Day: November 28, 2023

Nov 28

Rush-hour traffic in Seattle increases blood pressure, but not for the reason you think

It will come as no surprise to anyone who braves I-5 on a weekday at either 8 a.m. or 5 p.m. (or practically anytime in between) that your blood pressure tends to increase during sudden slowdowns and bumper-to-bumper backups. But a new study suggests that it’s not just the Tesla changing lanes without using a directional that is causing your heart to pound. Ultrafine particles circulating on and near congested freeways — a toxic mixture of exhaust from tailpipes, brake and tire wear, and road dust — increases blood pressure, which could lead to other health problems. “We are beginning to believe that it’s these really tiny particles that are responsible for health effects,” explained lead researcher Joel Kaufman, a University of Washington physician and professor of environmental and occupational health sciences. “It’s not just being in a car, it’s the people who live near roadways that have the same exposures.” Kaufman and his team drove healthy young people between the ages of 22 and 45 through rush-hour traffic in Seattle while monitoring their blood pressure. On some of the drives, unfiltered air was allowed to enter the car. On other drives, the car was equipped with a high-quality HEPA air filter, which blocked 86% of particulate pollution. The study used “sham filters” in some drives and real filters in others, so study participants and their drivers didn’t know whether the air was filtered or not. Researchers found that breathing unfiltered air in the car caused blood pressure increases of 4.5 millimeters of mercury compared to passengers riding in the car with filtered air. The effect is equivalent to someone eating a high-sodium diet, and the increased blood pressure lasted for at least 24 hours after the rush-hour drive in a car with unfiltered air. A blood-pressure increase of five points might not sound like much, but Kaufman said the impact should be weighed in terms of the number of people affected, potentially people who already have high blood pressure or other health issues. “We know that modest increases in blood pressure like this, on a population level, are associated with a significant increase in cardiovascular disease,” Kaufman said. “There is a growing understanding that air pollution contributes to heart problems. The idea that roadway air pollution at relatively low levels can affect blood pressure this much is an important piece of the puzzle we’re trying to solve.” A previous experiment by Kaufman’s lab found that exposure to diesel exhaust fumes increased blood pressure in a controlled environment. This new study, published Tuesday in the Annals of Internal Medicine, was designed to test that earlier finding in a real-world setting by isolating the effects of traffic-related air pollution. The research was funded by the U.S. Environmental Protection Agency and the National Institutes of Health. Kaufman, who has worked at the University of Washington since 1997, said the number of ultrafine particles inside unfiltered cars was striking — tens of thousands of particles per cubic centimeter. Those numbers were reduced dramatically by high-quality filtration. The findings add to growing concerns among public health experts about ultrafine particles, which are less than 100 nanometers in diameter and much too small to be seen. The microscopic particles are unregulated and may pose health risks, even at low levels. Michael Young, a former postdoctoral fellow in the University of Washington’s Department of Environmental and Occupational Health Sciences and lead author of the new study, said the study’s design overcame common obstacles to effectively measuring the impact of traffic-related air pollution. “Studies on this topic often have a challenging time separating the effects of pollution from other roadway exposures like stress and noise, but with our approach, the only difference between drive days was air pollution concentration,” Young said in a press release. “The findings are valuable because they can reproduce situations that millions of people actually experience every day.” Kaufman said the findings have reinforced his own tendencies when he finds himself driving in heavy traffic in and around Seattle. “When I drive, I keep my windows up and my car on recirculate,” he said. Although Kaufman already has a high-quality air filter in his car, he said he’d like to see automakers and after-market filter manufacturers make better filters readily available. “Even better would be reducing the number of cars on the road burning fossil fuels like gasoline or diesel, and making clean and convenient transportation readily available for people who need to commute long distances,” he said. EDITOR’S NOTE: The ending of this story has been amended to more accurately convey Kaufman’s opinion about in-car air filters and the filter he uses in his own vehicle.

Nov 28

C before A: Circulation more important than airways in preventing massive blood loss, study finds

When a patient is suffering a trauma that results in massive blood loss, focusing on stopping the bleeding first and then moving to restore the airway second is the best method for patient outcomes, according to a Nov. 28 analysis from the American College of Surgeons. Traditionally, clinicians have been taught the “ABC method,” that is, to restore the airway first, breathing next and circulation last when a patient is experiencing large amounts of blood loss. However, an analysis of research from several institutions shows that prioritizing these things in reverse order — the CAB method — improves chances of patient survival and overall outcomes. In a previous study, the CAB method had a mortality rate of 12.4%, almost half that of the traditional ABC method’s mortality rate of 23%. “Patients with massive bleeding benefit from an approach in which the priority is circulation, instead of securing the airway with intubation. In patients with exsanguinating injuries, we can improve outcomes by delaying intubation and supporting the airway with other maneuvers, such as oxygen and opening the airway,” stated Paula Ferrada, MD, lead author of the study, and chief of trauma and acute care surgery at Falls Church, Va.-based Inova Health System. “Those seconds can be the difference between life and death.”

Nov 28

Give back by giving blood on giving Tuesday

BAKERSFIELD, Calif. (KGET) — You can give in many ways this “Giving Tuesday,” including blood. Shane Hubbard, Houchin Blood Bank’s Creative Development Coordinator, joined 17 News at Sunrise to talk about how Houchin has been notoriously low on blood donations for the past few weeks, and how locals can prevent a blood shortage this season. How to support nonprofit organizations on ‘Giving Tuesday’ Being that the Giving Tuesday motto is based around donating money and time, community members can also donate monetarily as well. Watch the interview in the player for more details on how you can help.

Nov 28

Latest scientific findings provide new insights into heart and stroke health

More than 4,000 abstracts were presented during the American Heart Association’s Scientific Sessions 2023 and Resuscitation Science Symposium 2023, held earlier this month in Philadelphia. Here are some of the important scientific findings that could impact your heart and stroke health. Next wave of AI prediction models aims to predict risk of heart attack and stroke, as well as heart valve disease Artificial intelligence (AI) and deep learning models may help to predict the risk of cardiovascular disease events and detect heart valvular disease, according to two preliminary research studies. One study found that artificial intelligence analyzing sound data of the heart recorded from a digital stethoscope was able to more accurately detect heart valve disease than a health care professional who listened to the heart with a traditional stethoscope. In another study, an AI/deep learning program effectively analyzed and sorted eye images of people with prediabetes and Type 2 diabetes to determine their risk of cardiovascular disease events, like heart attack and stroke. “Computational methods to develop novel predictors of health and disease -; ‘artificial intelligence” -; are becoming increasingly sophisticated,” said Dan Roden, M.D., FAHA, professor of medicine, pharmacology and biomedical informatics and senior vice-president for personalized medicine at Vanderbilt University Medical Center, as well as chair of the Association’s Council on Genomic and Precision Medicine. “Both of these studies take a measurement that is easy to understand and easy to acquire and ask what that measurement predicts in the wider world.” Depressed? Anxious? Stressed? These could put you on the fast track to heart disease risk A study found that depression and anxiety may speed development of risk factors, like high blood pressure, high cholesterol or Type 2 diabetes, that increase heart attack and stroke risk. Participants previously diagnosed with anxiety or depression developed a new risk factor on average six months earlier than those who did not have depression or anxiety. Depression and anxiety increased the risk for a major cardiovascular event, such as a heart attack or stroke, by about 35%. A second study found that cumulative stress increased the risk of poor heart and brain health in two ways: by directly influencing physical well-being and increasing poor lifestyle behaviors, such as smoking and being sedentary, according to two new studies. “There are clear associations between psychological health and cardiovascular disease risk. These studies add to a growing body of data we have on how negative psychological health can increase the risk of heart and brain disease, They illustrate that health care professionals should be aware that negative psychological health -; things like depression or anxiety -; not only affect patient’s mental state of being, but also can impact their physical health and the risk for heart disease. So, these are not benign conditions, these are things for which we want to aggressively refer people to mental health professionals,” said Glenn N. Levine, M.D., FAHA, writing committee chair of the American Heart Associations’ 2021 Psychological Health, Well-Being, and the Mind-Heart-Body Connection scientific statement and master clinician and professor of medicine at Baylor College of Medicine, chief of the cardiology section at the Michael E. DeBakey VA Medical Center, both in Houston. AHA health information: How does stress affect the body? Heart disease risk higher among transgender adults in rural U.S. In a small study of adults living in the rural America, those who identified as transgender were more likely to have heart disease risk factors, like tobacco use, obesity and high blood pressure, than their cisgender peers. Transgender males had the highest odds of having cardiovascular disease risk factors. Transgender adults were more than six times more likely to use tobacco and almost four times more likely to have prediabetes or Type 2 diabetes. And those in the trans-male group were 13 times more likely to be obese. “The findings of this small study highlight two critical areas of concern – the potential increased cardiovascular risk among transgender people, along with the increased cardiovascular risk among people living in rural areas. These disparity gaps pack a one-two punch to our transgender patients and communities for a number of reasons,” said Carl Streed Jr., M.D., M.P.H., F.A.C.P., F.A.H.A. volunteer chair of the writing group for the American Heart Association statement on transgender and gender diverse populations, an assistant professor of internal medicine at Boston University School of Medicine and the research lead at the GenderCare Center at Boston Medical Center. “The physical risks are likely heightened by the mental stress that many LGBTQ+ people encounter due to discrimination that is often more prevalent in rural America, especially among states with policies limiting access to gender affirming care. The American Heart Association supports the need for more research and initiatives to ensure equitable health and health care for all people, especially persons and communities most at risk due to various diversity gaps in care whether they are based on racial, ethnic, sexual and/or gender identities, socioeconomic status or geography.” AHA health initiative: Pride with Heart A child’s race, ethnicity, neighborhood might influence survival after cardiac arrest Children can have cardiac arrests, too. And when they do, their race, ethnicity or neighborhood might impact survival and recovery, according to a new study. Hispanic and white children had similar odds of surviving and coming out of cardiac arrest in good neurological health. Black children were 26% less likely to survive to hospital discharge and 36% less likely to survive without neurological issues that kept them from fully resuming their daily lives. “The results from this observational work are compelling because the measured disparities in recovery are magnitudes different among white and Hispanic children in comparison to Black children,” said Sarah Perman, M.D., M.S.C.E., FAHA, an associate professor in the department of emergency medicine at Yale School of Medicine and chair of the Association’s Resuscitation Science Symposium 2023. “Exploring the drivers of these differences will be necessary to address the disparities in outcomes. Determining the reasons why Black children had cardiac arrest at a greater incidence also warrants more

Nov 28

Japan syphilis cases, congenital infections surge to record high in 2023

(Getty Images) TOKYO — Cases of syphilis in Japan reached a record 13,251 this year, coinciding with a sharp increase in congenital syphilis, which is transmitted from a pregnant woman to her unborn child. The sexually transmitted disease (STD) has been on the rise in Japan since around 2011. Numbers were declining in 2019 and 2020, but have increased rapidly since 2021. This year’s preliminary national tally through Nov. 19, released by the Tokyo Metropolitan Infectious Disease Surveillance Center on Nov. 24, exceeded 2022’s preliminary figure of 12,966, setting a new record for the third straight year. Syphilis is transmitted by the bacterium Treponema pallidum that enters through the skin and mucous membranes. Two to three months after infection, a rash appears on the palms, soles and other parts of the body, but it is usually neither painful nor itchy. It can be cured if treated with antibiotics at an early stage. Yasuhiko Onoe, director of Private Care Clinic Tokyo’s Shinjuku branch and an expert on STDs, pointed out that numbers of female patients in their 20s and male patients in their 30s to 50s with syphilis is rising. He urges those with symptoms to see a doctor immediately and to get tested at least six weeks after worrisome sexual activity even without symptoms, when the results will be accurate. Meanwhile, according to the National Institute of Infectious Diseases, there were 32 cases of congenital syphilis reported this year through Oct. 4, far exceeding the previous record of 23 cases in 2019. When transmitted from an infected mother to her unborn child through the placenta, miscarriage or stillbirth may occur, as well as congenital conditions such as deafness, blindness or intellectual disability. The number of congenital syphilis cases may rise further as they are reported later than cases among adults. “The situation is serious because syphilis is an STD that affects the next generation,” said Kei Kawana, chief professor of obstetrics and gynecology at Nihon University School of Medicine. Even if the infection is discovered after conception and treated immediately, transmission to the unborn child cannot be completely prevented. Kawana said, “It is important for anyone who wants to become pregnant to get tested together with their partner before conception, and to be careful that both of them are free of STDs.” (Japanese original by Sooryeon Kim, Lifestyle, Science & Environment News Department)

Nov 28

SUO 2023: Androgen Receptor Agonist versus Antagonist: Cardiac Morbidity

(UroToday.com) The 2023 Society of Urologic Oncology (SUO) annual meeting held in Washington, D.C. between November 28th and December 1st, 2023, was host to a prostate cancer course. Dr. Alicia Morgans discussed the cardiac morbidity of androgen receptor (AR) agonists, compared to AR antagonists. There are two broad categories of androgen deprivation therapy (ADT) to suppress testosterone levels: Surgical castration: Bilateral orchiectomy Medical castration, using either: Gonadotropin-releasing hormone (GnRH) receptor agonists GnRH agonists compete with GnRH produced in the hypothalamus and bind to receptors in the pituitary. This ultimately leads to a downregulation of the production of LH and testosterone. They are typically associated with an initial flare that usually lasts for approximately one week. GnRH receptor antagonists It is important to remember that hormonal therapy for prostate cancer lowers both testosterone and estrogen levels, which has many physiologic sequelae. How do GnRH receptor agonists and antagonists differ? As summarized in the table below, GnRH antagonists are associated with a much shorter time to castration (96 hours versus 3 to 4 weeks), do not lead to a testosterone flare, and may have lower PSA failure rates. This comes at the ‘cost’ of increased frequency of local injection site reactions (40% versus 1%) and the requirement for monthly injections or daily oral pills, versus intramuscular/subcutaneous injections every three months with GnRH agonists.While all GnRH agonists are equally effective for cancer control, GnRH antagonists may be useful in patients who require rapid reduction of testosterone levels (e.g., patients with severe symptoms or with impending emergencies – spinal-cord compression with impending paraplegia, severe bone pain, or bladder outlet obstruction). While there remains some debate as to whether GnRH antagonists have a more favorable cardiovascular safety profile compared to GnRH agonists, what is clear is that all ADT negatively impacts cardiovascular risk factors. ADT increases total cholesterol levels, triglyceride levels, and abdominal adipose tissue and impairs glucose metabolism.1 Medical complications occur in men because of both low testosterone and low estradiol levels. Many people think of ADT as causing “male menopause” because of the associated hot flashes and changes in mood/libido. However, it is clear that the complications of ADT can significantly impact morbidity and mortality in this population. The potential mechanisms of ADT-associated increased cardiovascular risk may differ from agonists to antagonists, with the following underlying mechanisms proposed: Local inflammation via activation of T cells caused by GnRH agonists triggering plaque destabilization and rupture Pro-inflammatory effects of Follicle Stimulating Hormone (FSH) and FSH-mediated alterations in adipocyte composition and adipokine release, inducing cardiometabolic changes Cardioprotection provided by testosterone interrupted by ADT (both forms) In 2014, Albertsen et al. demonstrated that degarelix (GnRH antagonist) was associated with a lower cardiovascular risk, compared to GnRH agonists, in a cohort of patients with a history of cardiovascular disease (~30%). As demonstrated in the Kaplan Meier curve below, patients receiving degarelix had a significantly lower rate of severe cardiovascular events or death (HR: 0.44, 95% CI: 0.26 – 0.74).2 These results have been similarly corroborated by Margel et al. who demonstrated in an open-label, phase 2 trial that GnRH antagonists were associated with lower risk of cardiovascular events or major cardiovascular and cerebrovascular events.3A subsequent systematic review and meta-analysis demonstrated that there was a significant reduction in both cardiovascular events and cardiovascular death with GRH antagonists, compared to GnRH agonists.4In 2020, the phase 3 HERO trial of relugolix (oral GnRH antagonist) versus leuprolide (GnRH agonist) was published in The New England Journal of Medicine. This was a multinational, phase III, randomized, open-label, parallel-group study to evaluate the safety and efficacy of relugolix in men with advanced prostate cancer. The primary endpoint was sustained castration through 48 weeks, defined as <50 ng/dL.Notably, 93% of patients in this trial had pre-existing cardiovascular risk factors.Of men who received relugolix, 97% maintained castration through 48 weeks, as compared with 89% of men receiving leuprolide. The difference of 7.9 percentage points (95% CI: 4.1 to 11.8) showed both the non-inferiority and superiority of relugolix (p<0.001 for superiority).Significantly, patients in the relugolix arm had a 54% reduction in the risk of major adverse cardiovascular events.This benefit was most pronounced in patients with a history of a prior major adverse cardiovascular event (3.6% versus 17.8%).5In 2021, results of the PRONOUNCE randomized trial comparing the cardiovascular safety of degarelix versus leuprolide in patients with prostate cancer were published. No significant differences were observed between patients treated with degarelix (5.5%) versus leuprolide (4.1%; HR: 1.28, 95% CI: 0.59 – 2.79, p=0.53). However, there were several significant limitations to this trial. The recruitment was slower than originally planned, with the primary outcome event rate lower than expected. The sponsor closed enrollment with 545 of the planned 900 participants recruited.The RADICAL PC study prospectively characterized 2,492 consecutive men (mean age 68 years) with prostate cancer (newly diagnosed or with a plan to ADT for the first time) from 16 Canadian sites. Cardiovascular risk was estimated by calculating Framingham risk scores. Most (58%) were current or former smokers, 22% had known cardiovascular disease, 16% diabetes, 45% hypertension, 31% body mass index 30 kg/m2 or greater, and 24% had low levels of physical activity. Interestingly, patients with more cardiovascular risk factors were more likely to receive ADT in this study. This may have been driven by greater age and lower socioeconomic status in the group with higher risk prostate cancer who were planned to get ADT.6 The NCCN guidelines currently recommend the ‘ABCDE’ systematic approach to addressing cardiovascular risk factors in cancer patients, as summarized below:Dr. Morgans concluded her presentation with the following take home messages: Pharmacologic ADT can be delivered as GnRH agonist or antagonist therapy Differences between these include mode of administration and testosterone flare, but disease control is similar ADT negatively affects cardiovascular risk factors and is likely associated with risk of cardiovascular events GnRH antagonists may be associated with lower risk of cardiovascular events when compared with GnRH agonists Systematic management of cardiovascular risk factors is a recommended approach to providing optimal cardiovascular care for patients

Nov 28

Toronto ER doctor says winter surge of respiratory illnesses has begun

Toronto emergency room doctors say the winter surge of COVID-19, flu and respiratory syncytial virus (RSV) infections is underway, with hospitals seeing a wave of visits across the GTA. In the last week, nearly 250 Ontarians have been admitted to hospital, and Public Health Ontario (PHO) reports the COVID-19 wastewater signal is at its highest level in more than a year. Toronto ER physician Dr. Kashif Pirzada took to social media this week to share he and his colleagues are doing far more resuscitations, crash intubations and seeing far more patients in cramped and packed emergency rooms. “We are admitting adults again on the ward even younger people in their 30s and 40s,’ said Dr. Pirzada. “It means we have to do life-saving maneuvers so we have to put people on ventilators and we have to put people on machines to help them breathe …that’s very serious. That’s when [the] mortality rate is very high as well.” Colleagues and I are doing far more resuscitations, crash intubations, and seeing far more patients in cramped and packed ERs. A bunch of bugs are to blame, including that-which-shall-not-be-named, and it’s only getting started. Some advice: – Now is the time to be a bit… pic.twitter.com/OLBGnHAEcn — Kashif Pirzada, MD (@KashPrime) November 27, 2023 “I had a healthy woman with no medical problems in her 40s, who was just fighting a cold for a few weeks and then developed severe pneumonia and had to end up in our ICU. So we saw that before COVID but now it’s much more common now.” With the virus season revving up a little sooner than normal, these Toronto doctors say hospitals are not yet in crisis mode like they were last year when emergency departments were completely overwhelmed and children were sometimes waiting days for an ICU bed. Dr. Pirzada said staffing levels are still not great. “We’re just lucky that it’s not as overwhelming as last year but if it does get stressed and I’m worried about the holiday season, especially with the early inkling that we’re getting now that we won’t be able to handle it the way things are going. I’m really worried about what’s going to happen in the next month or so.” When someone should be heading to an ER “If you cross the line where you have a fever of more than five days, that makes us worried. If you have severe chest pain or trouble breathing, that’s a bad thing, you need to get checked out,” said Dr. Pirzada. “[If] you are not eating or drinking anything, that’s also a bad sign, if you are so tired you can’t get up and do anything also a bad sign, especially in a kid, that’s also a sign to get checked.” Doctors say now is the time to protect yourself, and if you’re sick, stay home and wear a mask. “I went into a packed subway car the other day and I wear a mask in there because I was face to face with people. I think use your common sense like you don’t want to get more sick than you need to be. So in super crowded areas, I think it’s a good idea to wear [masks]. They’re annoying, they’re inconvenient, but I think they might save you a lot of grief this holiday season.” Dr. Pirzada adds getting a COVID-19 booster would also help. The advice comes as just 24 per cent of the population has completed a primary COVID-19 vaccine series and two or more booster doses.

Nov 28

Donating blood: How to give on Giving Tuesday without breaking the bank

LYNCHBURG, Va. – The Tuesday after Thanksgiving is known as Giving Tuesday, a time when people are encouraged to donate to a non-profit. One way to show generosity without spending any money is by donating blood. [RELATED: Southwest Virginia organizations participating in Giving Tuesday] Donating blood takes less than an hour and you can save up to three lives with just one donation, according to The American Red Cross. “What an amazing way to give to our fellow neighbors and community by a chance to save their lives. People who need blood need it for a very particular reason, and need it most often for life-saving measures,” said Blue Ridge Red Cross Executive Director, Michelle Dowdy. To find a blood drive near you visit The American Red Cross’ website. Once there, type in a zip code to find a location near you and schedule an appointment. Find Southwest Virginia organizations participating in Giving Tuesday here.

Nov 28

New formula could mean diabetes and weight loss drugs such as semaglutide are only needed every 4 months

GLP-1 agonists such as semaglutide and liraglutide can help patients with type 2 diabetes improve their blood sugar levels, lose weight and even improve their overall cardiovascular health. But these drugs are often taken as daily or weekly injections, meaning there is an inherent risk that adherence will suffer as time goes on. This could make the therapies less effective and cause patients to grow frustrated. According to a new study published in Cell Reports Medicine, however, those patients could potentially be taking GLP-1 agonists much less frequently in the future.[1] A team of specialists out of Stanford University have developed a new injectable hydrogel drug delivery system that helps medications slowly dissipate over time as opposed to hitting the patient all at once. This means a drug such as semaglutide could potentially be injected just once every four months and still have the same clinical impact it would have being injected weekly. “Adherence is one of the biggest challenges in type 2 diabetes management,” senior author Eric Appel, PhD, associate professor of materials science and engineering at Stanford, said in a prepared statement. “Needing only three shots a year would make it much easier for people with diabetes or obesity to stick with their drug regimens.” Appel et al. tested their new hydrogel on laboratory rats, finding significant success. Testing the new drug delivery system on pigs is the team’s next step, and then they hope they can start planning human trials. “At the very least, we have laid a pathway for the prolonged release of therapeutic GLP-1–based anti-diabetic and anti-obesity treatments that could have beneficial impact on type 2 diabetes management and, perhaps, other conditions as well,” Appel said in the same statement.