortality from CVD, cancer, and neurodegenerative diseases was significantly reduced already at a daily olive oil consumption of >0 to ≤1 teaspoon (median 1.5 g/d). This small amount of olive oil was associated with a 12% reduction in the risk of all-cause mortality. The authors subsequently performed substitution analyses and found that replacement of margarine, butter, mayonnaise, and dairy fat with olive oil was associated with a reduced risk of mortality. However, substituting olive oil for other vegetable oils (eg, canola, corn, safflower, and soybean oil) did not confer a reduced mortality risk. This suggests that vegetable oils may provide the same health benefits as olive oil.
A major challenge of this type of observational study is residual confounding. Despite adjustment for potential confounders, it cannot be inferred whether the observed associations of small to moderate amounts of olive oil consumption with reduced risk of all-cause and cause-specific mortality are causal or attributed to confounding. Furthermore, the biological mechanisms underpinning the observed associations are somewhat elusive, particularly for low levels of olive oil consumption and for non-CVD mortality. Olive oil and other vegetable oils contain high amounts of monounsaturated fatty acids (MUFAs), particularly oleic acid. Nevertheless, meta-analyses of observational studies have found no beneficial effects of increased circulating levels or intake of MUFAs or oleic acid on CVD (7-9), and instead found an increased risk of coronary heart disease with high circulating MUFA levels (9). Olive oil is also a source of phenolic compounds that could confer cardiovascular benefits and have been shown to possess anticarcinogenic properties in in vitro and animal studies (10). The PREDIMED trial showed that the group assigned to the Mediterranean diet supplemented with extra virgin olive oil had a significant lower risk of breast cancer compared with the control group (11). The inverse association between olive oil consumption and total cancer mortality in the current U.S. study was observed in both women and men, indicating that the association is not confined to a potential reduction in breast cancer mortality but might also apply to major causes of cancer-related deaths in men, such as deaths from lung, prostate, and colorectal cancer. A study in male rats with azoxymethane-induced colon cancer showed that dietary olive oil suppressed the development of colon carcinoma and that the effect may be explained by arachidonic acid metabolism and local prostaglandin E2 synthesis (12).
The findings for CVD mortality in the study by Guasch-Ferré et al (6) are complementary but not directly comparable with the results of the PREDIMED trial on major cardiovascular events (3). First, the amount of olive oil consumed in the Spanish and U.S. populations differed remarkably. In the PREDIMED trial, participants had a mean baseline extra virgin olive oil and refined/mixed olive oil consumption of 20-22 g/d and 16-18 g/d, respectively (3), and participants assigned to a Mediterranean diet with extra virgin olive oil substantially increased their consumption of extra virgin olive oil (to 50 g/d) (3). In the U.S. study, the mean baseline consumption of any olive oil in the highest category (>0.5 tablespoon/day) was about 9 g/d (6). Second, in the PREDIMED trial, participants were supplied with polyphenol-rich extra virgin olive oil. The U.S. study could not distinguish between different olive oil varieties. This distinction is important because refined olive oil has much lower levels of phenolic compounds than extra virgin olive oil and may therefore have fewer health benefits. Third, participants of the PREDIMED trial were at high cardiovascular risk, whereas the U.S. study included nurses and health professionals with a relatively low cardiovascular risk. In the U.S. study, results were, however, largely consistent in subgroups with and without major CVD risk factors, suggesting that olive oil consumption might be beneficial independent of cardiovascular risk.
A novel finding of the study by Guasch-Ferré et al (6) is the inverse association between olive oil consumption and risk of neurodegenerative disease mortality. Alzheimer’s disease is the major neurodegenerative disease and the most common cause of dementia. In a sensitivity analysis, the authors found a significant 27% reduction in risk of dementia-related mortality for those in the highest vs lowest category of olive oil consumption. Considering the lack of preventive strategies for Alzheimer’s disease and the high morbidity and mortality related to this disease, this finding, if confirmed, is of great public health importance. Another novel finding of the current study was the inverse association of olive oil consumption with risk of respiratory disease mortality. Because the mechanism behind this association is unclear and residual confounding from smoking cannot be ruled out, this finding is tentative and requires confirmation in a study that is less susceptible to confounding, such as a randomized trial.
To summarize, the current study and previous studies have found that consumption of olive oil may have health benefits. However, several questions remain. Are the associations causal or spurious? Is olive oil consumption protective for certain CVDs (eg, stroke [3,13] and atrial fibrillation [4]) only or also for other major diseases and causes of death? What is the amount of olive oil required for a protective effect? Is the potential effect related to MUFAs or phenolic compounds, ie, is the protective effect confined to polyphenol-rich extra virgin olive oil or are refined olive oil and other vegetable oils as beneficial? More research is needed to address these questions.
FDA grants approval to insomnia drug
The FDA granted approval to Quviviq to treat adults with insomnia.
Quviviq (daridorexant, Idorsia) is a dual orexin receptor antagonist that blocks the binding of wake-promoting neuropeptides orexins and is thought to minimize overactive wakefulness, as opposed to sedative treatments.
“After more than 20 years of research and a progressive understanding of the role of orexin in sleep-wake balance and of the potential of orexin receptor antagonism, we designed daridorexant to help address several issues people with insomnia face,” Martine Clozel, MD, chief scientific officer of Idorsia, said in a company release. “Daridorexant properties include a potent inhibition of both orexin receptors, a rapid absorption for sleep onset and a pharmacokinetic profile such that around 80% of daridorexant has been eliminated after a night of sleep to help minimize residual effects.”
Daridorexant was cleared for doses of 25 mg and 50 mg on the heels of two multicenter, randomized, double-blind, placebo-controlled, parallel-group studies during a phase 3 clinical program, which included 1,854 patients encompassing 160 clinical trial sites in 18 countries.
Participants received daridorexant or placebo once a day, in the evening, for 3 months. Researchers on the first study randomly assigned 930 participants to a 50-mg dose, while 924 participants received the 25-mg dose in the second study. Both studies included a 7-day placebo run-out period, after which patients could enter a 9-month, double-blind, placebo-controlled extension study. A total of 600 participants were treated for at least 6 months of cumulative therapy, including 373 treated for at least 12 months.
The drug produced effective boosts to patients’ sleep onset, maintenance and time. The 50-mg dose produced measurable easing of patients’ daytime somnolence.
The FDA recommended daridorexant be classified as a controlled substance. It is scheduled to be released to the public in May 2022.
Air pollution levels linked to 16% of pediatric asthma cases globally
Combustion-related nitrogen dioxide pollution appeared to significantly contribute to pediatric asthma incidence globally, particularly in urban areas, according to data published in The Lancet Planetary Health.
“Decades of research provide strong evidence that air pollution is bad for cardiovascular and respiratory health, but little information exists about the pollution levels and associated health consequences that cities around the world are experiencing,” Susan C. Anenberg, PhD, associate professor of environmental and occupational health and of global health at George Washington University, told Healio. “Because most cities globally lack air quality monitoring, our study is the first time that many cities have access to information about their air pollution levels and what they mean for children’s health.”
Anenberg and colleagues evaluated the long-term trends of annual average nitrogen dioxide (NO2) concentrations and how they correlated with pediatric asthma burdens in 13,189 urban areas globally from 2000 to 2019.
The researchers utilized an existing annual average NO2 concentration dataset for 2010 to 2012 from a land use regression model — based on 5,220 NO2 monitors in 58 countries and land use variables — to model additional years using NO2 column densities from satellite and reanalysis datasets. These concentrations were then applied in an epidemiologically derived concentration-response function with population and baseline asthma rates to estimate pediatric asthma incidence attributable to NO2.
Anenberg and colleagues estimated that, in 2019, 1.85 million (95% uncertainty interval [UI], 0.93-2.8) new pediatric asthma cases were attributable to NO2 globally, with two-thirds of those cases occurring in urban areas (1.22 million cases; 95% UI, 0.6-1.8).
“We found that over three-quarters of cities globally have nitrogen dioxide levels that exceed World Health Organization guidelines. As a result, we estimated that in 2019 about 16% of new cases of asthma among kids in urban areas were from breathing nitrogen dioxide. Globally, that’s down from about 20% in 2000, but the trend differs by world region,” Anenberg told Healio.
That 16% figure equated to 1.24 million pediatric asthma cases attributable to NO2 out of 7.73 million total cases in 2019.
Urban attributable fractions rose between 2000 and 2019 in south Asia (+23%), sub-Saharan Africa (+11%) and north Africa and the Middle East (+5%). However, they decreased in “high-income” countries, including those in Australasia, high-income Asia Pacific, high-income North America, Southern Latin America and Western Europe (–41%); Latin America and the Caribbean (–16%); central Europe, eastern Europe and central Asia (–13%); and southeast Asia, east Asia and Oceania (–6%).
Researchers noted that the contribution of NO2 concentrations, pediatric population size and asthma incidence rates to the change in NO2-attributable pediatric asthma incidence varied regionally.
“Our study shows the importance of considering demographic changes over time for understanding air pollution health risks,” the researchers wrote. “Improved and more widely accessible information about disease rates, and capturing population distribution and movement, will enable more accurate and highly resolved air pollution health impact assessments.”
POST MORTEM RESULTS ARE GRADUALLY REVEALING THE PATHOPHYSIOLOGY OF COVID 19 DISEASES.
Based on observations in USA, Spain, Italy, France and UK, and from postmortem of lungs involvement in COVID 19 , all revealed pulmonary thrombosis which is not typical ARDS , but more alarming that it is patient hypoxemia that is not responding to PEEP but high oxygen flow.
Like methemoglobin, the COVID 19 virus structural protein, sticks to heme – displaces oxygen – which release iron-free ion , that leads to toxicity and causes inflammation of alveolar macrophages- that results in bilateral CT scan changes as it is a systemic response.
There is No benefit of invasive ventilation, but patients May require frequent blood transfusions or plasmapheresis.
The COVID 19 virus attacks beta chain, dissociates heme, removing iron and converting it to porphyrin. The virus can dissociate oxy-Hb, carboxy-Hb andglycosylated Hb.
Lung inflammation results from the inability of both oxygen and CO2 exchange, leading to the ground glass on x rays, it mimics CO2 poisoning as an invisible enemy.
Chloroquine competes for the binding to porphyrin.
Favipiravir binds to the virus envelope protein with very high affinity, prevents entry into the cells as well as binding of the structural protein to porphyrin.
If free radicals scavengers and iron chelating agents are added to the protocol of management, it may lessen the inflammation process.
COVID 19, SARS2 is not ‘pneumonia’ nor ARDS. Invasive ventilation is not only the wrong solution, but emergency intubation can harm and result in more damage, not to mention complications from tracheal scarring and stiff lung during the duration of intubation.
Furthermore, a new treatment protocol needs to be established, so we stop treating patients for the wrong disease.
COVID-19 causes prolonged and progressive hypoxia by binding to the heme groups in the red blood cells.
People are desaturating due to failure of the blood to carry oxygen.
This will lead to multi-organ failure and high mortality.The lung damage seen on CT scans is due to the oxidative iron released from the haemolysed red blood cells which in turn overwhelm the natural defences against pulmonary oxidative stress and causes what is known as Cytokine storm.
There is always-bilateral ground-glass opacity in the lungs. Recurrent admission for post-hypoxic leukoencephalopathy fortifies our findings that COVID-19 patients are suffering from metabolic hypoxia due to blood capacity failure.
COVID-19 glycoproteins bond to the heme in RBC, and in doing so, the toxic oxidative iron ion is disassociated and released. The freely roaming iron in the blood without any physiological function will culminate into the following;
1) Without the iron ion, haemoglobin can no longer bind to oxygen. Once the haemoglobin is impaired, the red blood cell is essentially none functioning in carrying and delivering oxygen to any tissues.
RBC’s Become useless and a burden on the patients as they circulate around with COVID-19 virus attached to its porphyrin. This lead to the destruction of the red blood cells and the patient’s oxygen saturation levels drop significantly.
What is happening equates to carbon monoxide poisoning, in which carbon monoxide is bound to the haemoglobin with the failure of gas exchange.
Ventilations will not manage the root cause, which is blood organ failure.
COVID 19 patients, unlike CO poisoning in which eventually the CO can break off, the affected haemoglobin is permanently stripped of its ability to carry oxygen where the body compensates by secreting excess erythropoietin to stimulate the bone marrow to secrete new red blood cells. This is the reason we will find thrombocytosis and decreased blood oxygen saturation as one of the three primary indicators of COVID 19 severity score.
2) The freely floating iron ion are highly reactive and causes oxidative damage. This always happens physiologically and naturally to a limited extent in our bodies and such cleanup is a defence mechanism to keep the balance.
The Three primary Lung defences to maintain “iron homeostasis”, 2 of them are in the alveoli.
The first of the two are macrophages that roam around and scavenge up the free radicals of the oxidative iron. The second is a lining on the epithelial surface which has a thin layer of fluid packed with high levels of antioxidant molecules such as ascorbic acid (Vitamin C) among others.
When too much iron is in circulation, it begins to overwhelm the lungs’ counter measures begins, the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to the so-called Cytokine storm; this can be documented on high-resolution CT scans of
In COVID-19 patient lungs, It is a fact that it affects both lungs at the same time and Pneumonia rarely ever does that, but COVID-19 does every single time.
The liver is attempting to do its best to remove the iron and store it in its ‘iron vault’. Only its getting overwhelmed too. It is starved for oxygen and fighting a losing battle from all the haemolysis haemoglobin and the freed iron ion. The liver will start releasing alanine aminotransferase (ALT) which is the second of 3 primary COVID 19 severity score indicators.
A patient must be managed on maximum oxygen flow through a hyperbaric chamber on 100% oxygen at double or multiple atmospheres of pressure, for 90 minutes twice per day for five days.
This is in order to give what has left of their functioning haemoglobin a chance to carry enough oxygen to the organs and keep them alive.
We do not have nearly enough of those hyperbaric chambers, and we might use all parked grounded aeroplanes as a ready-made functional hyperbaric chamber with the advantage of providing double atmospheric pressure with an aerosol of prostacyclin as pulmonary hypertension modulator.
Blood transfusion with packed fresh red blood cells to patients after plasmapheresis may ameliorate the cytokine storm.
The main point that patients will require ventilators if they present late with multi-organ system failure to tie them over this life or death scenario. However, intubation is futile unless the patient’s immune system modulates the situation. We must address the root of the illness and avoid using traditional teachings to manage a failing system.
3) No longer armchair pseudo-physicians sit in their little ivory towers, proclaiming “Chloroquine use is stupid as malaria is bacteria, COVID-19 is a virus, anti-bacteria drug no work on the virus!”. A drug does not need to act on the pathogen to be effective directly. Chloroquine lowers the blood pH and interferes with the replication of the virus.
We advise that if COVID-19 positive patients are conscious, alert, compliant, they must be kept on maximum oxygen and initiate hyperbaric oxygen as early as possible.
If we reach the inevitably to ventilate, it must be done at low pressure but with maximum oxygen flow. We must avoid tearing up the lungs with maximum PEEP as we are doing more harm to the patient because we are managing the wrong organ.
There is a small village in northern Italy where the majority of its population suffers from thalassemia. They had no deaths and no cross-community spread. Moreover, parts of Nepal which are 1km above sea level are COVID-19 free. All points that we are chasing the wrong organ; it is not the lungs; it is a blood problem.
We recommend the following :
1. Inhibit viral growth and replication by the adjuvant use of CHQ+ZPAK+ZINC or other retroviral therapies being studies. The less virus load we have, the less haemoglobin is losing its iron, the less severity and damage with the prevention of cytokine storm.2. Hyperbaric medicine utilization in any shape or form for anyone with thrombocytosis and elevated ALT can prevent the rapid ascent to the abyss.3. Plasmapheresis and Blood transfusions will give supportive symptomatic relief.4. No international Travel until an effective vaccine is available.5. Cessation of tobacco, vaping and alcohol products.
Stay safe and Self Isolate
In 1st, US surgeons transplant pig heart into human patient
In 1st, US surgeons transplant pig heart into human patient: https://www.thehindu.com/news/international/in-1st-us-surgeons-transplant-pig-heart-into-human-patient/article38232190.ece
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