Health and Medicine – Page 2

Anti-covid, antiviral ensitrelvir

TL:DR – An antiviral drug called ensitrelvir could cut the time a person tests positive when they have COVID-19 by about a day. There is a controversial suggestion that it might also reduce the risk of developing long-covid.

An antiviral drug developed by Shionogi in partnership with Hokkaido University is an orally active 3C-like protease inhibitor, which can shorten the time between first testing positive after infection with SARS-CoV-2 and getting a negative test. Early signs are that it may well reduce the risk of developing long-covid, although that data is yet to be peer reviewed. There are some scientists sceptical of the claim having heared the results presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington, USA, in February. They suggest that more work in clinical trials is needed before the claim can be accepted. Mariana Lenharo has all the details in Nature.

Long-covid is also known as long-haul COVID, post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS). The term describes the long-term symptoms and effect on various body systems and organs following infection with SARS-CoV-2.

Currently, there are two orally active antivirals for treating COVID-19, Paxlovid (nirmatrelvir/ritonavir) and molnupiravir. The antiviral ensitrelvir has the brand name Xocova.

The controversy surrounding whether or not ensitrelvir can reduce the risk of a person developing long-covid is about whether or not the trials and the definitions offered by Shionogi on this point are valid. There had previously been a more general suggestion that shortening the time that a person tests positive for COVID-19 could be beneficial. That said, there is evidence that even those who only have mild symptoms of COVID-19 can still develop long-covid. It could be that long-covid is a side effect of the body’s immune response to infection rather than being due to residual virus. There is much we are yet to learn about this virus.

Semaglutide – the “skinny jab”

TL:DR – Semaglutide is known to US celebrities as the “skinny jab” and has apparently been the subject of a weight-loss craze. It has now been approved in the UK for weight-loss in the clinically obese.

Semaglutide is a pharmaceutical that can help control the symptoms of Type 2 diabetes for which it was first used. The nickname, the “skinny jab” comes from the drug’s activity as an appetite suppressant used in helping overweight people and the obese reduce their body weight. It is sold under the brand names Ozempic, Wegovy and Rybelsus and was originally developed by Novo Nordisk in 2012. Clinical trials of the weekly injected drug were completed in 2017.

In March 2023, the UK’s National Institute for Health and Care Excellence (NICE) recommended provision of the drug to specialist treatment centres under the National Health Service (NHS).

The main mode of action of the drug, according to the NICE website, is to activate the GLP-1 (glucagon-like peptide-1) receptor, which increases activity in the pancreas to boost insulin secretion into the blood. Insulin is the hormone that raises the concentration of glucose in the bloodstream.

Semaglutide also suppresses glucagon secretion. Glucagon is insulin’s counterpart hormone produced by the pancreas. It raises the concentration of glucose and fatty acids in the bloodstream.

The drug slows the rate at which the stomach empties its contents into the next portion of the gastrointestinal tract, the duodenum (the first section of the small intestine). This sustains a person’s feeling of fullness, or satiety, for longer and so can reduce the frequency with which they feel they need to eat.

The NICE website lists several cautions, side-effects, and contraindications for this expensive drug. Nevertheless, in February 2022 it put a case based on both risk-benefit and cost-benefit analyses for its use under the NHS for people with at least one weight-related condition and an exceptionally high body-mass index. In March 2022, NICE recommended provision of the drug for a sub-group of obese patients who might see a ten percent weight reduction if the drug is used in parallel with improvements in diet (less processed food and a reduction in calorie intake, fundamentally) and increased activity and exercise.

Brain-eating amoeba – the song

TL:DR – I wrote a song about a tragic tale in the news.

A contact on Mastodon read my post about the tragic tale of a Florida man who died from the so-called brain-eating amoeba. My contact thought the story or maybe just the headline sounded like a whimsical song from a band called The Chrysanthemums, Gloucestershire Is Just an Illusion. Althought I’d never heard of the band, I felt inspired and threw together some lyrics and recorded a little a capella lament. Poor fella.

Brain-eating amoeba

I woke up today
As you might have easily guessed
There’s one thing I must say
You might be a little impressed

I read in the news
There was a man out in Florida
Who liked to wash his nose
But, he didn’t bank on Naegleria

He caught a brain-eating amoeba
From the water in his neti pot
His hygiene wasn’t dry clean
Now the worms are dealing with his snot

He’d squirt water up each nostril
From a 6-inch length of hose
An amoeba wormed its way right in
And began to eat his nose

It slithered through his sinuses
And right into his brain
Sadly, so the story goes he was never the same again

He caught a brain-eating amoeba
From the water in his neti pot
His hygiene wasn’t dry clean
Now the worms are dealing with his snot

I woke up this morning
As you might have easily guessed
There’s one thing I got to say
Aren’t you just a little impressed?

My contact liked the vocal demo:

“Ah wow!! This is brilliant. I love it. See, tabloid headlines do, once in a blue moon, beget good songs. That’ll kill with a bit of angular guitar…sounded a bit like Yukio Yung/Terry Burrows”

So, I did some angular guitar, a new vocal, some drums (badly played on a MIDI keyboard), and some boxy bass…I might listen to Yukio Yung and The Chrysanthemums later.

You can still hear the original, rough and ready one-take vocal demo here

NB No intelligence, artificial or otherwise, was used in the writing and recording of this song.

Brain-eating amoeba

TL:DR – The brain-eating amoeba, Naegleria fowleri, does not eat brains but it can cause fatal brain swelling. Avoid it by only using sterile water for nasal irrigation and a noseclip when swimming in warm freshwater lakes.

Mrs Sciencebase was a yoga teacher for 20 years or thereabouts and one of the most peculiar aspects of that art was the use of the neti pot. A kind of jug with a long spout that allowed to pour a little water into your nostrils as part of a cleansing ritual. Technically known as nasal irrigation, but put simply it’s nothing more than pouring water into your nose.

CDC micrographs of Naegleria fowleri

It always struck me as a bit pointless, most of our bodily orifices are self-cleaning except perhaps when there is disease present and a trip to the doctor’s is recommend rather than a random infusion (see also douching, coffee enemas, ear candling etc). I should point out that Mrs Sciencebase was not a practitioner of this particular aspect of yoga.

Either way nowhere in the human laundry instructions does it say that our bodily orifices need any kind of irrigation. Of course, those same instructions also don’t mention climbing into the tumble dryer after a shower.

With all this in mind, I was a little bemused to hear of tabloid headlines (via @SophWarnes on twitter) of the case of a Florida man who died after irrigating his nostrils. Apparently a rare brain-eating amoeba, which goes by the name of Naegleria fowleri. This single-celled organism lives in fresh water and soil. It’s not a brain eater but if it gets into your head (via your nostrils) it can cause brain swelling with a high chance of death.

Primary amoebic meningoencephalitis (PAM) initially causes symptoms that are a bit like meningitis – fever, severe headache, nausea and vomiting. These can develop into stiff neck, light sensitivity, confusion, loss of balance hallucinations, seizures, and potentially death. It is worth noting that the amoeba does not eat brains. And, there were only 34 reported fatal cases in the USA according to the Centers for Disease Control (CDC). Most cases arose when someone was exposed to the pathogen when swimming in warm freshwater lakes or heated swimming pools that were not properly chlorinated. There is very little risk of PAM from drinking tap water.

The Healthline website has some advice for neti pot users. Basically, you should boil and coil tapwater you intend to use in your neti pot or buy sterilised water. Water filtered to NSF standard 53 should also be safe, according to the site.

Because PAM is so rare, studies and clinical trials for treatments are rare too. There is evidence that the antifungal agent, amphotericin B, injected close to the spinal cord can help. There is also some evidence that other antifungal agents have activity against N. fowleri: miltefosine, fluconazole, and azithromycin. The antibiotic rifampin may also work but would be contraindicated if an antifungal was being used, reports Healthline.

N. fowleri is very much a rare hazard of warm freshwater and so is generally present in the southern US states, but is also found in most other parts of the world – Australia, Africa, Asia, Europe, and Latin America. It might be assumed that with global warming, we are likely to see its presence in bodies of freshwater reaching further north from these regions.

Avian influenza, bird flu, H5N1

TL:DR – Scientists are worried that we might soon see the emergence of another pandemic, this one originating in avian influenza.

A bird flu pandemic has killed thousands of wild birds over the last couple of years. Scientists have now seen infection in mammals, and very recently a person died from avian influenza and several close contacts show signs of infection. The concern is that we might be headed for another H5N1 pandemic. Previous strains of H5N1 that infected people had a mortality rate of 60 percent.

Avian influenza, bird flu, H5N1

There are fifteen known variants of avian influenza. The most virulent, and usually fatal in birds, are the H5 and H7 strains. There are then nine variants of the H5 strain and the type of most concern because of the risk to human health is H5N1.

Up to May 2020, the World Health Organisation had reported a total of 861 human cases of bird flu, which killed 455 people since 2003. However, in February 2003, an 11-year-old Cambodian girl died of H5N1, her father tested positive and several close contacts had symptoms. At the time of writing, the WHO believes this strain of H5N1 is spreading among people and is pushing for a new human vaccine against the disease to be produced urgently.

Meet GINA, Global INitiative for Asthma

TL:DR – Thanks to GINA I have not needed to use salbutamol to treat my asthma for three years at the time of writing.

It’s three years since my asthma nurse introduced me to GINA, the Global INitiative for Asthma. It was a phone consultation because the then new virus SARS-CoV-2, which causes what became known as COVID-19, was beginning to spread. At the time, I was very worried that it would be a killer for me given my asthma. Eventually, medical science learned that people with asthma were not necessarily at any greater risk of morbidity and mortality.

Anyway, it was nice to meet GINA. GINA contradicts some of what general practitioners (GPs) in the UK have been advising asthma patients for years, but supports what the medical evidence suggests one should do in terms of medication. The main thing is GINA told me to stop using Salbutamol (the reliever spray) and to use my Symbicort (combined preventer with reliever spray) instead. Salbutamol is an old, out-of-date drug with some unpleasant side effects in long-term use, partly because it can affect the heart but mainly because inappropriate use in the absence of proper control of the condition with a preventer can lead to scarring in the lungs.

Modern relievers are more targeted to the lungs rather than other organs. Moreover, using the preventer at a higher dose, which is what my nurse recommended, means you reduce inflammation and mucus production, which are the main issues with asthma in parallel with episodic bronchoconstriction.

For three years, I have been taking twice as much preventer each day as I was before, and only very occasionally need to take extra to get a dose of reliever. I have not used Salbutamol at all in those three years and don’t expect to have to ever again. I no longer carry Salbutamol with me.

A GP friend was concerned when I told him about GINA, he reasoned, quite sensibly that taking this approach would be increasing one’s exposure to the preventer drugs, which are corticosteroids. This is true. But asthma is mostly about inflammation and these drugs reduce inflammation and so should reduce asthma symptoms. They do. He discussed the issue with colleagues and is now persuaded that GINA is a more sensible approach to asthma control than the current NICE recommendations in the UK. Hopefully, someone will introduce NICE to GINA soon.

Dual antidote for cyanide and carbon monoxide poisoning

TL:DR – Scientists have developed a life-saving antidote for exposure to the deadly gases hydrogen cyanide and carbon monoxide.

Scientists have made a groundbreaking discovery in the field of antidote development by creating a synthetic heme-model compound that has the potential to save lives in the event of simultaneous poisoning by carbon monoxide and hydrogen cyanide, which are frequently encountered in building fires. The compound, which has been tested on mice, resulted in an impressive 85% survival rate and rapid recovery. The chemical group known as heme is at the heart of hemoglobin, the oxygen-carrying molecule in our blood, and various enzymes in our body.

The researchers, led by Qiyue Mao of Doshisha University in Kyotanabe, Kyoto, Japan, and her colleagues, have published their findings in the scientific paper “A synthetic porphyrin as an effective dual antidote against carbon monoxide and cyanide poisoning.” The study shows that the antidote is highly effective and exhibits low toxicity. Moreover, the compound can be rapidly eliminated from the body through urinary excretion, making it an ideal antidote for emergency situations.

The fact that the synthetic heme-model compound is storable at room temperature is a significant advantage for emergency services, as it could be rapidly prepared and administered at the site of accidental exposure to fire-generated gases. The potential benefits of this discovery could be life-saving, and it represents a significant leap forward in the field of antidote development.

The compound was developed using porphyrin, a molecule that is known to bind to oxygen-carrying heme proteins in red blood cells. The synthetic heme-model compound mimics the structure of natural heme and binds to carbon monoxide and cyanide, preventing them from binding to the body’s own heme proteins. This mechanism of action makes the compound highly effective in treating poisoning by these deadly gases.

The findings of this study have significant implications for public health and emergency services. By providing a safe, effective, and easy-to-administer antidote, lives could be saved in emergency situations where carbon monoxide and hydrogen cyanide poisoning are a risk. The potential for this compound to be used in human patients is exciting and offers hope for those at risk of exposure to fire-generated gases.

Mao, Q. et al. Proc Natl Acad Sci, Feb 20, 2023

As an experiment, I used ChatGPT to edit the press release about this work from PNAS. The only changes I made were to add the sentence in italics at the end of the first paragraph, add the institution, and to change team to colleagues.

How real is artificial mindfulness?

TL:DR – In a perhaps contradictory experiment, I have used ChatGPT to offer readers some advice on mindfulness.

The chat about chatGPT is endless and intriguing. I caught sight of a debate on social media involving ministers and other churchy people about whether they could use the AI language model to write a sermon…or even a prayer. There was recognition that it was almost certainly happening. So, I thought…I wonder if chatGPT could produce something on mindfulness, a guide for those who wish to find some kind of enlightenment.

Mid Journey image: "A photorealistic cartoon of a seated woman in yoga attire in a peaceful natural, sunny setting by the sea surrounded by flowers and being mindful" — Mid Journey image on being mindful

This is the prompt I used:

You are an experienced mindfulness practitioner with a lot of wisdom and knowledge about the human condition. Give me some line by line advice for a novice who could use that advice as a guide on their life’s journey

This is how the bot replied:

Start small and be consistent: Begin with simple mindfulness practices, such as focusing on your breath for a few minutes each day, and make sure to stick with it. Consistency is key.

Notice your thoughts and feelings without judgement: Observe your thoughts and feelings without getting caught up in them or reacting to them. Simply acknowledge them and let them pass.

Find a balance between acceptance and change: Accept the present moment as it is, but also strive to make positive changes in your life.

Cultivate self-compassion: Treat yourself with the same kindness and understanding that you would offer to a good friend.

Connect with others: Nurture positive relationships and build a support system.

Practice non-attachment: Let go of attachments to material things and focus on what truly matters in life.

Find meaning and purpose: Reflect on what gives your life meaning and strive to align your actions with those values.

Cultivate gratitude: Regularly practice gratitude and appreciation for the good things in your life.

Learn to live in the present moment: Let go of regrets about the past and worries about the future.

Remember that growth is a process: Mindfulness is a journey, not a destination. Be patient and kind to yourself as you continue to learn and grow.

I then asked the bot for an executive summary of the above:

Mindfulness is a journey of self-discovery and growth. By practicing consistency, non-judgement, balance, self-compassion, connection with others, non-attachment, meaning and purpose, gratitude, living in the present moment, and being patient and kind to yourself, you can cultivate mindfulness, gain insight into your thoughts and emotions, and improve your overall well-being.

The image in this article was created by AI Mid Journey using the following /imagine prompt

“Photorealistic cartoon of a seated woman in yoga attire in a peaceful natural, sunny setting by the sea surrounded by flowers and being mindful”

This post almost ties in with a recent post I wrote without the assistance of the ChatGPT tool about using one’s internal patience app to improve one’s wildlife photography.

COVID-19 update

TL:DR – The COVID-19 pandemic is still with us, the January 2023 post summarises some aspects to date.

It has been a while since I added anything to the site about COVID-19. My periodic monitoring of the stats put out by the ZOE app suggests the disease is currently somewhat on the wane in the UK…for now. During the last few months of 2022, the figures for number of people active cases bounced up and down between around 2.5 million and 3.5 million in a couple of waves.

Today, when I check, the estimate is very much lower, 1.6 million. This figure is based on PCR and LFT tests and symptoms reported by the app’s almost 5 million users and is a statistical extrapolation from that data to the whole UK population. It hasn’t been this low since mid-September 2022. It doubled after that, then dipped again in early to mid-December to 2 million or so. It looks like the numbers have been steadily declining since then. There are, however, still almost 100,000 new cases daily in the UK.

The WHO statistics look a bit more complicated. Globally, there were almost 2.8 million new cases and over 13 000 deaths for the week 9th to 15th January 2023, representing a 0.46% mortality rate, which was down 7% on the previous week. But, if we look at 19th December 2022 to 15th January 2023 there were almost 13 million cases and nearly 53 000 deaths, an increase of 20% on the previous four weeks but a lower average mortality rate 0.41%.

The pandemic is in no way over. It is still advisable to wear a face covering in public places and to avoid high-risk areas and to reduce your risk of spreading the disease to vulnerable people. We should be pushing for governments and organisations to install good air filtering and sterilisation systems, not just to protect us from the SARS-CoV-2 virus that causes COVID-19, but also to be prepared for the next, inevitable, airborne disease, or even just a new variant that is more virulent than omicron. Maybe we could avoid a pandemic wave or an entirely new pandemic .

What is trypophobia? #TriggerWarning

TL:DR – Trypophobia is a fear or aversion to seeing clusters of holes.

Trypophobia is the name for the phobia (intense and apparently irrational fear) of irregular patterns or clusters of small holes or bumps. The term was coined by a web user back in 2005 on an internet forum. I always assumed its etymology lies in the word tripe and the Greek work for fear, maybe that is what she was thinking of. I find tripe repellant to look at (and eat, come to that).

trypophobia-trigger

It’s a weird one though isn’t it…why should anyone be scared of holes or bumps? Well, food full of holes might be rotten, whereas bumps might be present on food or skin because of disease. So, it could be that is the explanation. A subconscious response to seeing something that might cause harm.

But, as with lots of so-called irrational fears, nobody really knows. It seems like it’s not irrational to shy away from rotten food or snakes, or potentially lethal spiders, or being up high or trapped or exposed or whatever.

Me, I remember I had a dream as a child where my grandmother had a hole in her face from which were emerging lots of tiny flies, it was just a dream, but I still recall it and it makes my face tingle thinking about it. As does looking at some of those trypophobia triggers people post on the net, pictures of seed heads with holes, or photoshopped faces with lots of holes peppered in the skin. I’m not scared of any of these things as such, they just make my face tingle when I look at them or even just think about them.

I have a friend who has trypophobia who doesn’t like to see clusters of holes either, but she is also perturbed by seeing lots of the same animals, like insects or even flocks of birds. Again, the irrationality of it can be explained as perfectly rational if you think about the threat from certain insects or even birds.

In 2013, researchers Geoff Cole and Arnold Wilkins did a spectral analysis of visual trypophobia triggers and recognised that the same characteristics in those images are present in images of the skin and fur patterns of dangerous animals. So, maybe that’s part of the origins of this irrational fear too.

Trypophobia is yet to be officially recognised as a real condition, but for those of us who recognise the symptoms, it is very much a real condition, we just have to wait for the rest of the world to catch up. Some people have an extreme response to triggers while it is a very mild condition for some of us trypophobics.

The converse effect of the skin-crawling feeling of trypophobia is perhaps that pleasurable ASMR (Autonomous sensory meridian response) that certain sounds and images trigger. I first knew of the ASMR response when I listened to the Mike Oldfield album Platinum on headphones back in 1979. There is a track, Charleston, on that album which has a whispering scat section that flips back and forth through the stereo field and gives some listeners an ASMR type frisson, me included!

I originally wrote this post for my Sciscoop site back in May 2016 but noticed a lot of people reaching Sciencebase looking for trypophobia information and images. If you want to find images, any search engine prompted with the term trypophobia triggers, will do the job, there are so many real-world examples as well as artistic images that have been created as triggers. But, be warned, they could make your flesh crawl or give you goosebumps.

The correct spelling is trypophobia, but people are searching and landing here using misspellings including tryphobia, typhobia, thripopobia.