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Health24.com | Gene could explain why some women don’t need pain relief in childbirth

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  • Not all women have the same level of pain during childbirth
  • A study found that some women had higher pain tolerance for heat, cold and mechanical pressure
  • These women had a higher-than-expected occurrence of a rare variant of the gene KCNG4

A genetic variant that acts as a natural pain reliever may explain why some women don’t require pain relief during childbirth, researchers say.

The level of pain and discomfort experienced during childbirth varies widely, so researchers at the University of Cambridge in England decided to investigate why some women have less pain during labour and delivery.

“It is unusual for women to not request gas and air, or epidural for pain relief during labour, particularly when delivering for the first time,” said co-lead author Dr Michael Lee, a consultant in pain medicine in the Division of Anaesthesia.

“When we tested these women, it was clear their pain threshold was generally much higher than it was for other women,” he said in a university news release.

A rare genetic variant

Lee and his colleagues assessed women who didn’t request any pain relief during an uncomplicated vaginal delivery of their first baby. To test their pain threshold, researchers applied heat and pressure to their arms and had them plunge their hands into icy water.

Compared to a control group of women who required pain relief when giving birth, women in the test group had higher pain tolerance for heat, cold and mechanical pressure.

No differences were found in the groups’ emotional and thinking abilities, suggesting a difference in their ability to detect pain.

Genetic tests on both groups of women found that those in the test group had a higher-than-expected occurrence of a rare variant of the gene KCNG4. About one in 100 women have this variant.

This variant limits the ability of nerve cells to send pain signals to the brain, according to authors of the study published on 21 July in the journal Cell Reports.

New drugs to manage pain

“The genetic variant that we found in women who feel less pain during childbirth leads to a ‘defect’ in the formation of the switch on the nerve cells. In fact, this defect acts like a natural epidural,” said study senior co-author Ewan St John Smith, a group leader in the Department of Pharmacology.

“It means it takes a much greater signal – in other words, stronger contractions during labour – to switch it on. This makes it less likely that pain signals can reach the brain,” Smith said in the release.

Researchers said they hoped the discovery would lead to development of new drugs to manage pain.

“This approach of studying individuals who show unexpected extremes of pain experience also may find wider application in other contexts, helping us understand how we experience pain and develop new drugs to treat it,” said study senior co-author Dr David Menon, head of the Division of Anaesthesia.

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Health24.com | Probiotic might help ease children’s eczema

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  • Not all eczema treatments can be given to young children
  • In a study, a topical probiotic against eczema was tested on children, with good results
  • This fits in with evidence that eczema involves an imbalance in the skin’s microbiome

Applying a type of “good” bacteria to the skin may relieve children of the itch and discomfort of eczema, a new, small study suggests.

Eczema is a chronic inflammatory condition that causes dry, itchy skin and scaly rashes. It usually starts in early childhood, and commonly occurs along with allergies like hay fever and asthma, according to the American Academy of Allergy, Asthma and Immunology.

There are numerous treatments for eczema, both topical and oral, but not all can be given to young kids.

“So, there’s a big need for safe and effective treatments for young children,” said study author Dr Ian Myles. He is a researcher and staff clinician with the US National Institute of Allergy and Infectious Diseases.

Imbalance in microbiome

For the study, his team tested a topical probiotic against eczema in 20 children as young as three years of age. Over four months, 17 of the 20 saw their rashes and itchiness fade by more than 50%.

The children were also able to cut down on topical corticosteroids, a standard treatment for eczema – but one that can cause side effects like thinning of the skin and stretch marks.

The probiotic therapy is a spray solution containing live Roseomonas mucosa bacteria. Those microbes are normally present on the skin, and past research has found that R. mucosa from people with healthy skin can treat eczema in lab mice.

In contrast, samples of the bacteria from people with eczema either had no effect, or made the skin condition worse.

It all fits with evidence that eczema involves an imbalance in the skin’s microbiome. That refers to the vast array of bacteria and other microbes that naturally dwell on the skin and help maintain its health.

Staph infections

The skin, Myles explained, has to repair itself from daily wear-and-tear, and the microbiome assists in that. He said R. mucosa appears to produce oils that aid the skin’s repair capacity.

The treatment also reduced staph bacteria on the children’s skin, and those microbes can worsen eczema symptoms.

Dr John Browning, a paediatric dermatologist, said, “I think this is a really interesting study.” Browning was not involved in the research.

He said people with eczema often get staph infections and need antibiotic treatment. It’s possible R. mucosa could be an alternative, according to Browning, who is based at Children’s Hospital of San Antonio and Texas Dermatology and Laser Specialists.

The findings, published online on 9 September in the journal Science Translational Medicine, are based on 20 children and teenagers who were given the probiotic therapy for four months. They (or their parents) applied the spray solution twice a week for three months, and then every other day for the final month.

Lasting benefits

On average, Myles said, the kids’ itchiness and rash improved by 60% to 75%, with no significant side effects.

And there were signs it could have lasting benefits. Eight months after the therapy was stopped, the good bacteria were still colonising the children’s skin – indicating R. mucosa had “moved in,” Myles explained.

That, he said, suggests the therapy could be one time only. It would still be possible, though, that whatever caused the bacterial imbalance in the skin could do it again.

Myles said a broader goal is to figure out what those factors are – with diet, soaps and antibiotics being among the suspects.

Browning is part of another trial testing R. mucosa for treating eczema. But he does not think it is the only bacterium that matters.

Further development

“There could be a lot of variability patient to patient in whether this approach would be helpful,” Browning said.

Myles agreed, noting that not all study patients responded to the probiotic.

It’s unclear when the R. mucosa therapy could become commercially available. The US National Institutes of Health has licensed it to a private company, Forte Biosciences, to further develop.

Myles said the company worked to freeze-dry the probiotic so it can be reconstituted with water, then sprayed on. That will make it shelf-stable.

“We anticipate this being something you can pick up at the pharmacy,” he said.

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Health24.com | Smoking ups your risk of a fatal brain bleed

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  • A study has provided further evidence of a link between smoking and bleeding in the brain
  • External factors, such as smoking, have a much greater influence on the condition than genetics
  • Not smoking, or quitting if you’ve already started, is, therefore, an essential component of primary prevention

Smokers have a significantly raised risk of dying from a bleeding stroke, a new study warns.

For the study, researchers analysed data from over 16 000 same-sex twin pairs in Finland. The twins were born before 1958 and followed for about 42 years (between 1976 and 2018).

During the follow-up, there were 120 deaths from subarachnoid haemorrhage (SAH). This is a type of bleeding stroke that occurs under the membrane that covers the brain. The median age at death was about 61.

Further evidence

Compared to nonsmokers, the risk of fatal bleeding in the brain was three times higher among heavy and moderate smokers, and 2.8 times higher among light smokers.

The findings were published on 17 September in the journal Stroke.

“Our study provides further evidence about the link between smoking and bleeding in the brain,” co-author Ilari Rautalin said in a journal news release. Rautalin is a sixth-year medical and PhD student at the University of Helsinki in Finland.

Unlike previous research, this study found that high blood pressure, lower levels of physical activity and being female weren’t significant factors in the risk of a fatal brain bleed.

The paper didn’t have data on nonfatal cases. And the researchers couldn’t assess the impact of previous smoking on these brain bleeds, because former smokers and never smokers were combined in the nonsmoking category.

Essential component of primary prevention

Still, “this long-term study in twins helps to confirm the link between subarachnoid haemorrhage and smoking,” said Dr Rose Marie Robertson, deputy chief science and medical officer of the American Heart Association (AHA).

“Not smoking, or quitting if you’ve already started, is an essential component of primary prevention,” added Robertson, co-director of the AHA Tobacco Center for Regulatory Science. She was not involved in the study.

A previous study of nearly 80 000 twins in Denmark, Finland and Sweden suggested that external risk factors, such as smoking, have a much greater influence on subarachnoid haemorrhage than genetics.

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Health24.com | Some psoriasis meds may also help prevent heart disease

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  • Plaque in the arteries of people with psoriasis increases the risk of coronary artery disease
  • Treatment with biologic therapy reduced coronary plaque by 6% to 8% after one year
  • This is as effective as statin therapy on heart arteries

Biologic therapy for the skin condition psoriasis may reduce patients’ risk of heart disease, new research suggests.

Chronic inflammation in people with psoriasis is associated with the development of plaque in heart arteries, which increases the risk of coronary artery disease. In biologic therapy, patients receive protein-based infusions to reduce inflammation.

“This is the first time an imaging study in humans has shown what one year of ongoing, untreated inflammation can do to arteries of the heart, and that we can reverse this damage,” said study senior author Dr Nehal Mehta. He’s chief of the inflammation and cardiometabolic diseases lab at the US National Heart, Lung, and Blood Institute.

Prone to rupture

“Untreated inflammation is dangerous. You are just waiting for a heart attack or stroke to happen,” Mehta added.

This study focused on a dangerous type of coronary plaque called lipid-rich necrotic core. It’s composed of dead cells and cell debris, and is prone to rupture. Ruptured plaque can lead to a heart attack or stroke.

The study included 209 patients, aged 37 to 62, with psoriasis. They were selected to receive biologic therapy (124 patients) or assigned to the control group and received topical creams and light therapy (85 patients).

After one year of treatment, CT scans showed that patients who received biologic therapy had an 8% decrease in coronary plaque, while those in the control group had a slight increase.

The findings held even after the researchers adjusted for cardiovascular risk factors and psoriasis severity. The study was published on 15 September in the journal Circulation: Cardiovascular Imaging.

Just as beneficial as statin therapy

“Having inflamed plaque that is prone to rupture increases the risk of heart attack fivefold within 10 years,” Mehta said in a journal news release.

Treatment with cholesterol-lowering statins reduces coronary plaque approximately 6% to 8%, Mehta noted. “Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries,” he added.

Along with psoriasis patients, the study findings could have implications for people with other chronic inflammatory conditions such as HIV, lupus and rheumatoid arthritis, who also have an increased risk of heart disease, according to the researchers.

“We have never before been able to show healing of an inflamed plaque like this in humans. Biologic therapy reduces systemic inflammation and immune activation, and it has a favourable impact on improving overall vascular health,” Mehta said.

The authors said a larger study is needed to confirm the results.

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Health24.com | Hearing persists at end of life, brain waves of hospice patients show

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  • In their last hours, many people become unresponsive
  • However, EEG data indicated that their awareness of sounds was similar to healthy people
  • This suggests that they may still be aware of the presence of their loved ones, even though they seem unconscious  

Even if they appear unresponsive, dying people may still be able to hear.

That’s the takeaway from a Canadian analysis of hospice patients in Vancouver.

Researchers compared electroencephalography (EEG) data – a measure of electrical activity in the brain – collected when patients were conscious and when they became unresponsive at the end of life. Those patients were compared to a healthy control group.

The study looked at brain response to various patterns of common and rare sounds that changed frequency, and found that responses of some of the dying patients were similar to those of healthy people – even hours before death.

Dying brain can respond to sound

“In the last hours before an expected natural death, many people enter a period of unresponsiveness,” said lead author Elizabeth Blundon, a doctoral student in psychology at the University of British Columbia at the time of the study.

“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life,” she said in a university news release.

Co-author Lawrence Ward, a professor of psychology, said researchers were able to identify specific mental processes in both groups of participants.

“We had to look very carefully at the individual control participants’ data, to see if each one of them showed a particular type of brain response before we felt confident that the unresponsive patient’s brain reacted similarly,” he said in the release.

The findings were recently published in the journal Scientific Reports.

Being present is meaningful

“This research gives credence to the fact that hospice nurses and physicians noticed that the sounds of loved ones helped comfort people when they were dying,” said study co-author Dr Romayne Gallagher, a now-retired palliative care physician at St. John Hospice in Vancouver.

“And to me, it adds significant meaning to the last days and hours of life and shows that being present, in person or by phone, is meaningful,” she said. “It is a comfort to be able to say goodbye and express love.”

While the evidence of brain activity supports the idea that dying people might hear, it’s not known if they’re aware of what they’re hearing, Blundon noted.

“Their brains responded to the auditory stimuli, but we can’t possibly know if they’re remembering, identifying voices, or understanding language,” she said. “There are all these other questions that have yet to be answered. This first glimpse supports the idea that we have to keep talking to people when they are dying because something is happening in their brain.”

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Health24.com | Catch prostate cancer early. It could save your life

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  • Prostate cancer is the second most common type of cancer in American men
  • This kind of cancer usually grows slowly and doesn’t need aggressive treatment
  • Men over 55 should consider being screened for prostate cancer

About one in nine men will be diagnosed with prostate cancer, but experts say early detection can be a lifesaver.

“Prostate cancer that is detected early, typically while it is still within the prostate gland, has a better chance of being successfully treated,” explained Dr Alexander Kutikov, chief of the Division of Urologic Oncology at Fox Chase Cancer Center in Philadelphia.

“Some types of prostate cancer are aggressive. However, most cancers are quite slow-growing, and a significant portion can be monitored without aggressive treatment,” he said in a Fox Chase news release.

Men aged 55–69 should consider prostate cancer screening, the American Urological Association says.

No symptoms in early stages

“Much debate has centred around screening for prostate cancer. Given the risks and benefits of screening, not every man should be screened for prostate cancer,” Kutikov said. “Men should talk to their health care provider about their risk factors, options and preferences. Together, they can make a decision.”

In the early stages, prostate cancer usually causes no symptoms. More advanced prostate cancer may cause: difficulty urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night; blood in urine or semen; pain or burning during urination; discomfort in the pelvic area; bone pain, or trouble getting an erection.

“Many of these symptoms can be caused by something other than prostate cancer. However, you should let your healthcare provider know if you show any signs so the cause may be determined and treated, if needed,” Kutikov said.

September is National Prostate Cancer Awareness month. Prostate cancer is the second most common type of cancer in American men, according to the American Cancer Society. It says there will be about 191 000 new prostate cancer cases and more than 33 000 prostate cancer deaths in the United States in 2020.

Risk factors for prostate cancer include: older age (about 60% of prostate cancers are diagnosed in men over 65); race/ethnicity (Black men and Caribbean men of African ancestry have higher prostate cancer rates than men of other races), and a family history of prostate cancer.

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Health24.com | PODCAST | Health24’s sexpert discusses premature ejaculation and erectile dysfunction

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Erectile dysfunction can also occur due to: cardiovascular disease, diabetes, hypertension, high cholesterol, obesity, low testosterone levels, kidney disease, increased age, stress, anxiety, depression, relationship issues, prescription medications, sleep disorders, drug use, excessive alcohol, tobacco products, pelvic area damage. ED can be caused by only one or by several of these factors. It is important to work with a medical doctor to manage any health conditions.

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Health24.com | Under 50 and had a heart attack? Quit smoking, and you’ll live longer

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  • Cardiologists are always looking for ways to reduce the risk of cardiovascular events
  • They found that quitting smoking has a dramatic effect on young adults’ risk of heart disease
  • This is especially true in the case of young adults who have suffered a heart attack

If you’re a smoker under 50 and you suffer a heart attack, new research suggests kicking the smoking habit may be the best thing you can do to still be around years later.

“These results are definitive: among young people who have had a heart attack, quitting smoking is associated with a substantial benefit,” said corresponding author Dr Ron Blankstein, from the division of cardiovascular medicine at Brigham and Women’s Hospital in Boston.

“In cardiology, we are always looking for ways to reduce the risk of cardiovascular events, be it in the form of new medications or other interventions,” he said in a hospital news release.

Magnitude of risk in persistent smokers

“Our findings show the dramatic magnitude of the effect that quitting smoking can have for young adults,” he added. “But, unfortunately, we also found that most young patients kept on smoking after their heart attack, reinforcing that there is a major opportunity for improvement.”

In the study, the researchers analysed data on 2 072 patients who survived a heart attack before age 50 and were treated at Brigham and Women’s Hospital and Massachusetts General Hospital between January 2000 and April 2016.

Of those patients, 1 088 were smokers at the time of their heart attack. Data on smoking status one year after their heart attack was available for many of the patients and showed that 343 patients (38%) had quit smoking and 567 (62%) still smoked. Both groups were comparable in terms of age and race.

Over the next 10 years, 75 of the persistent smokers (13%) died, compared to 14 (4%) of those who had quit within a year of their first heart attack. Of the persistent smokers, 30 died of a heart attack or other cardiovascular event compared to six of those who quit smoking.

The study was published online recently in JAMA Network Open journal.

The “findings reinforce the critical importance of smoking cessation, especially among those who experience a heart attack at a young age,” Blankstein said. “Looking at the trajectories of young patients who quit smoking versus those who don’t paints a clear picture of the magnitude of risk compared to the benefit of smoking cessation.”

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Health24.com | Could Viagra, Cialis help boost colon cancer survival?

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  • ED medication may reduce the risk of death in men who suffer from colorectal cancer 
  • The reason why the drugs have an anti-tumour effect isn’t yet clear
  • However, according to an expert, they are known to block a protein that may play a role in cancer development

Erectile dysfunction (ED) drugs such as Viagra, Cialis and Levitra may do more than restore sexual function – they may also prolong the lives of men with colon cancer.

That’s the conclusion of a new Swedish study, which reported that the risk of premature death dropped by as much as 18% among colon cancer patients who used ED drugs.

The medications were also linked to a 15% reduction in risk for the key cause of death from colon cancer – that is, cancer that has spread.

“This is the first population-based study to explore the effect of these drugs on the death risk in men with colorectal cancer,” said lead author Wuqing Huang, a doctoral candidate at Lund University in Sweden.

Cancer-fighting potential

She and her colleagues focused on so-called “PDE5 inhibitors” – drugs that address impotence by regulating penile blood flow.

“There are two reasons why we considered the anti-cancer possibility of these drugs,” Huang said.

Prior studies suggested that ED drugs can inhibit tumour growth in mice and the activity of a gene called PDE5A. Huang said past work suggested colon cancer patients with lower PDE5A activity levels may live “significantly longer” than others.

To get a better handle on the cancer-fighting potential of the drugs, the researchers used a nationwide database to identify men in Sweden who were diagnosed with colon cancer between 2005 and 2014.

After excluding patients with late-stage cancer, researchers focused on more than 11 300 cancer patients who were not taking an ED drug and about 1 100 patients who were. (No one was instructed to use the drugs if they weren’t already doing so.)

Over more than four years of follow-up, about 10% of those who used an ED drug died, compared to 17.5% of patients who did not. The risk was even lower for those in the ED group who also had cancer surgery.

An observational study

Huang said the explanation for the drugs’ anti-tumour effect isn’t yet clear. It could have to do with the beneficial impact EDs have on immune function, reduced cell death and chemotherapy sensitivity, she said.

But until researchers can get a better understanding, “it is not suggested for colon cancer patients to get ED medications to control their cancer at this moment,” Huang said.

“The current evidence is not enough to provide recommendations, as our study is an observational study,” she stressed. “Clinical trials are necessary to confirm it.”

Still, Dr Andrew Chan, a professor at Harvard Medical School and Massachusetts General Hospital in Boston who reviewed the study, said the findings were intriguing.

“The work extends a prior study from this group showing that these medications may reduce the risk of developing colorectal cancer,” he noted. “It is also biologically plausible that these medications may have an anti-cancer effect, since they are known to block a specific protein that may play a role in cancer development.”

The findings were recently published in the journal Nature Communications.

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Health24.com | Stress and anger may worsen heart failure

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  • Stress and anger appear to make heart disease worse
  • Pandemic-related stressors may further exacerbate the situation  
  • More work is needed to find out if stress management can improve outcomes for heart failure patients

If you suffer from heart failure, try to stay calm. Stress and anger may make your condition worse, a new study suggests.

Mental stress is common in heart failure patients due to the complexities of managing the disease, progressively worsening function, and frequent medical issues and hospitalisations, according to lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale University in New Haven, Connecticut.

“We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events,” Harris said in a university news release.

Mental stress test

“Clarifying the relevant behavioural and physiological pathways is especially important in the era of Covid-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors,” Harris added.

The new study included 24 heart failure patients who completed daily questionnaires for one week about their stress, anger and negative emotions.

That was followed by a mental stress test in which the patients solved maths problems and described a recent stressful experience. Echocardiograms were done to assess diastolic heart function at rest and during stress.

Diastolic function is the heart’s ability to relax and refill between beats. In heart failure, a damaged or weakened heart doesn’t pump as much blood as the body needs – a condition that can be life-threatening.

Patients who reported experiencing anger in the week before the mental stress test had worse resting diastolic pressure, the researchers found.

Stress management

According to senior study author Matthew Burg, “Factors such as mental stress and anger often go unrecognised and are under-addressed. This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischaemic heart disease (narrowed arteries) and arrhythmic disease.”

Burg, a clinical psychologist at Yale, said more work is needed to identify factors that increase vulnerability to stress in heart failure, and to find out if stress management can improve outcomes for these patients.

The study findings were published online recently in the Journal of Cardiac Failure.

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