Day: 08/26/2022

Diabetes risk increases after COVID-19 diagnosis

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photo of a woman using a glucometer to take a blood glucose reading

People who recover from COVID 19 face a significantly higher risk of developing type 2 diabetes, new research suggests.

The study, published online March 16, 2022, by Diabetologia, reviewed data on 8.8 million people across Germany from March 2020 through July 2021. In that time, 35,865 people were diagnosed with COVID-19. These patients were compared against a control group of the same size (average age 43; 46% women) who weren’t diagnosed with COVID-19 but had experienced short-term upper respiratory tract infections, which frequently are caused by other viruses. The two groups were matched for factors such as gender, age, obesity, high blood pressure, high cholesterol, past heart attack or stroke, and the month they were diagnosed with COVID-19 or an upper respiratory infection.

Compared with people in the control group, those who recovered from COVID-19 were 28% more likely to develop diabetes in the months afterward. Researchers noted that most people who experience mild COVID-19 are unlikely to develop diabetes, but recommended that people who’ve had the infection stay alert for warning signs such as increased thirst, frequent urination, and fatigue.

Tomato flu outbreak in India

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Just as we are dealing with the probable emergence of fourth wave of COVID-19, a new virus known as tomato flu, or tomato fever, has emerged in India in the state of Kerala in children younger than 5 years.

The rare viral infection is in an endemic state and is considered non-life-threatening; however, because of the dreadful experience of the COVID-19 pandemic, the vigilant management is desirable to prevent further outbreaks.

Although the tomato flu virus shows symptoms similar to those of COVID-19 (both are associated with fever, fatigue, and bodyaches initially, and some patients with COVID-19 also report rashes on the skin), the virus is not related to SARS-CoV-2. Tomato flu could be an after-effect of chikungunya or dengue fever in children rather than a viral infection.

The virus could also be a new variant of the viral hand, foot, and mouth disease, a common infectious disease targeting mostly children aged 1–5 years and immunocompromised adults, and some case studies have even shown hand, foot, and mouth disease in immunocompetent adults

Tomato flu is a self-limiting illness and no specific drug exists to treat it.

The tomato flu was first identified in the Kollam district of Kerala on May 6, 2022, and as of July 26, 2022, more than 82 children younger than 5 years with the infection have been reported by the local government hospitals.

The other affected areas of Kerala are Anchal, Aryankavu, and Neduvathur. This endemic viral illness triggered an alert to the neighbouring states of Tamil Nadu and Karnataka. Additionally, 26 children (aged 1–9 years) have been reported as having the disease in Odisha by the Regional Medical Research Centre in Bhubaneswar. To date, apart from Kerala, Tamilnadu, and Odisha, no other regions in India have been affected by the virus. However, precautionary measures are being taken by the Kerala Health Department to monitor the spread of the viral infection and prevent its spread in other parts of India.

Editorial use only Children in a slum in New Delhi, India. Photographed in 2019.

The primary symptoms observed in children with tomato flu are similar to those of chikungunya, which include high fever, rashes, and intense pain in joints.

Tomato flu gained its name on the basis of the eruption of red and painful blisters throughout the body that gradually enlarge to the size of a tomato. These blisters resemble those seen with the monkeypox virus in young individuals

Rashes also appear on the skin with tomato flu that lead to skin irritation. As with other viral infections, further symptoms include, fatigue, nausea, vomiting, diarrhoea, fever, dehydration, swelling of joints, body aches, and common influenza-like symptoms, which are similar to those manifested in dengue.

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In children with these symptoms, molecular and serological tests are done for the diagnosis of dengue, chikungunya, zika virus, varicella-zoster virus, and herpes;

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once these viral infections are ruled out, contraction of tomato virus is confirmed. Because tomato flu is similar to chikungunya and dengue as well as hand, foot, and mouth disease, treatment is also similar—ie, isolation, rest, plenty of fluids, and hot water sponge for the relief of irritation and rashes. Supportive therapy of paracetamol for fever and bodyache and other symptomatic treatments are required.

Children are at increased risk of exposure to tomato flu as viral infections are common in this age group and spread is likely to be through close contact. Young children are also prone to this infection through use of nappies, touching unclean surfaces, as well as putting things directly into the mouth. Given the similarities to hand, foot, and mouth disease, if the outbreak of tomato flu in children is not controlled and prevented, transmission might lead to serious consequences by spreading in adults as well.

Similar to other types of influenza, tomato flu is very contagious. Hence, it is mandatory to follow careful isolation of confirmed or suspected cases and other precautionary steps to prevent the outbreak of the tomato flu virus from Kerala to other parts of India. Isolation should be followed for 5–7 days from symptom onset to prevent the spread of infection to other children or adults. The best solution for prevention is the maintenance of proper hygiene and sanitisation of the surrounding necessities and environment as well as preventing the infected child from sharing toys, clothes, food, or other items with other non-infected children.

Drug repurposing and vaccination are the most efficacious and cost-effective approaches to ensure the safety of public health from viral infections, especially in children, older people, immunocompromised people, and those with underlying health issues. As yet, no antiviral drugs or vaccines are available for the treatment or prevention of tomato flu. Further follow-up and monitoring for serious outcomes and sequelae is needed to better understand the need for potential treatments.

Source: Lancet respiratory Medicine

What’s the Tomato Flu?

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Likely not a new virus, but a manifestation of hand, foot, and mouth disease, experts say

Photo of a girl’s hands with tomato flu rash.

Several media outlets have called attention this week to an unfamiliar virus that’s been spreading among children in India — the “tomato flu.” But scientists say its unfamiliarity is up for debate.

Tomato flu, which got its name from the red, inflamed blisters that appear on infected patients, has been reported in more than 82 kids in Kerala, as well as an additional 26 children in two neighboring states, Tamil Nadu and Odisha, according to the Times of India.

Reports of the non-fatal, yet contagious, disease quickly caught on in the headlines, with news outlets reporting a rare, “new” viral infection. However, there are no data to confirm that tomato flu is in fact a new virus — or even a flu at all.

Instead, preliminary evidence suggests it may be just another clinical presentation of an infection that’s quite common in kids: hand, foot, and mouth disease.

“This is not a new disease, and is not a new virus,” said Daniel Lucey, MD, MPH, clinical professor of medicine at the Dartmouth Geisel School of Medicine in New Hampshire. “That’s my take at this point.”

Cases of tomato flu were first reported in Kerala in early May and have mostly spread among kids under 5 years old. There were about 100 cases as of July 26 reported in the region, some in kids as old as 9 years.

Little data describing testing or gene sequencing have emerged out of India since the start of the outbreak. However, last week a case report was published in the Pediatric Infectious Disease Journal, presenting the results of biological testing in two patients.

The case report analyzed a 13-month-old girl and her 5-year-old brother, both of whom were suspected to have tomato flu. The children developed vesicular rashes on their hands and legs about a week after returning from a month-long trip to Kerala with their family.

Two days after the kids first experienced a rash, the girl developed oral lesions, while the boy’s rash healed. Neither of the kids had a fever or any other flu-like symptoms.

The children received PCR tests for enteroviruses, and the girl was tested for monkeypox due to the appearance of her lesions. These samples were then sent to labs for gene sequencing. The researchers determined that the illness was caused by the coxsackievirus A16 — a pathogen that causes hand, foot, and mouth disease.

“This virus is not new,” said Julian Tang, PhD, of University Hospitals of Leicester in England, lead author of the case report. “I don’t think this is something to be alarmed about.”

Hand, foot, and mouth disease is typically mild, although it can lead to severe consequences in rare cases. There are no vaccines or antivirals available for the disease, Tang noted.

Lucey, who is also an expert from the Infectious Diseases Society of America, said it led him to believe two things: that this is very likely not a new virus, nor a new variant of a pathogen that’s already out there. He pointed to a phylogenetic tree included in the case report, which showed the relation of coxsackievirus A16 to a previous outbreak in China in 2011 to 2014, as well as an outbreak in France that occurred in 2006.

In a time when reports of new emerging viruses and outbreaks seem common, stories about infectious diseases can garner a lot of attention, Lucey said. But in this case, that attention has led to many misconceptions about tomato flu, he added, starting with its name, which he describes as a misnomer: “there are no tomatoes.”

Many recent news reports about tomato flu sparked a correspondence recently published in Lancet Respiratory Medicine. The letter stated that the “new” tomato flu virus “gained its name on the basis of the eruption of red and painful blisters throughout the body that gradually enlarge to the size of a tomato.”

The letter, written by Vivek Chavda, of L.M. College of Pharmacy in Gujarat, India, and colleagues, said that the symptoms of tomato flu can look similar to COVID-19, including fever, fatigue, and body aches. The authors raised the possibility that tomato flu could be a “new variant of the viral hand, foot, and mouth disease” or an after-effect of chikungunya or dengue fever, both of which are mosquito-borne illnesses.

However, some experts criticized the correspondence, stating that it made implications about the virus without data. No evidence of clinical presentations of the virus or virological test results were included in the paper. Chavda did not respond to a request for comment from MedPage Today as of press time.

Lucey said he would like to see biological testing and genetic sequencing from at least 10 more patients involved in the India outbreak, which is likely to be forthcoming. Until there are more data, however, he said hand, foot, and mouth disease is a probable cause of the outbreak.

“I think it’s important to address concerns,” Lucey said. “But for right now, I don’t think there’s any new virus, new disease or new clinical manifestation.”

WHO makes new recommendations for Ebola treatments, calls for improved access

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The World Health Organization (WHO) has published its first guideline for Ebola virus disease therapeutics, with new strong recommendations for the use of two monoclonal antibodies. WHO calls on the global community to increase access to these lifesaving medicines.

Ebola is a severe and too often fatal illness caused by the Ebola virus. Previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care – with fluid and electrolyte repletion and treatment of symptoms – significantly improve survival. Now, following a systematic review and meta-analysis of randomized clinical trials of therapeutics for the disease, WHO has made strong recommendations for two monoclonal antibody treatments: mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb).

Developed according to WHO standards and methods for guidelines, and published simultaneously in English and French, the guidelines will support health care providers caring for patients with Ebola, and policymakers involved in outbreak preparedness and response. The clinical trials were conducted during Ebola outbreaks, with the largest trial conducted in the Democratic Republic of the Congo, demonstrating that the highest level of scientific rigour can be applied even during Ebola outbreaks in difficult contexts.

The new guidance complements clinical care guidance that outlines the optimized supportive care Ebola patients should receive, from the relevant tests to administer, to managing pain, nutrition and co-infections, and other approaches that put the patient on the best path to recovery.

“This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs. From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible. As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.”

The two recommended therapeutics have demonstrated clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first 7 days after birth. Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis.

There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir.

All these recommendations only apply to Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus).

“Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler, University of Toronto, Canada, and co-chair of the guideline development group. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment – MAb114 or REGN-EB3 – now leads to recovery for the vast majority of people.”

Access to both these treatments remains challenging, especially in resource-poor areas. These drugs should be where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely. WHO is ready to support countries, manufacturers and partners to improve access to these treatments, and to support national and global efforts to increase affordability of biotherapeutics and their corresponding similar biotherapeutic products, WHO published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to improve drug access for communities and countries affected by Ebola.

“We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies programme. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks. This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.”

Although WHO was able to make strong recommendations for the use of two therapeutics, there is a need for further research and evaluation of clinical interventions, as many uncertainties remain. Further improvements could be made in supportive care, and in our understanding and characterization of Ebola virus disease and its longer-term consequences, and to ensure continued inclusion of vulnerable populations (pregnant women, newborns, children and older people) in future research.

15 Things You Should Give Up To Be Happy

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15 Things You Should Give Up To Be Happy

We hold on to so many things that cause us a great deal of pain, stress, and suffering – and instead of letting them all go, instead of allowing ourselves to be stress-free and happy – we cling on to them. Not anymore.

Starting today we will give up on all those things that no longer serve us, and we will embrace change. Ready? Here we go.

15 Things You Should Give Up To Be Happy

1. Give up your need to always be right

There are so many of us who can’t stand the idea of being wrong – wanting to always be right – even at the risk of ending great relationships or causing a great deal of stress and pain, for us and for others.

It’s just not worth it.

Whenever you feel the ‘urgent’ need to jump into a fight over who is right and who is wrong, ask yourself this question:

“Would I rather be right, or would I rather be kind?” ~ Wayne Dyer

What difference will that make? Is your ego really that big?

2. Give up your need for control

Be willing to give up your need to always control everything that happens to you and around you – situations, events, people, etc. Whether they are loved ones, coworkers, or just strangers you meet on the street – just allow them to be. 

15 Things You Should Give Up To Be Happy

Allow everything and everyone to be just as they are and you will see how much better will that make you feel.

“By letting it go it all gets done. The world is won by those who let it go. But when you try and try. The world is beyond winning.” ~ Lao Tzu

3. Give up on blame

 Give up on your need to blame others for what you have or don’t have, for what you feel or don’t feel. Stop giving your powers away and start taking responsibility for your life.

4. Give up your self-defeating self-talk

 Oh, my. How many people are hurting themselves because of their negative, polluted and repetitive self-defeating mindset? Don’t believe everything that your mind is telling you – especially if it’s negative and self-defeating. You are better than that.

“The mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive.” ~ Eckhart Tolle

5. Give up your limiting beliefs

Give up your limiting beliefs about what you can or cannot do, about what is possible or impossible. From now on, you are no longer going to allow your limiting beliefs to keep you stuck in the wrong place. Spread your wings and fly!

6. Give up complaining

Give up your constant need to complain about those many, many, many things – people, situations, events that make you unhappy, sad and depressed. Nobody can make you unhappy, no situation can make you sad or miserable unless you allow it to.

It’s not the situation that triggers those feelings in you, but how you choose to look at it. Never underestimate the power of positive thinking.

7. Give up the luxury of criticism

Give up your need to criticize things, events or people that are different than you. We are all different, yet we are all the same.

15 Things You Should Give Up To Be Happy

We all want to be happy, we all want to love and be loved and we all want to be understood. We all want something, and something is wished by us all.

8. Give up your need to impress others

Stop trying so hard to be something that you’re not just to make others like you. It doesn’t work this way. The moment you stop trying so hard to be something that you’re not, the moment you take off all your masks, the moment you accept and embrace the real you, you will find people will be drawn to you, effortlessly.

9. Give up your resistance to change

Change is good. Change will help you move from A to B. Change will help you make improvements in your life and also the lives of those around you. Follow your bliss, embrace change – don’t resist it.


“Follow your bliss and the universe will open doors for you where there were only walls.” ~ Joseph Campbell

10. Give up labels

 Stop labeling those things, people or events that you don’t understand as being weird or different and try opening your mind, little by little. Minds only work when open. 

“The highest form of ignorance is when you reject something you don’t know anything about.” ~ Wayne Dyer

11. Give up on your fears

Fear is just an illusion, it doesn’t exist – you created it. It’s all in your mind. Correct the inside and the outside will fall into place.

“The only thing we have to fear is fear itself.” Franklin D. Roosevelt

12. Give up your excuses

Send them packing and tell them they’re fired. You no longer need them. A lot of times we limit ourselves because of the many excuses we use. Instead of growing and working on improving ourselves and our lives, we get stuck, lying to ourselves, using all kind of excuses – excuses that 99.9% of the time are not even real.

13. Give up the past

I know, I know. It’s hard.

Especially when the past looks so much better than the present and the future looks so frightening, but you have to take into consideration the fact that the present moment is all you have and all you will ever have.

The past you are now longing for – the past that you are now dreaming about – was ignored by you when it was present.

Stop deluding yourself. Be present in everything you do and enjoy life. After all, life is a journey, not a destination. Have a clear vision for the future, prepare yourself, but always be present in the now.

14. Give up attachment

15 Things You Should Give Up To Be Happy

Many people mistake attachment with love but love and attachment have nothing to do with one another. Attachment comes from a place of fear, while love… well, real love is pure, kind, and self less, where there is love there can’t be fear. Because of that, attachment and love cannot coexist.

The moment you detach yourself from all things you become so peaceful, so tolerant, so kind, and so serene. You will get to a place where you will be able to understand all things without even trying. A state beyond words.

“Love allows your beloved the freedom to be unlike you. Attachment asks for conformity to your needs and desires. Love imposes no demands. Attachment expresses an overwhelming demand – “Make me feel whole.” Love expands beyond the limits of two people. Attachment tries to exclude everything but two people.” ~ Deepak Chopra

15. Give up living your life to other people’s expectations

Way too many people are living a life that is not theirs to live. They live their lives according to what others think is best for them, they live their lives according to what their parents think is best for them, to what their friends, their enemies and their teachers, their government and the media think is best for them.

They ignore their inner voice, that inner calling. They are so busy with pleasing everybody, with living up to other people’s expectations, that they lose control over their lives. They forget what makes them happy, what they want, what they need….and eventually, they forget about themselves.

You have one life – this one right now – you must live it, own it, and especially don’t let other people’s opinions distract you from your path.

YT Video URL : https://youtu.be/mJsguNeC-6E

5 Great Reasons To Write a Thank You Note More Often

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5 Reasons To Start Writing A Thank You Note More Often

When was the last time you sent someone a handwritten thank you note via snail mail?

With the advent of the internet and our increasing online presence, handwritten thank-yous have practically become obsolete, which is a dire shame.

Handwritten expressions of gratitude have the power to increase connection and joy, decrease depression, and make you stand out in a very competitive business world!

 I hope this post will help revive this beautiful life-giving habit of sending a thank you note that the world needs now more than ever. 

Why A Handwritten Thank You Note Matters?

One of my mother’s greatest parenting wins was teaching my sister and me how to cultivate gratitude. Anytime anyone would gift us something or do something kind for us (no matter how small the gesture), she would have us write them a thank you card. 

She insisted that we make the cards ourselves and that the messages we wrote inside be thoughtful and personal to the recipient. 

No mass-produced Hallmark cards with already printed messages allowed. 

What made her requirements so powerful was that they forced us to really engage with the task. Not only was the card personalized to the person and gesture, but when writing the message, we were forced to stop and really think about this person and our relationship with them, in order to make the message as sincere and personal as possible.

To this day, this is one of the greatest gifts my mother has given me because it instilled in me an underlying sense of gratitude which I think is a large reason I have such a positive outlook on life. 

When we make expressing gratitude a habit, we become more acutely aware of the blessings that come our way, large or small, and the result is a much more joyful life.

It’s not lost on me when the DMV officer is far more patient with me than he had to be, considering the circumstances. Or when my mailman goes out of his way to make sure my package doesn’t get soaked in the pouring rain. Or when a friend who I know struggles financially still insists on taking me out for dinner to celebrate a win.

5 Great Reasons To Write a Thank You Note More Often

1. It’s the fastest way to cultivate joy.

5 Reasons To Start Writing A Thank You Note More Often 35 Life-Changing Lessons to Learn from the Inspiring John Maxwell 29 Life-Changing Lessons to Learn from John Gottman 5 Ways to Cultivate Gratitude and Foster Genuine Joy What Does Making a Commitment to Succeed Really Means? The Powerful Connection Between Enjoying Success and Burnout

I define joy as being in a state of complete and utter gratitude. When we are in a state of joy, our hearts are wide open and we feel immense pleasure and happiness. One of the fastest ways to cultivate joy is to focus on the things and people in our lives we are grateful for. Writing a thank you card is an easy and actionable way to do this. 

When you’re in the act of writing someone a thank you, your thoughts are focused on whatever kindness was done to you rather than on the myriad of stressful thoughts that regularly occupy your mind, placing you in a state of gratitude which begets joy. 

2. It will improve your relationships.

Everybody likes to be appreciated. When you regularly express your appreciation for those you love and those who have been kind and generous with you, you deepen your connection with that person and create greater trust. This leads to greater intimacy and a much more fulfilling relationship. 

3. It will lower your anxiety and depression.

Gratitude is a natural antidepressant. When we express gratitude, our brain releases serotonin and dopamine, two neurotransmitters responsible for making us happy. 

Dopamine is the neurotransmitter responsible for making us feel motivated, and people with low levels of dopamine have greater self-doubt, higher levels of procrastination and far less overall enthusiasm. 

Serotonin is the neurotransmitter responsible for us feeling important and significant. This is the primary ingredient in most antidepressants, and people who are low in serotonin suffer from loneliness, depression and low self-esteem. When we express gratitude, our brain is flooded with serotonin as a result of not only feeling valued but also recognizing all there is to value in one’s life. 

4. It will make you stand out in the business world.

Handwritten thank yous are a dying art that few people utilize these days. Take advantage of that. When you apply for a job or a promotion, take the time to write your interviewer a note of appreciation. Your note will make you stand out of the sea of applicants and will show class, courtesy, integrity, and kindness – all qualities that are sought after in the business world. 

5. It will increase the recipient’s wellbeing.

We all know how good it feels to be seen and appreciated. Receiving a sincere handwritten thank you not only increases the writer’s joy, but it also increases the recipient’s wellbeing. In a world filled with discouraging news and tragic events, give someone a lift of spirits by letting them know how much you appreciate them. 

Your Turn to Send a Thank You Note

5 Reasons To Start Writing A Thank You Note More Often Thank You: The Only Mantra to Use for Experiencing Overwhelming Gratitude Do Not Love Half Lovers: A Life-Altering Poem by Khalil Gibran Thankfulness: Letters from Your Soul On Thankfulness Gratefulness: How to Live Each Day to the Fullest Brilliant Advice on How to Start Your Day Right 11 Things You Should Remind Yourself Daily

I challenge you to think of someone who has done you a kindness. Or someone who you admire. Or someone who has left an indelible mark on your life. 

Could be anyone: Your mother. Your brother. The mailman/mailwoman. A client. Your boss. One of your children. Your spouse. A friend. Your local coffee barista. An old colleague. A high school teacher. A college professor.

Take a minute to really think about what this person has added to your life. 

Maybe you learned an important lesson from them. Maybe they were generous with their time/love/money. Maybe they ensure that you receive your mail every single day and that’s valuable to you. Maybe their presence in this world brings you comfort and joy. Maybe they put up with an awful lot from you and still love you and treat you kindly. 

Maybe they birthed you and gave you life. Maybe they helped you grow and evolve as a person. Maybe they cracked open your heart. Maybe they picked up your kids from school so you could go to an important appointment. Maybe they took care of your dog while you were away. Maybe they showed up for you at a really difficult time and were a true friend. Maybe you just appreciate their goodness.

The only thing I ask is that you not rush the letter. Take your time and really write from the heart. Make sure your message is hand-written on paper of any kind, and then pop it in the mail. 

There is no shortage of things to be grateful for and there is no shortage of people to thank. 

So who will you send a thank you note today? 

Polypill Proves Its Mettle for Heart Protection Post-MI

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Trial affirms benefit of single drug-combo pill compared with usual care in secondary prevention

Combining aspirin, an ACE inhibitor, and a statin into a single “polypill” improved cardiovascular outcomes in secondary prevention compared with prescribing the medications separately, the SECURE randomized trial showed.

The polypill reduced the primary composite risk of cardiovascular death, nonfatal type 1 MI, nonfatal ischemic stroke, and urgent revascularization by a relative 24% over usual care, with a rate of 9.5% versus 12.7%, respectively (P=0.02), reported Valentin Fuster, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York, during the European Society of Cardiology (ESC) Congress.

Looking at just the hard outcomes without revascularization likewise favored the polypill (8.2% vs 11.7%, HR 0.70, 95% CI 0.54-0.90).

“The use of a cardiovascular polypill as a substitute for several separate cardiovascular drugs could be an integral part of an effective secondary prevention strategy,” Fuster and colleagues wrote in their study, which was published simultaneously in the New England Journal of Medicine.

“By simplifying treatment complexity and improving availability, the use of a polypill is a widely applicable strategy to improve accessibility and adherence to treatment, thus decreasing the risk of recurrent disease and cardiovascular death,” they added.

The trial didn’t show much difference between groups in blood pressure or LDL cholesterol levels; rather, the researchers chalked the differences up to improved adherence leading to greater antiplatelet exposure, perhaps along with pleiotropic effects of statins and ACE inhibitors beyond those measures.

The trial was consistent with the propensity-matched NEPTUNO study, which showed a 27% reduction in major adverse cardiovascular event risk with a similar polypill in a secondary prevention setting, which was also attributed to higher medication persistence.

Moreover, the study’s results add to the evidence for the benefits of fixed-dose combo pills seen in primary prevention as well.

“There is a history here of 15 years,” noted Fuster at a press conference for the hotline trial session. The group first showed that adherence to medication after MI was a big problem, then showed in the FOCUS study that the polypill improved adherence. Fuster said that this advantage now translates into a “striking” clinical benefit.

Notably, the event curves began to separate for both the primary and key secondary endpoints right from the beginning and continued to do so at the median 3 years of follow-up in the trial, Fuster pointed out.

“I would like to emphasize one thing: that the impact of the data I presented is not different than the impact of aspirin,” he said. “We have in front of us something that could be simple and for countries middle-income and low-income, which is how we started the trial, it actually could be meaningful. But now the next step is we have to go to the agencies for approval.”

A combination pill with atorvastatin was approved for use in Europe but now it’s time to go to the FDA, he added.

Martha Gulati, MD, director of cardiovascular disease prevention at the Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute in Los Angeles, noted that the polypill wouldn’t just be useful in lower-income countries.

Access and cost are not just issues in the developing world, she argued, pointing to the less-than-perfect adherence achieved in the polypill group in the high-risk population studied.

High scores for adherence were seen at 6 months in 71% of the polypill group and 62.7% of usual care patients (risk ratio [RR] 1.13, 95% CI 1.06-1.20) and at 24 months in 74.1% and 63.2%, respectively (RR 1.17, 95% CI 1.10-1.25).

“That’s so telling, because you’ve had something that could kill you and is a pretty serious medical event and then people don’t take their medication,” Gulati noted. “A lot of patients who have had myocardial infarction, these are not the only drugs they’re on. They’re often on expensive antiplatelet agents, they may be on medications for diabetes, they might need more than just a statin eventually, they may need other lipid-lowering agents.”

“We put a great burden on our patients and a financial burden as well with every copay. So making it easy is something, to me, we should be interested in,” she said. “Even the generic drugmakers should have some interest in making it available.”

It’s really a public health problem, Fuster agreed. “People do not have adherence to what we know.”

The SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) trial included 2,499 patients ages 75 and older (or at least age 65 with an additional risk factor) who had type 1 MI in the prior 6 months.

They were randomized to treatment with a single daily pill containing aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (92% on 40 mg, and the rest on 20 mg based on patient history and blood test results) or usual care based on ESC guidelines.

Results were consistent across the countries where patients were enrolled (Spain, Italy, France, Germany, Poland, the Czech Republic, and Hungary), age (mean 76), sex (31% women), diabetes and kidney disease status, and prior revascularization.

“The trial results are broadly applicable to the general population,” Fuster’s group suggested, “especially considering that the average age at the time of a first myocardial infarction is now 65.6 years for men and 72.0 years for women, along with the high prevalence of diabetes mellitus, chronic kidney disease, and previous coronary artery disease in these patients.”

All patients were enrolled before the end of 2019 and followed for a median of 36 months, during which the COVID-19 pandemic likely kept some patients from trial visits.

Other limitations included a lack of adjustment for multiple comparisons of secondary outcomes, which made the lower cardiovascular death rate in the polypill group (3.9% vs 5.8%) only a hypothesis-generating finding.

Between COVID-19 and the 14% withdrawal rate, the trial enrolled fewer patients than planned and had a lower event rate than expected, dropping the statistical power for the primary endpoint below the anticipated 80% to a “rather limited” level, noted Louise Bowman, MBBS, of the University of Oxford in England, who served as the study discussant at the hotline trial session.

An extra 10 or so events would have tipped the results the other direction, she pointed out.

In addition, “there was no way to blind participants, but that instantly risks bias, especially when it comes to reporting outcomes and adherence, and probably affects willingness to attend study visits and have blood samples taken,” she added.

Bowman expressed surprise that the adherence didn’t decline much from 6 to 24 months. “There may be biases at play, perhaps the true difference is even greater … Samples might be obtained only from more adherent participants who are more able to attend clinics.”

Still, she agreed with Fuster that the early divergence in the event curves was very encouraging for a real impact.

“I would advise caution in overinterpretation, given the limitations,” she said. However, “I will leave you with a question to consider: Do we actually need a study of a polypill strategy in order to change practice? Or should we be asking if there are any good reasons why the polypill is not a good idea given everything we now know?”

Can Walking Barefoot Heal Your Heart?

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Person Walking Barefoot on Ground at Sunrise
  • Why do so many people equate relaxation and pleasure with walking barefoot along the beach as the waves roll in? How come my son River’s first instinct is to take his shoes off when he sees a field of green grass?

Is it kooky human behavior that is simply hard-wired into our genetic makeup, or is there something more to this urge to remove footwear?

The Unshod, or Shoe-Less, Revolution

Historically speaking, it seems like we’re right in step with our forebearers. Long before we had cushiony sneakers, our distant ancestors tended to walk barefoot over rock, rubble, dirt, stick, and stream. Their feet were strong and nimble, able to sense and react to any surface they encountered. More recent native cultures often walk through nature on their naked soles, instead of wearing moccasins or similar footwear.

Commonalities like “barefootedness”, that we see repeated among ancient groups, beg for further investigation as to “why?” Especially in cultures where simple foot gear was already an option.

Thankfully, there is good science behind shoelessness and the findings are fascinating.

Current Research on Grounding

It turns out that the sensation we feel when our feet make contact with moist sand is more than just a feeling. This therapeutic touch of mother earth is laden with remarkable health benefits,

  • reducing inflammation,
  • boosting antioxidants in our body,
  • improving sleep,
  • and, promoting healthy blood flow.

The primordial practice of walking barefoot, sometimes referred to as “grounding,” is only just beginning to be studied by modern science. One of the most groundbreaking findings is the powerful heart health effect of direct skin contact with the earth.

A study published by the Journal of Alternative And Complementary Medicine from 2013 states that walking barefoot “reduces blood viscosity, which is a major factor in cardiovascular disease”.

Blood viscosity is a term used to describe the “thickness and stickiness of your blood.” The lower the viscosity, the easier your blood flows through your blood vessels and circulates throughout your body. The higher your blood’s viscosity, or thickness, the slower it moves.

To test the effects of grounding on blood viscosity, subjects had their red blood cells (RBCs) examined under a microscope to determine the number of clumped groups of RBCs in each sample. High instances of aggregation (or clumping) in human blood increases your blood viscosity and can result in cardiovascular disease. This experiment was intended to measure whether grounding to the earth’s innate electrical charge would have a positive effect on this blood condition. Can grounding help to prevent the deadly disease that is linked to it?

Long story short, walking barefoot substantially lowered the instance of unwanted blood cell clumping in every one of the subjects and promoted healthier circulation.

*A later study in the same journal found that “grounding” or “earthing” may help regulate both the endocrine and nervous systems as well.

We present-day humans live in a sea of electromagnetic waves radiated by mobile phone signals, Wi-Fi, automatic doors etc. This is referred to as “dirty electricity” or “electromagnetic pollution.” Luckily for us, the earth’s surface is rich with electrons that can neutralize this dirty electricity. Vibrating and charging the currents within us back into healthy balance.

This can boost our energy, balance our mood, clarify our thinking, and perhaps even save our lives.

A Sacred Science barefoot challenge for you:

Next time you’re in front of an appealing patch of earth,

  1. Remove your shoes and socks and do the unthinkable…
  2. Step forth onto said terra firma and feel the sensation that runs through your body…
  3. Envision the cells in your bloodstream recalibrating as you do so, because well, they are.

That’s it.

I’d recommend you do this at least a few times a week for better heart health and overall happiness. We’re earth dwellers, why separate ourselves from her with rubber soles? And if you’re wondering if winter gets in the way of this little exercise, my family walks barefoot in the snow as well 🙂

*I find it’s fun to go foot-naked in odd places in the midst of shoe-wearers who scratch their heads in confusion as they watch… BUT it’s also nice to do in the comfort of your own backyard or the middle of the forest.

Stay shoeless,

Nick Polizzi
Host of Proven: Healing Breakthroughs Backed By Science
& Founder of The Sacred Science

New Research Links Gallstones, Pancreatic Cancer

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Patients diagnosed with pancreatic ductal adenocarcinoma are more likely to have had gallstones than patients without pancreatic cancer, according to research presented at the 2022 Digestive Disease Week.

“Understanding this association between gallstone disease and pancreatic cancer might be a key to differential diagnosis strategies,” said Teviah Sachs, MD, MPH, the chief of the Section of Surgical Oncology at Boston Medical Center and an associate professor of surgery at Boston University School of Medicine, at a media briefing describing the results. The early symptoms of pancreatic ductal adenocarcinoma (PDAC), the third-leading cause of cancer-related death in the United States, often mimic those of gallstone disease, Dr. Sachs said, making diagnosis difficult.

To analyze this relationship, Dr. Sachs and his co-investigators examined records from the SEER-Medicare database between 2008 and 2015, comparing the experience of 14,643 patients with PDAC and 14,605 patients who did not have cancer (abstract 761). The team looked for evidence of either gallstone disease diagnosis or gallbladder removal in the 13 months before PDAC diagnosis. Groups were matched with respect to age, sex and race.

Dr. Sachs reported that 4.5% of the PDAC patients and 1.8% of controls without cancer had received a gallstone disease diagnosis in the year before their PDAC diagnosis (odds ratio [OR], 1.36; 95% CI, 1.16-1.60). Patients with gallstone disease were diagnosed at an earlier disease stage (stage I-II) (47.9% vs. 40.5%; P<0.0001) and a higher proportion underwent pancreaticoduodenectomy (17.6% vs. 12.9%; P<0.0001), compared with patients without gallstone disease.

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Underscoring that the study does not show gallstones cause pancreatic cancer, Dr. Sachs said, “We can’t be certain at this time … whether the gallstone disease that we’re seeing is the precursor or the end result of pancreatic cancer. We do know that there’s an association.” Finding patients with possible precursors—such as gallstone disease—can determine who should receive an MRI scan or endoscopic ultrasound to hopefully identify pancreatic cancer before it progresses.

Interpret With Caution

Madhav Desai, MD, a gastroenterologist at the Kansas City VA Medical Center, in Missouri, said the findings are important and should inspire further research.

Dr. Desai, who was not involved in the study, cautioned that gallstone disease includes everything from asymptomatic gallstones to gallstones that cause pancreatitis—differences not accounted for by the umbrella term “gallstone disease.”

In response, Dr. Sachs noted that although their data are not broken down by type of gallstone, he expects the proportion of different gallstone types in the cancer population to mirror those in the general population.

Dr. Desai noted that pancreatic ductal obstruction from cancer sometimes causes upstream bile duct obstruction and cholangitis, as consequences rather than causes of cancer.

In addition, Dr. Sachs believes that any screening imaging within a year of PDAC diagnosis that could have identified gallstones also should have been able to spot a pancreatic tumor.

Noting that some risk factors for pancreatic cancer and gallstones overlap, Dr. Desai said, “We should be cautious of interpreting results and avoid any unnecessary concerns for patients with gallstone disease, especially those who are asympto

Medical Marijuana: What You Should Know

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What Is It?

What Is It?

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Medical marijuana is derived from the Cannabis sativa plant.Humans have turned to it as an herbal remedy for centuries, and today people use it to relieve symptoms or treat various diseases. The federal government still considers it illegal, but some states allow it to treat specific health problems. The FDA, the U.S. agency that regulates medicines, has approved one cannabis-derived drug product cannabidiol (Epidiolex) to treat certain seizure disorders.

Key Ingredients

Key Ingredients

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Marijuana has chemicals called cannabinoids. Medical researchers usually focus on the health effects of two in particular: delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the substance that makes you high; CBD doesn’t have mind-altering effects.

Forms of Medical Marijuana

Forms of Medical Marijuana

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There are a variety of ways to take the drug. You can inhale a vaporized spray, smoke the leaves, take a pill or liquid, or bake it into foods. All of the types differ in terms of how often you should use them, how they’ll affect your symptoms, and side effects you may feel.

How It Works in Your Body

How It Works in Your Body

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The chemicals in marijuana affect you when they connect with specific parts of cells called receptors. Scientists know that you have cells with cannabinoid receptors in your brain and in your immune system. But the exact process of how the drug affects them isn’t clear yet.

What Does It Treat?

What Does It Treat?

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State laws differ on the conditions that you can legally treat with medical marijuana. But you might be allowed to use it if you have Alzheimer’s, ALS, cancer, Crohn’s disease, epilepsy, seizures, hepatitis C, AIDS, glaucoma, multiple sclerosis, posttraumatic stress disorder, chronic pain, or severe nausea. But scientists aren’t sure that it helps all of these conditions. The research is most clear that it can work as a painkiller, to stop vomiting during chemotherapy, to relieve some MS symptoms, and to treat a few rare forms of epilepsy.

Are There Risks?

Are There Risks?

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If you smoke it, you could have breathing problems such as chronic cough and bronchitis. Research has linked cannabis use and car accidents. If you use it while pregnant, you may affect your baby’s health and development. Studies also show a tie between pot and psychotic disorders such as schizophrenia.

FDA-Approved Versions

FDA-Approved Versions

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Besides the approval of cannabidiol (Epidolex) as a treatment for two rare kinds of epilepsy, the FDA has also approved three synthetic cannabis-related drug products: Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone). If you have nausea caused by chemotherapy, you might take a synthetic cannabinoid, either dronabinol or nabilone. Dronabinol also can help boost appetite for people with AIDS.

Laws in Conflict

Laws in Conflict

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California was the first state to legalize medical marijuana, in 1996. as of March 2021, 36 states in the U.S. have done so. (Recreational weed is also legal in some places.) But the federal government still considers it an illegal drug, which can create confusion. For instance, even if you have a prescription, the Transportation Security Administration doesn’t allow cannabis in your luggage.

How Do You Get it?

How Do You Get it?

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The rules vary, depending on where you live. Generally, you’ll need to consult with a doctor and have a condition that your state has approved for treatment with cannabis. You might get an ID card. In some areas, you buy products at a specific store called a dispensary.

Do People Become Addicted?

Do People Become Addicted?

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Doctors don’t know much about the addiction risk for people who use the drug for medical reasons, and it needs more study. But people who use marijuana to get high can go on to have substance misuse issues. The most common problem is dependence. If you’re dependent, you’ll feel withdrawal symptoms if you stop using. If you’re addicted — a more severe problem — you’re unable to go without the drug.

Why Don’t We Know More?

Why Don’t We Know More?

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Although cannabis has been an herbal remedy for centuries, the evidence for how well it works is lacking in many cases. Scientists prefer large studies with certain types of controls before they draw conclusions, and much of the research thus far hasn’t met those standards. Products vary in strength and it’s hard to measure doses, which has made judging the benefits of marijuana even more complicated.

An Opioid Alternative?

An Opioid Alternative?

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Could cannabis help solve issues involving these powerful painkillers? In some states, prescriptions for this pain medicine fell and researchers found a link to fewer overdose deaths. But another study found a link between pot use and abuse of these narcotic drugs. Scientists need more evidence before they can say for sure.