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NEW SMA CURE: First drug to treat spinal muscular atrophy approved in Italy

25 February 20246 January 2024 by Redazione My Special Doctor

Approved in Italy Nusinersen for the treatment of patients with SMA, a rare genetic neuromuscular disease that predominantly affects children and is the leading genetic cause of infant mortality. Data from clinical trials have shown significant results in terms of increased survival in children with the disease and achievement of important developmental motor milestones, such as head control, sitting, crawling and walking. Italy an example of excellence in the world for accelerated time to approval and access to the new therapy.

What is SMA
Spinal muscular atrophy (SMA) is characterized by the loss of motor neurons in the spinal cord and brainstem, resulting in severe and progressive muscle weakness and atrophy. Individuals with the most severe Type of SMA may eventually go into paralysis and have difficulty maintaining vital functions, such as breathing and swallowing.

Due to the loss or defect in the SMN1 gene, people with SMA do not produce sufficient amounts of SMN protein, which is critical for motor neuron survival. The severity of SMA correlates with the amount of SMN protein. Individuals with Type 1 SMA, the most severe form, produce very low amounts of SMN protein and do not achieve the ability to sit without aids or live beyond two years without respiratory support. Individuals with Type 2 and Type 3 SMA produce a higher amount of SMN protein and have less severe forms of SMA, but still capable of changing life expectancy and quality of life.

Approval
Nusinersen constitutes the first treatment for this disease approved in Italy; the drug was reviewed under the Italian Medicines Agency’s accelerated approval pathway, aimed at speeding up access to drugs that treat serious or life-threatening diseases and generally address unmet clinical needs.

The approval of nusinersen is largely based on the results of two multicenter, controlled registrational studies, including the final data from the ENDEAR study (for childhood-onset SMA) and the interim data from the CHERISH study (for late-onset SMA), which demonstrated clinically and statistically significant efficacy and favorable benefit-risk profile of nusinersen. The approval was further supported by data from the open-label NURTURE study, obtained in pre-symptomatic individuals genetically diagnosed with SMA and with the possibility of developing SMA Type 1, 2, or 3.

Nusinersen is administered intrathecally, that is, via a lumbar puncture directly into the cerebrospinal fluid (CSF) around the spinal cord, the site of motor neuron degeneration caused by insufficient levels of SMN protein in SMA patients.

Antarctica is born: the EU agreement against antibiotic misuse

24 February 20246 January 2024 by clemente.ferrara

It all happened during“European Antibiotic Day,” organized by the European Centre for Disease Prevention and Control. Europe’s two most impotant scientific societies Escmid and Esicm have agreed to enter into an agreement called Antarctica (Antimicrobial resistance critical care), designed to combat antimicrobial resistance in intensive care units. In a nutshell, this is a stipulation that aims to significantly reduce the abuse of antibiotics and promote their much more rational and controlled use.

Data in hand

In fact, according to the latest estimates, up to 50 percent of antibiotics are administered too easily and excessively or inappropriately in hospitals in the European Union. In fact, according to surveys, the use of antibiotics to treat multidrug-resistant infections in Europe even doubled between 2010 and 2014. Italy specifically, is one of the states where there is very high consumption (27.8 doses per thousand inhabitants per day).

Such abuse will lead to very serious consequences if not stopped in time. In fact, if we continue at this rate, it is estimated that by 2050“superbugs” (i.e., those viruses that have developed strong resistance to even the strongest antibiotics) will become the world’s most prevalent cause of death, even more so than cancer. Suffice it to say that at present, in Europe, there are four million infections with antibiotic-resistant germs each year with 25 thousand deaths (world estimates instead record a rate of 700 thousand deaths from this cause).

Italian health care poverty

As if that were not enough, there is a further increase in health poverty in Italy. In fact, more and more people, due to the growing economic crisis and rising unemployment (especially youth unemployment), no longer have the ability to purchase medications for their health and are increasingly turning to health care centers. This is stated in the report “Donate to Cure.”, compiled by the Banco Farmaceutico Foundation and Bfr Research, according to which in 2017 the demand for medicines by the aforementioned institutions (about 1722) grew by 9.7 percent, with the number of people assisted exceeding 580,000 (with a growth rate of 4 percent), registering higher numbers especially among young people under 18 years of age.

In the words of Mario Melazzini, general manager AIFA: “Of even greater concern is the gap that has been created between the average level of spending, which stands at about 695 euros a year, and that of the indigent, who have about 106 euros, 17 less than in 2016.” And again, “We must never forget that behind the numbers and statistics are people, and there are inequalities in access to medicines, problems with treatment adherence, poor information, and a general worsening of health conditions.”

Family physicians and chronic diseases: not all drugs are prescribable

24 February 20246 January 2024 by Redazione My Special Doctor

Family doctor, general practitioner, primary care physician, general practitioner, general physician, or even, in institutional settings, general practitioner. Whatever you want to call him, this doctor is known to all Italians because he is the doctor to whom every citizen turns at the first symptom of discomfort. But perhaps not everyone knows that the family doctor cannot prescribe a number of medications, including those for diabetes. A limitation that physicians and specialists themselves, as well as patient associations, do not find justified and therefore call for its abolition.

Within our national health service, the primary care physician is the first-level health officer, that is, the one who provides the first level of care on the ground. Having issued the diagnosis, the general practitioner can prescribe drugs with a special prescription or indicate specialist medical visits through a so-called referral. However, he cannot prescribe innovative drugs, namely new generation antidiabetics, anticoagulants, and chronic obstructive pulmonary disease (COPD) drugs. Under current regulations in Italy, in fact, the prescription of entire classes of drugs is entrusted exclusively to medical specialists as part of the compilation of the “treatment plan.”

The rationale behind these prescribing restrictions is purely economic: these are drugs with costs on average higher than others available for the same conditions. A difference that GPs object to because, according to them, the choice of drugs should be based on shared criteria of prescriptive appropriateness, and not instead reserved only for certain categories of professionals.

As for the effects on citizens, according to primary care physicians, limiting prescriptions hinders patients’ right to access medication and risks compromising the effectiveness of treatment. Physicians, therefore, clamor to be able to prescribe the drugs they deem most appropriate, particularly antidiabetic drugs, some of which are real therapeutic advances for blood glucose control, or new anticoagulants that improve therapeutic adherence, or COPD drug combinations.

Immediate prescribing, therefore, ensures direct benefits to patients, who would not go to crowded specialist facilities. Expanding expertise would also enable family physicians to gain new professionalism and new scientific knowledge with respect to innovative drugs.

by Paola Mantovano

Medicine too expensive, Italians give up medical care

22 February 20246 January 2024 by Redazione My Special Doctor

In 2018, about 539 thousand Italians could not afford some
medical care
and adequate medications because they did not have sufficient income. The number rises staggeringly to 13 million if we talk about people who have decreased their visits, and all of this is documented in the 2018 Report sponsored by the non-profit Banco Farmaceutico Foundation and BFResearch, “Donate to Cure: Health Poverty and Drug Donation.”
The numbers in the report show a disturbing truth: poverty and inequality in Italy are increasing, and they also have an impact on health. The example is that poor families use 2.5 percent of their total spending to receive medical care, compared with 4.5 percent (almost double) for a normal family.

Another disturbing finding is that, having to cut spending on their own medical care, more and more families are using their health care expenditures almost exclusively for the use of medicines, because spending on preventions is being cut drastically. The case of dental services is demonstrative: poor families spend about €30 a year compared to more than €300 for the rest of Italians.
The insistence on saving money at all costs, even on health care, is a habit that is catching on in our country and is confirmed by data from the triennium 2014-16: affluent families have been able to increase their preventive care with checkups and examinations, while poor families have always gone on the cheap, deeming various treatments “not urgent” or “unnecessary.”

Several anomalies have also been recorded regarding the number of deaths, as Gian Carlo Blangiardo says, a demographer at the University of Milan Bicocca and the next president in pectore of Istat: “From the most recent demographic balance sheet released by Istat, there were 649,000 deaths in Italy in 2017, 34,000 more than in 2016. In 2015, there were 50 thousand more deaths than in 2014. In the last century, only during World War II (1941-44) and 1929 were similar peaks recorded.” Finally, Sergio Daniotti spoke, the president of the non-profit Banco Farmaceutico Foundation, who had his say on Italians’ spending on medical care: “There are far too many people who do not have enough income to afford the bare minimum to survive. The data published this year in the Health Poverty Report show that the phenomenon has been substantially consolidated over time and is not expected to decrease significantly in the coming years.”

Flouroquinolones: when it is best to avoid them

21 February 20246 January 2024 by rosanna.feroldi

All
antibiotics
should be used with caution, only when prescribed by a physician to treat a bacterial infection of some importance that could not heal on its own, and should be taken by carefully following the directions regarding dosage, timing, and mode of administration. The use of some antibiotics, however, requires more caution than others because the side effects that may result from their action in the body are particularly severe.

Among them are the fluoroquinolones: a class of broad-spectrum (i.e., effective against an extensive number of Gram+ and Gram- bacteria) antibiotics that have been used for more than 30 years for the treatment of serious and life-threatening bacterial infections, especially of the respiratory and urinary tracts, the gastrointestinal tract, and the bones.

In addition to the already known adverse events of these drugs, two reviews conducted by the European Medicine Agency(EMA) and the similar U.S. agency (FDA, Food and Drug Administration) during 2018 revealed additional significant critical issues that dictate that the use of systemically administered fluoroquinolones (i.e., by mouth, through injections, or by inhalation) should be limited exclusively to situations where no effective therapeutic alternatives are available to clear the body of infections so severe that they are life-threatening.

As early as November, the EMA had reported that taking systemic fluoroquinolones may be associated with Severe and disabling adverse events, long-lasting and potentially permanent, at the level of the muscles, bones, joints, and nervous system, in addition to those already known to affect the gastrointestinal system (risk of severe diarrhea, especially from Clostridium difficile) and cardiac (with contraindication for use in people with long QT syndrome and/or bradycardia, i.e., slow heartbeat).

These serious side effects of commercially available fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin, prulifloxacin, and rufloxacin) include inflammation and rupture of tendons (especially the Achilles tendon of the ankle), muscle pain or weakness and joint pain or swelling, difficulty in walking, neuropathy and paresthesias (feeling of pins and needles, burning, etc.), fatigue, depression, memory problems, impaired sleep, vision and hearing, impaired taste and smell.

The appearance of swelling and injury at the level of tendons can occur within two days of the start of treatment with a fluoroquinolone antibiotic or several months after its discontinuation, and it is this long interval between taking the therapy and the appearance of the side effect that for many years prevented physicians from understanding the actual correlation between the two events and, therefore, the significance of the risk associated with the use of these drugs.

The likelihood of occurrence of the mentioned adverse events is higher in people over 60 years old, in those who already have problems with Musculoskeletal or renal level or has received an organ transplant and in those who are also taking or have recently taken corticosteroid medication systemically (by mouth, injections, inhalation) or jointly (infiltrations) to treat other conditions.

But it is not over. Just before Christmas, the FDA added an additional and more alarming rationale for limiting the use of fluoroquinolones as much as possible. In fact, according to audits conducted by the U.S. agency, treatment with these antibiotics is also associated with an increased risk of dissection and rupture of the aorta: the body’s main artery that collects oxygenated blood exiting the heart and distributes it throughout the body.

At greatest risk of such events (which place the affected person in immediate life-threatening danger and therefore represent an absolute medical emergency) are especially the elderly and those who have or are at risk of developing aortic aneurysms, such as people suffering from atherosclerosis, high blood pressure, and/or certain predisposing genetic conditions such as Mafran syndrome and Ehlers-Danlos syndrome.

In all of the above cases, fluoroquinolones should not be used unless they represent the only class of drugs available to treat a life-threatening infection, and their eventual use should always be closely monitored by the physician, however.

All people on systemic fluoroquinolone antibiotic therapy should follow the doctor’s instructions, without spontaneously discontinuing treatment, and immediately report any onset of symptoms such as:

Pain or inflammation in the Achilles tendon (or other tendons);
Pain, burning, tingling, numbness, or weakness in the arms and legs or other parts of the body;
Severe pain behind the sternum or in the upper back (similar to that of a heart attack), radiating to the neck, shoulders, and jaw;
Severe abdominal or lower back pain radiating to the legs.

Source

Fluoroquinolone Antibiotics: Safety Communication – Increased Risk of Ruptures or Tears in the Aorta Blood Vessel in Certain Patients(https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm628960.htm)
Important Information Note on Medicines Containing Fluoroquinolones(http://www.aifa.gov.it/content/nota-informativa-importante-su-medicinali-contenenti-fluorochinoloni-23102018)
Disabling and potentially permanent side effects have led to discontinuation or restrictions in the use of quinolone and fluoroquinolone antibiotics. EMA/795349/2018 (https://www.ema.europa.eu/en/news/disabling-potentially-permanent-side-effects-lead-suspension-restrictions-quinolone-fluoroquinolone)

Some drugs used in Parkinson’s disease stimulate creativity

19 February 20246 January 2024 by pcarrieri

In individuals with Parkinson’s disease, the use of dopaminergic drugs that can stimulate receptors for dopamine, a deficient neurotransmitter in this disease, can result in side effects characterized by poor impulse control: these include pathological gambling, hypersexuality, and compulsive shopping. However, the same drug treatment has stimulated increased creativity and the acquisition of new artistic skills in some individuals with Parkinson’s disease.

While poor impulse control, such as especially pathological gambling, is well recognized in the literature, creativity remains underestimated, probably because it is an often-appreciated event and as such not likely to create distress, either in patients or their families. In a recent study, researchers evaluated about 20 subjects with Parkinson’s disease who exhibited greater artistic creativity after dopaminergic treatment than before. Among the artistic activities found in first place is painting, but also the development of poetic skills(Schrag and Trimble 2001; Walker et al, 2006).

There is no doubt that a stimulating family environment could bring out creative aspects more frequently during Parkinson’s disease treated with dopaminergic drugs. But a not insignificant aspect is that the same patients in whom there is the appearance of artistic activities also report a state of well-being and a loss of awareness of the disease and even of disease-related physical limitations(Chatterjee et al, 2006).

Source: Garcia-Ruiz PJ, Martinez Castrillo JC, Desojo LV. Creativity related to dopaminergic treatment: A multicenter study. Parkinsonism Relat Disord. 2019 Feb 22. pii: S1353-8020(19)30056-2.

Bibliography

Chatterjee A, Hamilton RH, Amorapanth PX: Art produced by a patient with Parkinson’s disease. Behav Neurol 2006;17:105-108

Schrag A, Trimble M: Poetic talent unmasked by treatment of Parkinson’s disease. Mov Disord 2001;16:1175-1176

Walker RH, Warwick R, Cercy SP: Augmentation of artistic productivity in Parkinson’s disease. Mov Disord 2006;21:285-286.

Improvements to coronary plaque with biologic therapy for psoriasis

18 February 20246 January 2024 by Renato Torlaschi

ILa biological therapy in patients with psoriasis severe is associated with significant improvements in coronary plaque characteristics, according to new research coordinated by Nehal N. Mehta, of the National Heart, Lung, and Blood Institute in Bethesda, USA, ad published in Cardiovascular Research, a journal of the European Society of Cardiology.

The severe psoriasis is characterized by a high risk of myocardial infarction early and coronary artery disease rates similar to those of type 2 diabetes, and in affected patients, the extent of noncalcified plaque correlates significantly with both traditional cardiovascular risk factors and psoriasis severity.

Mehta and colleagues characterized coronary plaque before and after therapy in 121 individuals with moderate to severe psoriasis. Of these, 32 received topical treatment and 89 received biologic therapy, of three different types: anti-TNF, anti-IL12/23 or anti-IL17.

After one year of follow-up, in patients treated with biologic drugs, the U.S. researchers found a 5 percent reduction in total coronary plaque and also in non-calcified plaque, while in those who had undergone topical therapy there was no significant improvement. Indeed, in the latter subjects, coronary artery disease has progressed, and part of the fibrous component of the plaque has converted to fat-fibrous, signaling a lipid infiltration whose consequences are well known: the fibrous wall thins and may eventually rupture, increasing the risks of thrombus formation.

Patients treated with biological therapy also improved in terms of systemic inflammation, although the authors themselves recommend caution and urge larger, randomized studies.

However, optimism is also warranted because the result adds to that of previous research, in which biological therapy was seen to reduce the risk of a new cardiovascular event in subjects who had already had a myocardial infarction.

Drug excipients: inactive, but not for all

18 February 20246 January 2024 by rosanna.feroldi

The excipients, that is, “biologically inert” substances added to a drug to improve their taste, color, absorption efficiency, mode and time of action in the body, are generally considered safe and harmless for those taking them, following favorable outcomes of countless tests conducted over decades and extensive use in clinical practice.

However, what is true for many people is not true for everyone. A recent research conducted in collaboration between two prestigious U.S. research centers, the Massachusetts Institute of Technology and the Brigham and Women’s Hospital – Harvard Medical School of Boston, indeed indicates that many of the theoretically “inactive” compounds contained in a tablet, capsule, effervescent powder or syrup may, in fact, be the source of intolerances, allergic reactions and hypersensitivity in susceptible patients.

In most cases these are not serious reactions, often being limited to headaches, gastrointestinal complaints, itching or other dermatological manifestations. However, these drawbacks may lead to discontinuation or discontinuation of necessary treatment (reducing its effectiveness) or may worsen the underlying disease they are supposed to treat, especially in people who are more frail and debilitated or who have to take many different medications at once, such as the elderly.

For example, an excipient that causes gastrointestinal discomfort such as nausea or diarrhea may prevent adequate nutrition or absorption of needed nutrients in the intestines, while an “inactive” compound that induces nighttime itching may hinder rest and promote fatigue and a sense of malaise during the day.

Unfortunately, although all substances contained in a drug are listed by law in the package insert, it is not so easy for either the person taking it or the prescribing physician to have a full understanding of the associated risks, since the dosages of individual excipients are not reported and many compounds become potentially harmful only as a result of accumulation with continued use and not after one or a few intakes.

Moreover, for most of the drugs containing the same active ingredients (i.e., compounds actually endowed with therapeutic activity) there are countless different formulations containing different excipient mixes, which have further multiplied since the introduction of equivalent drugs. How to solve the situation?

According to the researchers, action needs to be taken mainly on two fronts: at the level of pharmaceutical companies, efforts should be made to develop new formulations of drugs in use, paying close attention to avoidance of excipients not necessary potentially allergenic/sensitizing (dyes, flavors, lactose, gluten, lecithins, FODMAP sugars, etc.); at the legislative level, forcing Indicate more precisely all excipients used in the package inserts.

A third and no less important aspect concerns the rational and conscious use of medications by patients, who should use medicines of any kind (over-the-counter or prescription) only in cases of actual need, respecting the directions given by the doctor or found on the package insert regarding timing and dosage, and reporting to the doctor or pharmacist any unanticipated adverse reaction, to enable more timely pharmacovigilance.

Source

Reker D et al. “Inactive” ingredients in oral medications. Science Translational Medicine 2019;11(483):eaau6753. doi10.1126/scitranslmed.aau6753 (http://stm.sciencemag.org/content/11/483/eaau6753.abstract)

Doctor-prescribed fruits and vegetables? Surprising savings for the health care system

18 February 20246 January 2024 by Renato Torlaschi

Healthy foods prescribed as if they were drugs: a new study published in March in PLoS Medicine suggests adopting this strategy in the United States for beneficiaries of Medicare and Medicaid-the two major federal health insurance programs-with the stated aim of reducing the risk of chronic diseases, such as cardiovascular disease or diabetes, while lowering the cost of care.

Making use of computer models, researchers at Tufts University in Boston estimated that healthy food prescriptions could prevent millions of cardiovascular events, such as heart attacks and strokes, and save billions of dollars in health care costs.

To run the simulations, the authors included people between the ages of 35 and 80 years and enrolled in Medicare or Medicaid; as part of the modeling, they used data from the three most recent surveys on the health and nutrition of U.S. citizens, as well as those produced by published studies in the literature and meta-analyses that included demographic information, dietary habits, and health care costs.

Several hypotheses were examined in the study: including an estimate of the impact that a 30 percent discount for purchasing doctor-prescribed healthy foods might have.

Already limiting prescriptions to
fruits and vegetables,
now consumed in insufficient quantities in the U.S., it has been estimated that 1.93 million cardiovascular events could be avoided, with a total savings of $39.7 billion. When they ran the estimate assuming a wider prescription of healthy foods, they calculated that 3.28 million cardiovascular events and 120,000 cases of diabetes would be prevented and $100.2 billion would be saved.

“We found that partial coverage of the cost of purchasing fruits, vegetables, whole grains, nuts, seeds and vegetable oils would be highly cost-effective, ” said Yujin Lee, first author of the study. and would be quite similar in cost-effectiveness to prescription drugs for high cholesterol or hypertension.”

Lee Y, Mozaffarian D, Sy S, Huang Y, Liu J, Wilde PE, Abrahams-Gessel S, Jardim TSV, Gaziano TA, Micha R. Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med. 2019 Mar 19;16(3):e1002761.

Medications: mistakes to avoid

15 February 20246 January 2024 by Redazione My Special Doctor

Some would never want to take them; others would want a pill to cure every ailment and would not leave home without an emergency kit in their bag. In few areas as in the use of drugs are people’s attitudes so diverse as to contemplate all the nuances between opposites. What they all, or at least the majority, have in common is the possibility of making errors in intake, either under or over, due to forgetfulness, inaccurate understanding of the directions given by the doctor or listed on the package inserts, prejudices or false beliefs that lead to “revising” dosages and duration of therapies in an imaginative way, with the sole result of reducing the efficacy and safety of the medications taken. A few usage cautions to take the best care of yourself .

Gut bacteria deployed to combat anxiety

15 February 20246 January 2024 by Renato Torlaschi

The human gut is home to billions of bacteria that collectively form the gut microbiota, whose crucial role in digestion has long been known. But a growing body of scientific evidence is pointing out that these microorganisms also affect our behavior and even our brains. Now, the authors of a new systematic review show that bringing about a change in our gut flora can be an effective way to alleviate the symptoms of anxious states.

Researchers from Shanghai Jiao Tong University School of Medicine analyzed 21 studies focusing on interventions to treat anxiety through modulation of gut bacteria. The review, which involved 1,503 subjects and was published in the journal General Psychiatry, confirmed that some approaches are indeed effective.

To manipulate gut bacteria in participants, two main approaches were used: in seven of the studies included in the analysis, patients’ diet was changed, while in the other 14, probiotic supplements were administered. Probiotics, often referred to as “good bacteria,” are found in certain foods and can help rebalance depleted intestinal flora. Of the probiotic studies, seven used only one type of bacteria, two used two types, and the remaining five used three or more bacterial strains.

In all the studies reviewed, the Chinese researchers found a positive effect; in some cases it was small, but in eleven of them there was a marked improvement in anxiety symptoms: five through the probiotic approach and six through the dietary approach. The review also improved our knowledge regarding the combination of traditional anxiety medications with intervention on gut bacteria: to this propósito, the authors found that improvements occurred only when dietary interventions were combined with medications and not with probiotic intake.

Taken alone, the diet interventions had an 86 percent efficacy rate, which could be related to the more effective growth of different types of bacteria following the dietary regime change. Regarding supplementation with probiotics, however, experts speculate that the bacteria in the supplements might compete against each other and consequently fail to produce the desired changes to the gut microbiome. It is also possible that only certain types of bacteria make a difference, and identifying them will be the task of future research.

Yang B, Wei J, Ju P et al. Effects of regulating intestinal microbiota on anxiety symptoms: A systematic review

General Psychiatry 2019;32:e100056.

Hospitalizations and deaths in England and Wales

15 February 20246 January 2024 by Alessia Giannino

In Britain, the most common type of poisoning is acute poisoning . From the 1970s to the present there has been a gradual increase in poisoning deaths. Although official statistics show most cases to be accidental, a deeper analysis reveals intentionality in many of them. In Britain,murder by poisoning appears to be rare, as most murderers are impulsive. Many of those who decide to commit suicide by poison die before they reach the hospital, as they are often so determined to die that they make sure no one can oppose their plan.

Epidemiological statistics in England and Wales are similar to those in other states such as Scotland. In “developed” states, young children are much better protected from malnutrition, infection and trauma than before. Increased are the cases in which children unwillingly swallow toxic substances. Hundreds of children under the age of 10 die from poisoning every day in England and Wales, and most of them because they ingest carbon monoxide. In contrast to hospitalizations, the mortality rate of these children is very low, especially since only a few stay in the hospital more than one night and therefore not really suffering from poisoning. Of course, as far as young children are concerned, it is normal for them to put anything in their mouths, and it often happens that they ingest medicines left unattended and within their reach.

Accidental poisoning of adults can depend on several factors, including toxic gases and vapors, along with some metals such as lead. When it comes to self-poisoning, the accusation falls on those drugs capable of giving a state of unconsciousness. Some can be purchased freely without a prescription, while others cannot. At present, barbiturates no longer rank first among the most commonly used drugs because their prescription has been restricted. Their place has been taken by antidepressants, sedatives, tranquilizers, hypnotics, and all those drugs that are used every day to treat psychoneurotic afflictions.

Source: Roy Goulding’s Vademecum of Poisoning Therapy.

Alzheimer’s disease: beware of those drugs

15 February 20246 January 2024 by rosanna.feroldi

Despite intense research, the causes of Alzheimer ‘s disease continue to be essentially unknown. It has long been believed that mainly two protein factors, ß-amyloid plaques and Tau protein, are involved in its onset. But not all neurologists are convinced of this, and, in any case, it remains to be understood what determines the formation of these toxic substances for brain cells and what is their exact action.

Undoubtedly, the genetic predisposition individual plays an important role in determining the extent and speed of the cognitive decline, but study after study is becoming increasingly clear about the negative contribution of various environmental factors that can interfere with brain cell function and integrity, either directly or indirectly: from substances taken in with food to pollution, from sources of oxidative stress to drugs.

Precisely with regard to the latter, a new call for attention comes from a study conducted by researchers at the University of Nottingham (UK) who investigated the impact on intellectual performance and its age-associated deterioration of anticholinergic active ingredients-a class of drugs comprising molecules used to treat countless clinical conditions and whose use is widespread among the elderly.

They are anticholinergics, e.g., amitriptyline and paroxetine (two commonly used antidepressants), some antipsychotics (quetiapine, olanzapine, chlorpromazine), first-generation antihistamines such as promethazine (used against allergies and sleep disorders), furosemide (a diuretic indicated in cases of hypertension heart failure, and other diseases associated with water retention), amantadine (for the control of Parkinson’s disease), colchicine (prescribed for acute gout attacks), and baclofen (a centrally acting muscle relaxant).

Analyzing the medical records of some 58,800 patients diagnosed with dementia and 255,600 subjects without a diagnosis of dementia (all over the age of 55 and included in British family physician registries), the researchers found a correlation between taking anticholinergic drugs such as those mentioned above and increased risk of developing Alzheimer’s disease.

Specifically, people over 55 who had been chronically using these drugs for more than three years, at the higher dosages or in the “more active” versions, had a 50 percent higher risk of dementia over the next 10 years than those who had never taken them.

Responsible for the largest increase in the risk of Alzheimer’s disease were antipsychotics (+70%), antimuscarinics used against urinary incontinence (+65%), and anti-parkinsonian drugs (+52%), while antidepressants and antiepileptics seem to have a smaller, but still not negligible impact (+30% and +40%, respectively), especially in light of the fact that no effective therapies are currently available against Alzheimer’s disease.

How then to behave? Of course, if an anticholinergic drug is absolutely necessary to treat a significant health problem it must be used. But this need needs to be evaluated with caution, opting for safer alternative therapies whenever possible and, above all, avoiding administering these drugs chronically, over several years, if the benefit obtained is modest and not such as to justify the potential risks to brain health.

Source Coupland CAC et al. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med 2019; doi:10.1001/jamainternmed.2019.0677 (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353?widget=personalizedcontent&previousarticle=2736349)

Over-the-counter drugs: are you using too many?

14 February 20246 January 2024 by Redazione My Special Doctor

” Over-the-counter” or OTC (short for Over-The-Counter) drugs are valuable remedies to alleviate many common, annoying but not serious ailments that can occasionally occur in daily life, without having to go to force from the doctor to get the prescription. Their free purchase in pharmacies is allowed because decades of employment by millions of people has demonstrated that OTC drugs are effective and safe when taken at the dosages and In the manner indicated on the package inserts or packages, and That are easy to manage even without having medical knowledge specifications. However, to reap the expected benefits without taking no risks, it should not be abused: especially of these .

Mite allergy worsens in autumn: how to defend against it

14 February 20246 January 2024 by rosanna.feroldi

Pollen allergy sufferers, with the arrival of autumn, can literally breathe a sigh of relief, since the substantial reduction in the amount of allergens in the air finally grants a respite from annoying symptoms such as a stuffy and dripping nose, itchy and reddened eyes, accompanied by more or less abundant tearing. Unfortunately, the same cannot be said for those who have to cope with dust mite allergy: “perennial” allergens (in that they are always present in the environment), which are concentrated in homes and offices and give greater problems during the fall-winter season, when prolonged stay in closed, heated rooms increases exposure.

As much as and more than pollen allergy, dust mite allergy can cause oculorhinitis (corresponding to the above symptoms) or allergic asthma, representing more than just discomfort and requiring repeated medication for prolonged periods to keep the manifestations under control. In addition, mite allergy sufferers may have a reduced quality of life from difficulty sleeping during the night (resulting in fatigue and discomfort during the day) and the need to take extremely careful care of the hygiene of their living environments (mites and their sensitizing droppings lurk in blankets, pillows, mattresses, carpets, couches, etc., and it is not easy to flush them out).

To permanently remedy all these drawbacks, allergen-specific immunotherapy, initially developed against some pollen allergies and now also available against mite allergies, has been used for several years. In both cases, treatment consists of progressive desensitization from the allergens causing the abnormal immune reaction by administering controlled increasing doses of the allergens themselves until the allergy is “switched off” completely or largely. In addition to the strategy of administering allergen-specific immunotherapy by subcutaneous injection (which has long been used by allergists but is inconvenient for patients who have to travel to an outpatient clinic to take it), a sublingual drug, which must be prescribed by the allergy-immunology specialist but can then be taken at home, has also been available in Italy for a few months.

In addition to undoubted symptomatic and general well-being benefits, allergen-specific immunotherapy also has favorable clinical and practical implications, as it avoids the need to continuously take medications that can lead to side effects (especially, in the case of asthma corticosteroids), and economic ones, as it substantially reduces spending on symptomatic medications and allergy-related absences from school/work, improving performance in the professional sphere. Confirming the positive cost-benefit ratio of the treatment is the fact that the Tuscany Region has decided to grant free allergen-specific immunotherapy to all people with mite allergies in whom it finds indication. The hope is that other regional health systems will follow suit.

Sources: Tuscany Region(www.regione.toscana.it/bancadati/atti/Contenuto.xml?id=5216521&nomeFile=Delibera_n.646_del_13-05-2019); Accarizax RCP, July 17, 2019 (AIFA – farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_003016_043755_FI.pdf&sys=m0b1l3 )

Pro-arrhythmic drugs: more attention needed

12 February 20246 January 2024 by rosanna.feroldi

Congenital long QT syndrome is a cardiac condition present from birth that essentially consists of a “repolarization defect,” that is, an electrophysiological alteration that results in a lengthening of the time required for the cells of the heart to “recharge” after contraction of the ventricles. The name of the disease comes from the fact that this increased repolarization time can be seen on the electrocardiogram (ECG) tracing as the elongation of a particular segment called precisely “QT.”

By itself, long QT syndrome gives no symptoms and for this reason is poorly diagnosed, except during electrocardiograms required for other reasons, such as preoperative examinations, pre-sports check-ups, apparently unmotivated fainting spells, or other cardiological disorders. Unfortunately, when it occurs it does so in a striking manner, with ventricular fibrillation, cardiac arrest, and sudden death. Triggering these effects can be a very intense physical exertion or emotion or a fright or sudden awakening in the middle of the night. But sometimes fatal arrhythmia can also occur during sleep.

To date, there is no real cure for long QT syndrome, but there are some steps that can help reduce the risk. Among these, a very important one concerns medications that may need to be taken throughout life for a wide variety of reasons: from antibiotics to analgesics, from antacids to antidepressants. Many commonly used drugs, in fact, tend to have a “pro-arrhythmic” action, that is, to promote transient alterations in heart rhythm. In people without long QT syndrome, this generally does not create particular problems (except perhaps some palpitation during therapy). In contrast, if a person with long QT syndrome is taking a pro-arrhythmic drug, the risk of ventricular fibrillation and sudden death are significantly increased.

For this reason, the European Society of Cardiology (ESC) guidelines dedicated to this condition have long and strongly recommended that drugs known to be pro-arrhythmic should not be prescribed to sufferers, opting, where possible, for alternative therapeutic solutions without cardiac effects. In clinical practice, however, these recommendations seem to be largely disregarded. In particular, a recent Danish study indicates that 60% of people with congenital long QT syndrome are prescribed pro-arrhythmic drugs in the years after diagnosis, even for prolonged periods.

The most prescribed “arrhythmia risk” drugs were found to be some antibiotics (such as azithromycin, clarithromycin and erythromycin; 34.1 percent), antacid proton pump inhibitors (esomeprazole, lanzoprazole, omeprazole, pantoprazole; 15.0 percent), antidepressants (citalopram, escitalopram, sertraline; 12.0 percent) and antifungals (fluconazole; 10.2 percent). Those considered in the study were less likely to be prescribed pro-arrhythmic drugs in the year following the diagnosis of congenital long QT syndrome than in the previous year, but not by much (28.4 percent vs. 23.2 percent), while in more than one-third of the cases (33.5 percent) the at-risk drug therapy was still ongoing after five years. The likelihood of prescribing risky drugs increased slightly with age and multiplied by more than 2.5 times when the same drug had been taken by the patient before (probably, on the basis of erroneous reassurance with respect to possible cardiac side effects).

Although the study did not show a correlation between pro-arrhythmic drug use and increased mortality from ventricular arrhythmia or all causes, the authors and ESC experts urge greater caution on the part of physicians when prescribing potentially high-risk drug therapies in those with congenital long QT syndrome. On the other hand, even patients with a known diagnosis should remember to always inform any specialist physicians they spontaneously visit for consultations in various clinical settings of the cardiac issue they are suffering from, to enable them to identify optimal and safe treatment strategies.

In addition, those suffering from congenital long QT syndrome should always seek advice from their physician and/or pharmacist even when it comes to choosing commonly used over-the-counter drugs that are generally considered safe and manageable: although they indeed are for most people, some of them may be contraindicated in those who are genetically predisposed to cardiac arrhythmias (this is the case, for example, with some antihistamines).

Source:

Weeke PE et al. Long-termproarrhythmic pharmacotherapy among patients with congenital longQT syndrome and risk of arrhythmia and mortality. European Heart Journal 2019;40, 3110-3117. doi:10.1093/eurheartj/ehz228(academic.oup.com/eurheartj/article/40/37/3110/5488147)

Hair falling out more than usual? Here’s why

12 February 20246 January 2024 by Redazione My Special Doctor

Hair is strongly affected by health status general organism, but also the lifestyle one leads, the stress level, the medications one takes, and, in both men and women, of hormone levels. Eating disorderly, being anxious or depressed, not drinking or getting enough sleep, smoking, not taking vitamins and salts enough minerals, but also being pregnant or menopausal or suffering from of specific acute or chronic diseases can affect luster, vitality and density of the canopy, often with unhappy outcomes. A list of the main factors that can increase hair loss and some tips to remedy them.

Useful strategies for taking the best care of yourself

12 February 20246 January 2024 by Redazione My Special Doctor

Having to take regular medication to keep under control one or more chronic diseases is a fairly common need, but equally common is to forget about it from time to time or to make some mistakes. These are rarely inconveniences that expose one to serious risks, but if forgetfulness and inaccuracies are repeated with some frequency the probability that the therapy loses some of its effectiveness is quite high. Here are a few pointers for adhering faithfully to medication schedules and dosages prescribed by the doctor without much effort, thanks in part to the help of technology.

Can we tell if we are getting sick by reading DNA?

10 February 20246 January 2024 by Redazione My Special Doctor

Analyzing DNA for genetic traces associated with the risk of certain diseases. For some it is a good way to prevent the onset of disease, but the scientific community views the practice with skepticism.

In the United Kingdom.Matthew Hancock is the U.K. secretary of state for health. In recent days, he announced during a speech to the Royal Society, of having a high risk of developing a prostate cancer. By age 70, the probability of contracting this type of cancer would be 15%.At least according to the dna tests to which he underwent to measure the risk associated with 16 different conditions.

Decrease the risks

However, these types of DNA tests have limitations. First, they havelimited accuracy, produce results that do not change clinical and therapeutic attitudes, and

The test

The test Hancock underwent was performed by Genomics Plc. This is a so-called polygenic risk test, in which a large number of variants, found in the genome, are analyzed to develop an estimate of the risk of contracting a particular disease, with the idea that each may contribute a small part. In themselves, these types of analyses are very useful on studies of large cohorts of patients because they allow us to

The results on the individual case

At the level of the individual, however, these tests are of more limited value, Not only are they not comprehensive, but In conclusion, the clinical relevance to date of these tests remains doubtful.

To know from DNA analysis if and what we can get sick from?

Certainly predicting and controlling the future has always been one of the dreams of human beings. The discovery and studies of DNA seem to represent a kind of realization of this dream: that is, to be able to know in advance what we will fall ill with and consequently have the ability to take the necessary steps to avert this eventuality.

But is this really the case?

Scientists are very cautious about this.

For example, the polygenic risk test, by which many genome variants are analyzed to then make an estimate of the risk of contracting a specific disease, may have value but only on large numbers of patients.

Indeed, this would make it possible to identify variants linked to a given condition and thus possible metabolic pathways involved in order to prepare new drugs.

On the individual case the value of the test is limited, the clinical relevance is doubtful.

In fact, these tests involve multifactorial diseases, in which both environment and lifestyle play an important role.

As Leonardo Salvati, Director of the Graduate School of Medical Genetics at the University of Padua, points out in Wired, “These tests analyze only a part of the genetic component associated with a given condition, that is, only a tot of polymorphisms,” without taking into account individual genetic variants and their interactions.

Esketamine: the new depression drug approved in the U.S.

7 February 20246 January 2024 by Redazione My Special Doctor

A new drug has been approved by the Food and Drug Administration (Fda) a nasal spray, based on esketamine, a ketamine derivative, that appears to relieve symptoms of depression. Some experts appeared skeptical about the new drug.

The nasal spray

The government agency approved the esketamine-based spray. It part of the anesthetic ketamine molecule that appears to act within hours already, so it may then become the first fast-acting depression drug available on the U.S. market.

Mixed opinions

Opinions in the medical community immediately appeared mixed and were soon divided: some welcomed the arrival of the new depression drug and others expressed doubts and skepticism about the substance.

Most critics argued that the new drug was approved too quickly and, more importantly, not taking into account the high risk of abuse of the substance, which is sometimes misused as a drug with psychedelic effects.

Ketamine

In fact, it is not only a drug but also a drug. In fact, ketamine is certainly an anesthetic drug, but it is also simultaneously a hard drug, which is why caution should be exercised and the public should be warned about potential abuse.

The ability to administer esketamine via a nasal spray does not imply that patients will be able to use it independently. In fact, the drug will be available only in certified clinics in which patients can be followed and monitored by physicians , a decision by the Fda that surely aims to significantly reduce the risk of abuse and addiction.

The economic aspect should also be considered since one course of treatment will cost about $7,000 .

Quick effect

The new drug , developed by the pharmaceutical company Janssen, unlike most of the antidepressants available, whose desired effects can take as long as 4-6 weeks therapeutic time , is able to act in a few hours and will be directed only to patients in whom other therapies have not been successful.

Epileptic seizure: what to do?

5 February 20246 January 2024 by Redazione My Special Doctor

The seizures are self-limiting and very often do not allow a rapid intervention. It is necessary, therefore, to keep some pointers in mind:

Preventing lessons that the patient might unintentionally procure for himself or herself.
Observing the crisis
Clearing the ways breathing from any obstructions and place the patient in the position of security
Avoid Introduce objects between the teeth.

Treatment must be determined by a specialist, and usually the drug of choice is diazepam. For febrile convulsions, which are more common in children, it is necessary to administer the drug rectally, and it will be helpful to reduce body temperature by sponging cool water all over the body and administering antipyretics. Usually by the time the doctor examines the child, the crisis is already over, but in case it persists, hospitalization for appropriate investigations is recommended.

Source: Medical Guard Handbook edited by Piercarlo Salari

The CDC in the US (Center for Disease Control): new symptoms of COVID-19

5 February 20246 January 2024 by Redazione My Special Doctor

The Center for Disease Control has added several symptoms to the list of Coronavirus symptoms. Meanwhile, several hospitals in New York are testing Covid-19 patients on a common drug usually used in reflux therapy to see if it can help defeat the virus. The latest updates.