A to Z of Medical Conditions

Posted on A to Z of Medical Conditions

The best way to take pills according to science

How Posture Affects Taking Pills


Your posture when taking a pill makes a big difference in how fast your body absorbs the medicine. CREDIT Khamar Hopkins/Johns Hopkins University

When you have a headache and reach for the pain reliever, you’re probably not thinking about your body position when you take the pill. But a new Johns Hopkins University study finds your posture can make a big difference—as much as an hour longer—in how fast your body absorbs the medicine.

The findings are based on what’s thought to be the first model to simulate the mechanics of drug dissolution on a human stomach.

“We were very surprised that posture had such an immense effect on the dissolution rate of a pill,” said senior author Rajat Mittal, a Johns Hopkins engineer and an expert in fluid dynamics. “I never thought about whether I was doing it right or wrong but now I’ll definitely think about it every time I take a pill.”

The work is newly published in Physics of Fluids.

In recent years models have been created to authentically represent the workings of several major organs, notably the heart. The model developed by the team, called StomachSim, appears to be one of the first to be able to conduct realistic simulation of the human stomach. Blending physics with biomechanics and fluid mechanics, StomachSim mimics what happening inside a stomach as it digests food, or in this case, medicine.

Most pills do not start working until the stomach ejects their contents into the intestine. So the closer a pill lands to the last part of the stomach, the antrum, the faster it starts to dissolve and empty its contents through the pylorus into the duodenum, the first part of the small intestine. If you’re aiming a pill for this part of the stomach, posture is critical to play into both gravity and the natural asymmetry of the stomach.

The team tested four postures. Taking pills while lying on the right side was by far the best, sending pills into the deepest part of the stomach to achieve a dissolution rate 2.3 times faster than even an upright posture. Lying on the left side was the worst. The team was very surprised to find that if a pill takes 10 minutes to dissolve on the right side, it could take 23 minutes to dissolve in an upright posture and over 100 minutes when laying on the left side.

“For elderly, sedentary or bedridden people, whether they’re turning to left or to the right can have a huge impact,” Mittal said.

Standing upright was a decent second choice, essentially tied in effectiveness with lying straight back.

The team also considered what stomachs that aren’t functioning at full strength due to gastroparesis caused by diseases such as diabetes and Parkinson’s Syndrome meant for pill dissolution. Even a small change in the conditions of the stomach can lead to significant differences in the outcome of an oral drug, said lead author Jae Ho “Mike” Lee, a former postdoctoral researcher at Johns Hopkins.

The impact of stomach disease on drug dissolution was similar to that of posture—which underscores how significant a difference posture makes.

“Posture itself has such a huge impact it, it’s equivalent to somebody’s stomach having a very significant disfunction as far as pill dissolution is concerned,” Mittal said.

Future work will attempt to predict how the changes in the biomechanics of the stomach affect how the body absorbs drugs, how food is processed in the stomach and the effect of posture and gastroparesis on food digestion.

Posted on A to Z of Medical Conditions, Infectious Diseases

Vagus nerve stimulation – an electric pill for inflammation?

aVNS


Individualised auricular vagus nerve stimulation at the right time and with the right strength. CREDIT TU Wien

A system out of balance

When a virus – such as SARS-CoV-2 – triggers an inflammatory response in the body, this information is transmitted to the brain via the sensory nervous system. The Vagus nerve, which extends from the brain to most organs in the human body, responds in a regulatory way with an anti-inflammatory reflex. However, if the anti-inflammatory response is too weak, an excessive inflammation may negatively affect the body’s own regeneration. To restore the balance between the initially protective inflammatory response and the regenerative processes, aVNS systems can be used.

To test their hypothesis that aVNS also supports the healing process in severe Covid-19 cases, TU researchers worked closely with the Hospital Favoriten, the Medical University of Vienna, the Health Service Centre of the Vienna Private Clinic, the Sigmund Freud Private University Vienna and the Immunological Day Clinic Vienna.

aVNS in severe Corona courses

In its most recent study, the research team was able to show that the positive effect that Vagus nerve stimulation has on the course of severe Corona diseases, which was already predicted in 2020 – at the beginning of the pandemic – actually exists. For this purpose, the team investigated the use of aVNS on patients who were acutely ill with Corona and were about to receive artificial respiration.

When the virus attacks the body, the inflammatory response and healing process can become unbalanced. The inflammatory response of the body then causes more damage than the virus itself. This balance must be restored – for example, by using an aVNS system. “The electrostimulation of the auricular vagus nerve was not only able to stop the inflammatory reaction in Covid-19 patients, it was even able to counteract it,” Eugenijus Kaniusas, professor at the Institute for Biomedical Electronics at TU Wien, emphasises the result.

Stimulating at the exact right time

The therapeutic success of aVNS also increases by adapting the system. If an aVNS system constantly sends electrical impulses, this can lead to side effects such as pain. The power consumption is also significantly higher compared to when the system reacts individually to the patient and sends targeted stimuli. To realise this, the researchers around PhD student Babak Dabiri have integrated a closed-loop control. Eugenijus Kaniusas explains: “This allows us to stimulate the Vagus nerve exactly when the brain is listening. This is the case when the heart is contracting and blood is flowing into the vessels or when the person is exhaling.” In this way, over- and under-stimulation can be prevented, which often results from persistent aVNS.

While simple measurements refer exclusively to the past, Kaniusas and his team worked with predictions: “In the study, we were able to show that predictive stimulation works and leads to the desired result. This was possible due to a feedback function of the system, via which the aVNS system can constructively interfere with the parasympathetic system,” the electrical engineer Kaniusas says. “The aVNS system listens to the measured biosignals and sends its stimulus at exactly the right time, like an intelligent electric pill,” he finally draws a comparison. This is an important step in the direction of personalisation, through which the research team also expects better therapeutic success and more acceptance by users.

Posted on A to Z of Medical Conditions, Alzheimer's, Cancer, Cardiovascular disease, Diabetes, Weight Loss

All physicians should know the benefits of plant-based diets for these six health conditions

Plant based food
Plant based food


A new commentary in the American Journal of Lifestyle Medicine says that all physicians should be aware of the benefits of a plant-based diet for six health conditions: weight loss and maintenance, cardiovascular disease, cancer, diabetes, Alzheimer’s disease, and COVID-19.

“The field of medicine, despite its prominent influence in society, has invested little to promote healthy lifestyle choices,” says the commentary co-authored by Saray Stancic, MD, FACLM, director of medical education for the Physicians Committee for Responsible Medicine. “The consequence of this is reflected in our ever-rising chronic disease statistics, most notably obesity and diabetes rates.”

Part of the problem, say the authors, is that “medical schools offer an anemic number of hours of nutrition education over 4 years,” which does not improve in postgraduate training. They note than in a recent survey of more than 600 cardiologists, 90% reported they had not received needed nutrition education during training.

The commentary acknowledges that not all physicians must be experts in nutrition, but says that they should at least have rudimentary knowledge of the benefits of a plant-based diet for these six conditions, for which they provide detailed evidence, including the following:

  1. Weight loss and maintenance. A study of 70,000 people that found those who consumed a vegan diet weighed about 9 pounds less than those who did not. They also had a reduced risk of death.
  2. Cardiovascular disease. Animal products are high in saturated fat and cholesterol, which are key drivers of cardiovascular disease. But a recent metanalysis found that those consuming a vegetarian diet decreased LDL “bad” cholesterol by 13 mg/dl. Another analysis found a 24% lower rate of heart disease deaths among vegetarians compared to omnivores.
  3. Cancer. Adopting healthy behaviors, which includeremaining physically active and consuming diets rich in vegetables, fruits, and whole grains, has the potential to reduce breast cancer risk by as much as 50-70%. Research also shows that diets that include soy and are high in fiber reduce breast cancer risk. Diets high in dairy products increase prostate cancer risk. High-fiber diets reduce colorectal cancer risk, while daily consumption of red and processed meat increases its risk.
  4. Diabetes. A Harvard study, which included participants from the Health Professionals Follow-Up Study, Nurses’ Health Study, and the Nurses’ Health Study II, concluded that those who consumed a plant-based diet could expect a 34% reduction in type 2 diabetes risk.
  5. Alzheimer’s disease. A study found that those who adhered to the primarily plant-based Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) diet, which is focused on brain-healthy foods such as green leafy vegetables, other vegetables, beans, berries, nuts, and whole grains, had a 60% lower risk of Alzheimer’s disease.
  6. COVID-19. Harvard’s smartphone-based COVID-19 study found that in those who consumed a primarily plant-based diet there was a 41% reduction in risk of severe COVID-19 as well as a 9% reduction in infection of any severity.

“It is time for all physicians across the globe to speak to the importance of diet and lifestyle in health,” concludes the commentary, which recommends that physicians do this by counseling patients, assuring hospitals provide healthy menus, lecturing in the community, writing articles, using social media, and providing commentary to media.

Posted on A to Z of Medical Conditions

Researcher receives grant to develop improved Lyme disease diagnostics and therapeutics

team


Assistant Professor Brandon Jutras, left, and research scientist and Edward Via College of Osteopathic Medicine medical student Mari Davis, right, in the lab at the Fralin Life Sciences Institute. Photo by Alex Crookshanks for Virginia Tech. CREDIT Credit Virginia Tech

Lyme disease is carried by black-legged ticks and infects people when they are bitten and transmit the bacterium Borrelia burgdorferi. Black-legged ticks are especially common in the northeastern United States, and people are exposed to the ticks usually during outdoor activities. Warming temperatures and climate change have caused tick populations to explode and infiltrate more areas of the country, increasing the chance of getting the disease.

The Centers for Disease Control and Prevention estimate that 476,000 people are infected with Lyme disease every year in the United States.

Early symptoms of Lyme disease are fever, headache, fatigue, and the possibility of a telltale bullseye rash at the bite site. If left untreated, the infection can spread to the joints, heart, and nervous system and cause debilitating long-term conditions including Lyme arthritis, carditis, and neuroborreliosis. Sometimes patients can still develop these symptoms despite proper therapy.

Brandon Jutras, assistant professor in the Department of Biochemistry in the College of Agriculture and Life Sciences, received a grant from the Global Lyme Alliance to improve diagnostic testing for all stages of Lyme disease and to develop new ways to treat patients when conventional treatment options have failed.

“We’re thrilled to partner with the Global Lyme Alliance, a longstanding organization dedicated to improving the outcome of patients suffering from this enigmatic disease,” said Jutras, an affiliated faculty of the Fralin Life Sciences Institute and the Center for Emerging, Zoonotic, and Arthropod-Borne Pathogens.

“This grant gives us the opportunity to try radical and innovative approaches like monoclonal antibody therapy. I applaud the Global Lyme Alliance for supporting this high-risk, high-reward research.”

When the infection is caught early and treated with antibiotics in the preliminary stages, patients often recover quickly without long-term effects. Patients who are treated in later stages of the disease may continue to suffer from ongoing symptoms, termed post-treatment Lyme disease.

“Late-stage complications of Lyme disease are due to how our immune system responds. With this funding, we are now able to test new ways to prevent our immune system from overreacting,” said Jutras.

Jutras recently made a discovery that may transform the way we understand acute and chronic symptoms of Lyme disease and Lyme arthritis.

“According to the CDC, cases of vector-borne diseases, such as Lyme disease transmitted from vectors to people, more than doubled between 2004 and 2018 in the United States. The Jutras lab already made a number of important discoveries about the bacterium that causes Lyme disease, B. burgdorferi,” said X.J. Meng, University Distinguished professor and interim director of the Fralin Life Sciences Institute.

 “The Jutras lab recently discovered that the Lyme disease spirochete possesses a unique property in that it sheds peptidoglycan after it infects the human host. This discovery affords the opportunity for scientists to develop novel diagnostics by utilizing a unique biomarker for different stages of Lyme disease. This new grant from the Global Lyme Alliance will now allow the Jutras lab to further explore innovative therapeutic strategies against Lyme disease.”

Virtually all bacteria have a cell-wall component called peptidoglycan. But, as it turns out, the peptidoglycan of the Lyme disease bacterium is unique. They also shed it as they replicate. The B. burgdorferi peptidoglycan can be found in the joints of Lyme arthritis patients with post-treatment Lyme disease, and it can cause arthritis on its own. 

The Jutras lab is developing methods focused on using peptidoglycan as a marker for new diagnostic tests for Lyme disease. Their research now includes using anti-peptidoglycan antibodies to improve existing diagnostics.

“An overarching goal of the Global Lyme Alliance is to foster transformative advances in the diagnosis and treatment of patients suffering from post-treatment Lyme disease. In pursuit of this goal, we are excited to fund the research of Dr. Jutras,” said Timothy J. Sellati, chief scientific officer of the Global Lyme Alliance. “The unique nature of B. burgdorferi peptidoglycan may lend itself to serving as a biomarker for bacterial persistence after treatment and as a target for removal as a means of minimizing or eliminating an underlying reason for persistent symptomatology.”

The Jutras lab is currently developing new ways to either mask or destroy lingering B. burgdorferi peptidoglycan to treat patients suffering from post-treatment Lyme disease.

“In a very short amount of time, Dr. Jutras has developed an impactful research program that engages several Virginia Tech students in Lyme disease research,” said Glenda Gillaspy, professor and department head of biochemistry in the College of Agriculture and Life Sciences. “Together, Dr. Jutras and his team are poised to use biochemical and molecular techniques to help innovate this field, and this recent award will provide significant and important support for the work.”

Posted on A to Z of Medical Conditions, Social media

Health apps could help older adults with anything from sleep to diabetes, but most don’t use them

Key findings about health app use by older adults


The percentage of adults age 50-80 who said they use a mobile app for a specific health-related purpose. Data from the National Poll on Healthy Aging from the University of Michigan CREDIT University of Michigan

Mobile apps make it possible to track everything from exercise and calories to blood pressure and blood sugar, and use the information to stay on target with health goals or managing a chronic condition.

But a new poll shows that most people over age 50 aren’t using such apps – and that those who might get the most help out of them are less likely to actually use them.    

Less than half (44%) of people age 50 to 80 have ever used a health-related app on their smartphone, wearable device or tablet, according to the new findings from the National Poll on Healthy Aging.

Those who say they are in poor health, and those with lower incomes or levels of education, were far less likely to have ever used such apps. Half of those who haven’t ever used a health app, or have stopped using them, said they are not interested in using them.

The percentage of older adults who currently use at least one app is even smaller, at 28%. One-third of this group uses an app to track exercise, while smaller percentages use apps to track sleep, weight, nutrition, blood pressure, to guide meditation, or to manage mental health and stress. One-quarter of current users have shared information from their apps with their health care providers.

And among older adults who have diabetes, just 28% use an app on their device to log their blood sugar levels and 14% use an app to log their medications. But nearly half of older people with diabetes say they would be interested in using an app in both of these ways.  

The poll is based at the University of Michigan Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, U-M’s academic medical center.

“Now that most older adults have at least one mobile device, health-related apps can provide an opportunity to support their health-related behaviors, manage their conditions and improve health outcomes,” said Pearl Lee, M.D., M.S., a geriatrician at Michigan Medicine who worked on the poll report.

Lee and co-authors James Aikens, Ph.D., and Caroline Richardson, M.D., both of the U-M Department of Family Medicine, say the potential is especially important for older adults with diabetes.

The poll also included questions about continuous glucose monitors, which people with diabetes can wear on their skin to monitor their blood sugar over the long term. Such monitors can connect with mobile devices to feed readings into an app.

Only 11% of the poll respondents who have Type 2 diabetes said they currently use a CGM, though another 68% had heard of such devices and over half of them said they would potentially be interested in using one.

“AARP’s research has found a sharp increase in older adults purchasing and using technology during the pandemic, and many are interested in using technology to track health measures,” said Indira Venkat, Vice President, Consumer Insights at AARP. “With more people 50+ owning and using technology, we may start to see an increase in older adults using apps to monitor their health.”

Disparities in app use

Recent data show that 83% of people age 50 to 64, and 61% of people over age 65, own a smartphone, and just under half of people in each age group own a tablet device. That’s up from 34% of 50-64-year olds and 13% of those over 65 having a smartphone a decade ago, and even lower percentages having tablets at that time.

Despite this rise, the poll highlights disparities in the use of mobile health apps by income and education level, as well as age. It also shows that lack of awareness, or mistrust of the security of health apps may be holding many older adults back.

Poll director Preeti Malani, M.D., an infectious disease physician with training in geriatrics at Michigan Medicine, notes that older adults with incomes over $100,000 were nearly three times more likely than those with incomes under $30,000 to use health apps, at 43% vs. 15%. Those with college degrees were more than twice as likely to use health apps as those who had not completed high school.

“People who describe  their health as fair or poor – the people who might be most in need of the kind of tracking, support and information a good health app can give – were significantly less likely to use such apps than those who say they’re in excellent, very good or good health,” Malani notes. “Health providers should consider discussing the use of health apps with their patients, because one-third said they had never thought about using one.”

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI, and administered online and via phone in August 2021 among 2,110 older adults age 50–80. The sample was subsequently weighted to reflect the U.S. population. Read past National Poll on Healthy Aging reports and about the poll methodology.