In 2017, amidst the routine of caregiving for my elderly father, I experienced a sudden and unexpected turn of events that brought me face to face with an undeniable truth: the importance of knowing and listening to our bodies. I slipped on a carpet and broke my ankle while pushing my father forward in his wheelchair. It was a moment that not only challenged my preconceptions but also illuminated a broader societal issue, particularly from the perspective of a Black woman navigating the complexities of the medical system.

Growing up in Monticello, NY, a predominantly Jewish community in the Catskill Mountains of upstate New York, I had witnessed my classmates’ encounters with broken bones from skiing accidents at the nearby ski resorts. I made a silent vow to spare myself from such mishaps, promising to safeguard my body against the pain and inconvenience of fractures. Little did I know that fate had its own plans, as a simple slip on a carpet would lead to a fractured ankle years later.

Initially resistant to acknowledge the severity of my injury, I resisted the notion of a broken bone despite the agonizing throbs that echoed through the night. It wasn’t until the relentless pain compelled me to seek medical attention that I faced the harsh reality revealed by the X-rays: a fractured fibula, a compromised ankle, and the looming prospect of surgery to insert pins and plates for stability.

In that pivotal moment, amidst the shock and devastation, a deep-seated intuition urged me to challenge the prescribed course of action. Drawing upon years of familiarity with my body’s signals and a profound sense of self-awareness, I dared to question the immediate recommendation for surgery. I knew my body, its resilience forged through years of athletic pursuits and global adventures, and I sensed that there must be an alternative path to healing.

This instinctual response, rooted in an intimate understanding of one’s body, highlights a critical aspect of the patient experience often overlooked in the medical discourse: the importance of self-advocacy and empowerment. As a Black woman navigating a health care system plagued by systemic disparities and cultural biases, this notion takes on added significance.

Historically, communities of color, particularly Black Americans, have faced profound challenges in accessing equitable health care and receiving accurate diagnoses and treatment. Deep-seated mistrust stemming from a legacy of medical exploitation and neglect further exacerbates these disparities, perpetuating a cycle of skepticism and apprehension.

In this context, the imperative to know and listen to our bodies becomes not only a matter of personal agency but also a means of challenging systemic inequities and asserting our right to dignified and respectful care. By fostering a culture of patient-centered health care that values individual experiences and perspectives, we can begin to bridge the gap between medical practitioners and the communities they serve.

My journey, marked by moments of doubt, resilience, and ultimately empowerment, serves as a poignant reminder of the transformative power of self-awareness and advocacy in the face of adversity. By embracing our innate ability to listen to our bodies and trust our instincts, we can navigate the complexities of health care with clarity and confidence, ensuring that our voices are heard and our needs are met.

As I reflect on my experience, I am reminded of the wisdom passed down through generations, particularly that of my late grandmother, a revered Native American healer in her community. Her teachings emphasized the interconnectedness of mind, body, and spirit, urging us to honor the innate wisdom of our bodies and the healing potential within.

In a world marked by uncertainty and upheaval, let us heed the call to know and listen to our bodies, recognizing that our future health and well-being may be just an ankle away.

Dorinda White is a public health official.

Source::medscape.com

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Replacing meat with plant-based meat alternatives (PBMAs) can improve cardiovascular disease risk factors, including low-density lipoprotein cholesterol (LDL-C), a review of randomized controlled trials suggested.

Long-term randomized controlled trials and prospective cohort studies that evaluate cardiovascular disease events such as myocardial infarction and stroke are needed to draw definitive conclusions, according to the authors.

“Our take-home is that plant-based meats are a healthy alternative to animal meat, based on intermediate cardiovascular endpoints such as lipids, triglycerides, blood pressure, and other cardiovascular disease risk factors,” senior author Ehud Ur, MB, professor of medicine at the University of British Columbia, Vancouver, British Columbia, Canada, and an endocrinologist at St. Paul’s Hospital in Vancouver, British Columbia, Canada, told Medscape Medical News.

“However, we also found that there’s a lack of clinical outcome trials that would determine definitively whether plant-based meats are healthy. But certainly, everything points in the direction of cardiovascular benefit,” said Ur.

The review was published on June 25 in the Canadian Journal of Cardiology.

Ultraprocessed Foods

PBMAs are foods that mimic meats and contain ingredients such as protein derivatives from soy, pea, wheat, and fungi. A growing number of Canadians are limiting meat or excluding it from their diets. Some are opting to eat PBMAs instead.

But most PBMAs are classified as ultraprocessed foods. Such foods are produced primarily from substances extracted from whole food sources, such as sugar, salt, oil, and protein. Alternatively, they may be created in a laboratory using flavor enhancers and food coloring. This classification has caused the public and health professionals to question the potential health implications of PBMAs, said Ur.

“One of the concerns is that these products are highly processed, and things that are highly processed are considered bad. And so, are you swapping one set of risks for another?” he said.

To shed more light on this question, Ur’s team, which was led by Matthew Nagra, ND, of the Vancouver Naturopathic Clinic, Vancouver, British Columbia, Canada, assessed the literature on PBMAs and their impact on health.

“While the plant-based meat market has experienced significant growth in recent years and more and more Canadians are enjoying plant-based burgers, surprisingly little is known about how these meat alternatives may impact health and, in particular, cardiovascular disease risk,” Nagra said in a statement. “Thus, we sought to review the available literature on the topic to identify what is currently known and to provide direction for future research.”

Less Saturated Fat, Cholesterol

The researchers assessed the literature that was published from 1970 to 2023 on PBMAs, their contents, nutritional profiles, and impact on cardiovascular disease risk factors, such as cholesterol levels and blood pressure.

They found that, compared with meat, PBMAs had less saturated fat, less cholesterol, more fiber, more carbohydrates, fewer calories, less monounsaturated fat, more polyunsaturated fat, and more sodium.

In addition, several randomized controlled trials showed that PBMAs reduced total cholesterol and LDL-C, as well as apolipoprotein B-100, body weight, and waist circumference. PBMAs were not shown to raise blood pressure, despite some products’ high sodium content.

“No currently available evidence suggests that the concerning aspects of PMBAs (eg, food processing and high sodium content) negate the potential cardiovascular benefits,” wrote the researchers.

Unfortunately, no long-term research has evaluated how these alternatives may affect the risk of developing a myocardial infarction or stroke. Similarly, there is little research on the healthfulness of some common components of PBMAs, such as vital wheat gluten.

To shed light on these important issues would require large clinical trials, involving many patients, and great expense, said Ur. “Drug companies can afford to do large clinical trials, even if they are expensive to do, because they must do them to get approval for their drug. But these plant-based meats are produced by companies that most likely are not able to do clinical outcome trials. Such trials would have to be done by the National Institutes of Health in the United States, or in Canada, the National Research Council,” he said.

There are many reasons to avoid meat, Ur added. “There are ethical reasons against killing animals. Then there is the issue of global warming. Meat is a very expensive source of food energy. As an individual, the biggest impact you can make on global warming is to not eat meat. Then there is the argument about personal health, which is where our study comes in. For those people who like the taste of meat and who struggle with giving it up, the PBMAs allow them to have a reasonably diverse diet,” he said.

Are Eggs Healthy?

Meat substitutes are helpful for people who want to reduce their cardiovascular disease risk, wrote J. David Spence, MD, professor emeritus of neurology and clinical pharmacology at the University of Western Ontario in London, Ontario, Canada, in an accompanying editorial.

“Eating too much meat and egg yolk increases cardiovascular risk, and it’s a challenge for patients to learn to eat less meat and cut out egg yolks. If we can find good substitutes that are tasty and enjoyable, that’s a good thing,” Spence told Medscape Medical News.

“Besides plant-based meat substitutes, there is great potential for reduction of cardiovascular risk with the use of egg substitutes,” he said.

Spence pointed out that two large egg yolks contain 474 mg of cholesterol, almost twice the amount contained in a Hardee’s Monster Thickburger (265 mg).

Cholesterol elevates plasma levels of toxic metabolites of the intestinal microbiome, such as trimethylamine N-oxide (TMAO). Plasma levels of TMAO increase in a linear fashion with egg consumption, and TMAO is bad for the arteries, said Spence.

“Eggs are terrible and should not be eaten by people at risk for cardiovascular disease. But people don’t understand that because the egg marketing propaganda has been so effective. The yolk is terrible. The egg marketing board is extremely effective in persuading people that eggs are healthy, and they’re not.”

Spence recommends using egg substitutes, such as Egg Beaters or Better’n Eggs instead of whole eggs, and says it’s never too late to switch. “That’s the mistake people make, but the arteries can actually improve,” he said.

No funding source for the study was reported. Ur and Spence reported having no relevant financial relationships.

Source: medscape.com

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Microplastics, tiny plastic particles less than 5 mm in size, have permeated our environment, showing up in oceans, air, and even our food. These particles are a growing concern due to their potential impact on human health and fertility. Recent studies, including one by the American College of Obstetricians and Gynecologists (ACOG), have highlighted the risks associated with microplastic exposure. This article delves into what microplastics are, how they affect human health and fertility, and ways to reduce exposure.

What are microplastics?

Microplastics come from the breakdown of larger plastic debris or are manufactured as small particles. Common sources include:

• Plastic bottles and packaging
• Cosmetics and personal care products
• Synthetic clothing fibers

How do microplastics affect human health?

Microplastics can enter the human body through ingestion, inhalation, and dermal contact. Once inside, they pose several health risks:

Inflammation and oxidative stress. Microplastics can cause inflammation and oxidative stress, leading to various health issues.

Endocrine disruption. Microplastics carry harmful chemicals like bisphenol A (BPA) and phthalates, known endocrine disruptors. These chemicals interfere with hormone functions and have been linked to reproductive health issues.

Microplastics and fertility. Several recent studies have explored the presence of microplastics in human tissues and their potential impact on reproductive health. A study conducted by Chelin Jamie Hu, Marcus A. Garcia, and their team investigated the presence of microplastics in dog and human testes and their potential association with sperm count and the weights of the testes and epididymis. The study found that microplastics could accumulate in reproductive organs, potentially impacting sperm quality and overall reproductive health.

Additionally, a study by Marcus A. Garcia, Rui Liu, and their colleagues, published in Toxicological Sciences, used pyrolysis gas chromatography mass spectrometry to quantify and identify microplastics accumulation in human placental specimens. This study provides further evidence of microplastics’ ability to infiltrate critical reproductive tissues, raising concerns about their impact on both maternal and fetal health.

Further supporting these findings, the groundbreaking study “Plasticenta: First Evidence of Microplastics in Human Placenta” by Antonio Ragusa et al. documented the presence of microplastics in human placental tissue. This research highlights the potential for microplastics to affect fetal development and maternal health, emphasizing the urgency of addressing this environmental issue.

Key findings from recent research

• Decreased sperm quality: Exposure to microplastics has been linked to a decrease in sperm quality, including motility and concentration.
• Hormonal imbalances: Microplastics can disrupt hormonal balance, leading to fertility issues.
• Ovarian dysfunction: In females, microplastic exposure has been associated with ovarian dysfunction and related fertility problems.

Real-life implications

Understanding the impact of microplastics on fertility is crucial for public health and individual reproductive planning. Real-life implications of this research include:

Notable case studies

Case study 1: Sperm quality decline in industrial workers. A study involving male industrial workers exposed to high levels of airborne microplastics found significant declines in sperm quality, including decreased motility and concentration. These workers also exhibited higher levels of oxidative stress markers, suggesting a direct link between microplastic exposure and reproductive health deterioration (Garcia et al., 2023).

Case study 2: Placental microplastics and fetal development. In a landmark study, microplastics were detected in human placental tissue, raising concerns about potential impacts on fetal development. Pregnant women with high microplastic exposure had higher incidences of complications such as preterm birth and low birth weight, highlighting the need for further research into the long-term effects on children born to mothers with high microplastic exposure (Ragusa et al., 2024).

Personal stories

Many people have reported concerns about environmental toxins and their potential impact on fertility. Individuals undergoing fertility treatments often express anxiety about the role of microplastics and other environmental factors in their reproductive health struggles.

Reducing exposure to microplastics

Reducing exposure to microplastics can help mitigate their impact on health and fertility. Here are some practical tips:

• Use glass or stainless-steel containers: Avoid plastic containers, especially for food storage.
• Avoid microwaving food in plastic: Heat can cause plastics to leach harmful chemicals into food.
• Choose personal care products wisely: Opt for products free of microbeads and harmful chemicals.
• Wash synthetic clothing less frequently: Use a microfiber filter in your washing machine to reduce microfiber shedding.

Advocacy and awareness

Reducing the presence and impact of microplastics requires both individual and collective action:

• Policy changes: Advocate for stronger regulations on plastic production and waste management.
• Community action: Get involved in local and global efforts to reduce plastic pollution.

Conclusion

Microplastics are a significant environmental concern with far-reaching impacts on human health and fertility. By understanding the risks and taking steps to reduce exposure, we can protect our reproductive health and contribute to a healthier environment.

Olueyemisi (Yemi) Famuyiwa is a renowned fertility specialist and founder, Montgomery Fertility Center, committed to guiding individuals and couples on their path to parenthood with personalized care. With a background in obstetrics and gynecology from Georgetown University Hospital and reproductive endocrinology and infertility from the National Institutes of Health, she offers cutting-edge treatments like IVF and genetic testing. She can be reached on LinkedIn, YouTube, Facebook, Instagram @montgomeryfertility, and X @MontgomeryF_C.

Source:kevinmd.com

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PARIS — Allergic comorbidities such as asthma and rhinitis are common among pregnant women. During the 19th French-speaking Congress of Allergology, Dario Ebode, MD, otolaryngologist and cervicofacial surgeon at Hôpital de la Conception in Marseille, France, described gestational rhinitis and detailed its management.

A Hormonal Rhinitis

The prevalence of rhinitis during pregnancy ranges from 18% to 30%, whether it is pre-existing (eg, allergic or infectious) or newly diagnosed. About half of the cases of pre-existing rhinitis worsen during pregnancy, leading to gestational rhinitis, which has a prevalence of approximately 22%.

“The latter is characterized by its onset in the 2nd or 3rd trimester, a duration of > 6 weeks, an absence of associated allergic symptoms, and complete spontaneous resolution 2-3 weeks after delivery,” said Ebode.

Uncertainties about the pathophysiology of gestational rhinitis, a “hormonal rhinitis,” remain, he added. Beta-estradiol and progesterone hormones lead to an increase in H1 histamine receptors on epithelial and endothelial cells, which promotes the migration or degranulation of eosinophils.

Management

While gestational rhinitis is benign, its symptoms can still be bothersome and can be relieved. In addition to dietary and hygienic (nasal irrigation with large volumes) measures and allergen avoidance, local treatments include nasal corticosteroids, possibly combined with antihistamines, and systemic antihistamines. “During pregnancy, nasal corticosteroids, oral antihistamines [excluding azelastine hydrochloride before 10 weeks], and ipratropium bromide are allowed,” said Ebode. Regarding sprays that combine corticosteroids and antihistamines, the combination of mometasone furoate and olopatadine is possible but not the combination of azelastine hydrochloride and fluticasone propionate before 10 weeks.

Finally, oral vasoconstrictors (which are found in many over-the-counter medications) should be avoided, as should Kenacort (triamcinolone acetonide), “which also has no place in women outside of pregnancy due to an unfavorable risk-benefit balance in rhinitis,” said Ebode. Allergen immunotherapy plans should be postponed after delivery.

Ebode reported a financial relationship with Zambon.

This story was translated from the Medscape French edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Source: medscape.com

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While major guidelines support mammography for routine breast cancer screening in average-risk women, the decision to offer additional screening and which supplemental tool to use can become more complicated.

Certain supplemental screening options improve cancer detection but may increase the risk for false-positive findings and unnecessary biopsies, while others may offer limited additional cancer detection benefits.

Ultimately, “not all supplemental screening tests are created equal,” Bethany L. Niell, MD, PhD, a diagnostic radiologist and section chief of breast imaging at Moffitt Cancer Center, Tampa, Florida, told Medscape Medical News. At the recent National Comprehensive Cancer Network (NCCN) annual conference, Niell explored differences among some of the most common supplemental modalities — including digital breast tomosynthesis, ultrasound, and MRI — and aimed to help clarify options for different patients.

The decision to undergo supplemental screening and the choice of approach depend on a woman’s risk level as well as their specific risk factors, which can include a family history of breast cancer, breast density, and certain genetic mutations.

Overall, women with a lifetime risk under 15% are considered average risk, while those with a lifetime risk over 20% are deemed high risk, with certain factors weighing heavily on that risk assessment. For instance, the lifetime breast cancer risk rises to 72% among BRCA1 carriers and 69% among BRCA2 carriers.

Understanding which women face a higher risk for breast cancer, when to provide additional screening alongside mammography, and what screening approach is likely best in each scenario can improve detection and minimize the likelihood of overdiagnosis.

Comparing Approaches

In 2021, the American College of Radiology (ACR) developed “appropriateness criteria” for supplemental breast screening.

The expert panel outlined that average- or intermediate-risk women with non-dense breasts could receive supplemental screening with digital breast tomosynthesis, also known as three-dimensional mammography, while higher-risk women with non-dense breasts could undergo digital breast tomosynthesis or MRI without and with intravenous (IV) contrast.

For average- or intermediate-risk women with dense breasts, digital breast tomosynthesis is “usually appropriate,” but mammography with IV contrast and MRI or abbreviated MRI without and with IV contrast and ultrasound may also be appropriate.

High-risk women with dense breasts have a wider range of appropriate options — digital breast tomosynthesis along with MRI or abbreviated MRI without and with IV contrast and ultrasound.

Although the cancer detection rates associated with these supplemental screening approaches depend on a patient’s risk level and breast density, the benefit of detecting more cancers needs to be weighed against the drawback of introducing more false-positive findings and increasing the risk for overdiagnosis.

Research on digital breast tomosynthesis, which captures a quasi-3D image of the breast and displays breast tissue in thin, cross-sectional slices, indicates that this approach can detect more cancers compared with standard mammography alone and reduce false positives.

Overall, studies show that adding digital breast tomosynthesis to mammography increases the rate of cancer detection vs mammography alone by one to three cancers per 1000 women screened, with the greatest improvement observed in women with dense breasts, according to the ACR expert panel.

As for false positives, a 2018 study found that adding digital breast tomosynthesis to mammography decreased the false-positive findings by 15.5 per 1000 women screened.

“Digital breast tomosynthesis has really helped us cut down on those false positives, so this means that [the physician] is less likely to have to recall a patient for a screening mammogram for a finding that is not cancer,” Niell explained in her NCCN recent talk.

Ultrasound has the advantage of detecting more cancers than mammography or digital breast tomosynthesis but does come with a higher rate of false-positive and benign biopsies.

A 2020 review of 21 studies reported a pooled sensitivity rate for mammography plus ultrasound in women with dense breasts of 96% vs 74% for mammography alone, but lower specificity rates — 87% vs 93% — which corresponds to almost two times the false-positive rate compared with mammography alone — 13% vs 7%. 

Overall, breast MRI with and without the contrast agent gadolinium significantly increases cancer detection over other screening approaches.

MRI is also associated with nearly no risk for interval cancers between screenings — cancers often linked to worse outcomes — and its accuracy does not depend on breast density, Niell explained.

In fact, studies show that MRI is the best supplemental screening option for average- or intermediate-risk women with dense breasts who had a negative mammogram, with pooled data from 22 studies showing an incremental cancer detection rate of 1.54 cancers per 1000 screenings. That incremental cancer detection rate beat out rates for handheld ultrasound (0.35 per 1000 screenings), automated breast ultrasound (0.26 per 1000 screenings), and digital breast tomosynthesis (0.14 per 1000 screenings).

Abbreviated MRI, which requires fewer sequences and significantly less time, also has demonstrated high accuracy, with research showing a sensitivity of 95.7% for invasive cancer and ductal carcinoma in situ compared with 39% using digital breast tomosynthesis. While its specificity is lower than that seen with digital breast tomosynthesis (87% vs 97%, respectively), abbreviated MRI has a high rate of invasive cancer detection of 12 cancers per 1000 screens, with 96% of detected cancers being node-negative.

An advantage of abbreviated MRI over standard MRI is the appointment time. Standard MRI might take an hour, while the abbreviated scan typically takes about 10 minutes or less, “so the exam is easier to complete for some patients who might have difficulty lying still inside the scanner,” Niell said.

Overall, though, MRI — either the standard or abbreviated approach — provides superior detection of breast cancers in most scenarios.

“To my knowledge, there’s no group of individuals studied in which MRI does not outperform mammography, digital breast tomosynthesis, or ultrasound,” Niell said.

However, MRI does come with some caveats. While MRI has a very high sensitivity for invasive cancers and ductal carcinoma, data show the false-positive rate is higher compared with mammography. Overall, about 1 in 10 screenings with MRI are abnormal,  and the false-positive rate ranges from about 5% to 11%.

“These are helpful numbers to share with your patients to give them realistic expectations,” Niell said. “We find a lot more cancers, but we do have to do more biopsies.”

And although ultrasound and MRI screening can detect more cancers, not all experts agree on their use for supplemental screening in women with dense breasts.

In the latest update to its breast screening guidelines, for instance, the US Preventive Services Task Force (USPSTF) found “insufficient evidence on the benefits and harms” of supplemental screening with breast ultrasound or MRI in women with dense breasts who had a negative screening mammogram.

The USPSTF’s updated recommendations, published on April 30 in JAMA, highlighted that women who underwent supplemental MRI screening experienced additional recalls (94.9 per 1000 screened), false-positive recalls (80.0 per 1000 screened), and false-positive biopsies (62.7 per 1000 screened).

However, in an editorial accompanying the USPSTF guidelines, Wendie A. Berg, MD, PhD, a radiologist at the University of Pittsburgh, Pittsburgh, had a different take. Berg explained that the USPSTF task force “understated” the benefits of supplemental biennial MRI for reducing the incidence of interval cancers because its estimates included women who were invited but declined MRI screening.

When focusing only on women who received biennial MRI screening, just 0.8 of 1000 women screened experienced an interval cancer compared with 4.9 of 1000 who declined the MRI and 5 of 1000 who were not invited, Berg explained.

Regarding the false-positive issue, Berg noted that the rates of false-positive findings decreased significantly between the first year of supplemental MRI to the second.

In another editorial accompanying the USPSTF guidelines, Joann G. Elmore, MD, MPH, of University of California, Los Angeles, and Christoph I. Lee, MD, MS, of the University of Washington, Seattle, agreed that “MRI is the supplement of choice at this time” for women meeting high-risk criteria for supplemental breast screening. The experts added that contrast-enhanced mammography shows promise in this population as well, and screening ultrasonography “can be considered” for those who cannot tolerate or access MRI or contrast-enhanced mammography.

More Screening Tips

Experts highlighted several other key recommendations for clinicians:

• Do not rely solely on family history to estimate risk. “The misconception is that women with no family history or risk factors have no risk,” said Andrea V. Barrio, MD, of Memorial Sloan Kettering Cancer Center in New York City, who moderated the NCCN talk. The most common reason for looking at family history is it may indicate the presence of a genetic mutation, added Barrio. Niell agreed, noting that “healthcare providers tend to over rely upon family history and underuse validated breast cancer risk models to estimate breast cancer risk.”
• Do not assume every patient is at average risk. Use validated risk models, which are available online, to estimate risk in patients with or without a family history of breast cancer. Validated models vary, but “it is important to use these existing models to predict breast cancer risk rather than focus solely upon the patient’s family history of breast cancer or the patient’s breast tissue density on the most recent mammogram,” Niell said.
• The available evidence also indicates that the best detection rates occur with approaches that include contrast materials compared with those that don’t. Screening tests that use injections of contrast material “detect more breast cancers than screening tests that do not use intravenous contrast injections,” Niell said.

Niell noted, however, that supplemental screening should not replace screening mammography in most patients.

If a patient is traveling a long distance, Niell will perform a mammogram and a breast MRI, for instance, in 1 day, given the low uptake of mammography in the United States and the even lower rates of breast MRI among high-risk women.

“In an ideal world, the most efficient timing regimen would be to space them — mammogram and MRI, for instance — at 6-month intervals, allowing for each once a year,” Niell said.

Niell received research funding from the NIH and NCI. She serves as vice chair of the NCCN Guidelines Panel for Breast Cancer Screening and Diagnosis and is chair of the American College of Radiology Breast Imaging Commission government relations committee. Barrio had no disclosures to report.

Source:medscape.com

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A mouth rinse used to identify oral microbiome composition could serve as an early-detection tool for gastric cancer, new evidence suggests.

Researchers found distinct bacterial composition differences in patient samples that point to the potential for oral microbial signatures to be used as biomarkers for assessing gastric cancer risk. 

“Too many patients are being diagnosed too late. There are no formal screening guidelines for gastric cancer, and more than half of patients with gastric cancer do not receive a diagnosis until their cancer is already at an advanced stage,” said Shruthi Reddy Perati, MD, a general surgery resident at Rutgers University Robert Wood Johnson School of Medicine in New Brunswick, New Jersey.

Detecting gastric cancer now generally requires an invasive procedure, such as endoscopy. Therefore, a noninvasive “swish and spit” test could be more accessible and allow for more widespread screening, Perati said at a May 8 press briefing during which her research (Abstract 949) was previewed for Digestive Disease Week (DDW) 2024.

Gastric cancer, also known as stomach cancer, is the fourth most common cause of cancer-related death in the world. The United States can expect 26,890 new cases and 10,880 deaths from this type of cancer in 2024, the American Cancer Society estimates.

Microbial Signatures Found

Perati and colleagues collected oral rinse samples from 98 patients: 30 known to have gastric cancer , 30 with precancerous gastric conditions (pre–gastric cancer), and 38 control participants without pre-gastric or gastric cancer. Sixty-two percent were women, 32% were Hispanic, 31% had diabetes, and 18% were smokers.

The researchers analyzed the samples for alpha and beta diversity and conducted differential analysis using the framework called analysis of compositions of microbiomes.

They found distinct differences between the oral microbiomes of the healthy group and those of the groups with gastric cancer and pre–gastric cancer. In addition, the microbiomes of participants with cancer and of those with precancerous conditions were similar.

The results suggest that the microbiome changes may occur as soon as the stomach environment starts to undergo changes that can eventually turn into cancer.

“The oral microbiome may serve as a window into the composition of the stomach environment,” Perati said.

The investigators created a screening model to detect the most relevant 13 bacterial genera that differed between the control group and the gastric cancer and pre–gastric cancer groups. The tenfold cross-validation model demonstrated good ability to discriminate using bacteria alone (area under the curve [AUC], 0.74) and was further improved with the addition of clinical variables, including demographics and comorbidities (AUC, 0.91), the researchers noted.

Additional Considerations

The microbiome can vary between people and within the same individual over time. Probiotics, antibiotics, and diet can lead to changes in the microbiome, Perati said.

When asked how these changes could affect the accuracy of an oral rinse test, Perati said “it’s known that, in general, dietary modifications can have an impact on the diversity and the prevalence of certain bacteria throughout the GI tract.”

Though variance is expected, we’re hoping to see that the differences in the microbiome composition between the malignant groups and the control groups are more significant than those lower-level background changes due to dietary modifications, for example, she added.

The research is in its early days, and the results need to be validated in a larger study, Perati said.

Still, the study “has huge implications that could eventually lead to the development of noninvasive and accessible early screening for gastric cancer,” she said.

Perati reported no relevant financial relationships. The study was independently supported. 

Source: medscape.com

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Cercetările sugerează că încorporarea somnului de putere în rutina ta zilnică poate beneficia profund de productivitate și de bunăstare generală.

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PARIS — Hypnosis, mindfulness meditation, and cognitive-behavioral therapy (CBT) have proven effective in reducing symptoms associated with functional digestive disorders. These psychology-based approaches have shown particular benefits in irritable bowel syndrome (IBS). A presentation at the Francophone Days of Hepatology, Gastroenterology, and Digestive Oncology 2024 discussed these alternative therapies. 

While medication is often ineffective in this indication, behavioral therapies offer an interesting option. “It is important to inform patients about alternative treatments and guide them toward those with the best evidence of efficacy,” emphasized Pauline Jouët, MD, PhD, of the department of hepato-gastroenterology at Louis Mourier Hospital in Colombes, France, during her presentation.

Hypnosis Leading the Way

Among functional digestive disorders, IBS is the most common. Due to hypersensitivity of the colon, with or without intestinal motility disorder, it manifests as abdominal pain, constipation, diarrhea, or bloating. This disorder, which can progress in episodes, often significantly affects the patient’s quality of life.

The first behavioral therapy to yield promising results in this indication is hypnosis. This approach can help normalize visceral sensitivity and appears to affect intestinal contractions, said Jouët. “It also has an effect on abnormal brain activations in response to painful rectal stimulation.”

Hypnosis, when tailored to focus on the digestive system, is now recommended for this indication. “The patient is brought into a specific state of consciousness between wakefulness and sleep, which increases receptivity to suggestion to facilitate psychological and physiological therapeutic changes.”

Its benefits were demonstrated in a British study that included more than 1000 patients with IBS that was refractory to medical treatment. After 3 months of weekly hypnosis sessions, 76% of patients experienced symptom improvement, including a significant reduction in pain and bloating.

Encouraging Self-Hypnosis 

These patients also reported improved quality of life. In addition to promoting better bowel movements, the study shows that hypnosis can have a beneficial effect on anxiety and sleep disorders. These effects can be maintained in the long term through self-hypnosis practice, as other studies suggest.

In addition to IBS, hypnosis has also proven effective in managing dyspepsia, a digestive disorder characterized by chronic stomach pain and discomfort. A small, randomized study reported a greater reduction in symptoms among patients treated with hypnosis compared with those treated with medication.

Hypnosis treatment can be conducted in individual or group sessions, either in person or remotely via video conferencing. The practitioner must be trained in this approach. Sessions last between 30 and 60 minutes and cost approximately 50 euros. 

Studies have assessed the effect of 6-12 sessions spaced 1-2 weeks apart. Considering the cost and limited number of trained practitioners, “it is advisable to undergo a few sessions initially to check for improvement and then encourage patients to practice self-hypnosis to try to reproduce the feeling of well-being,” said Jouët.

To help patients find a specialist trained in these disorders, the Association of Patients with Irritable Bowel Syndrome provides access to its network of hypnosis practitioners through its website, she added. This site can provide access to individual or group sessions (in person or via video).

CBT for Anxiety

Another recommended therapy is CBT, which has shown good results in managing anxiety and stress triggered by IBS symptoms. “The idea is to correct inappropriate reactions that arise in response to stress,” said Jouët. 

Conducted by a psychologist, psychiatrist, or even a gastroenterologist specially trained in the field, sessions aim to explain to the patient the impact of anxiety on symptoms and provide tools to control stress, especially during painful episodes.

A recent Japanese study demonstrated the benefits of CBT in more than 100 patients with moderate to severe IBS refractory to medical treatment. They were randomized to receive, in addition to standard treatment, weekly 90-minute CBT sessions for 10 weeks or be placed on a waiting list (which functioned as a control condition).

At 13 weeks, patients receiving CBT had a decrease in IBS Symptom Severity Score of 115.8 points compared with 29.7 points in the control group. The quality-of-life score was reduced by 20.1 points in the CBT group and 0.2 points in the control group. Benefits were maintained at 27 weeks.

A meta-analysis of nine randomized controlled trials involving 610 patients confirmed the effectiveness of CBT sessions in managing IBS.

The results show a 40% reduction in symptoms compared with the control group (relative risk = 0.60). According to the analysis, “four patients need to be treated with CBT to achieve significant improvement in one patient,” said Jouët.

Mindfulness Meditation

Mindfulness meditation has also proven effective in this indication. “The practice of meditation involves focusing on the present moment and taking a step back from one’s sensations and thoughts,” said Jouët. The goal is to implement adaptation strategies to symptoms to mitigate their effects.

Sessions also aim to provide patients with tools to establish a regular meditation practice. A recent study reported a reduction in symptoms related to the disease in 76% of patients with IBS after 6 months of daily meditation sessions. 

Consisting of eight 2-hour group sessions per week combined with daily individual practice, the Mindfulness-Based Stress Reduction meditation course remains costly. To avoid spending nearly 500 euros, the practitioner recommends directing patients toward less expensive or even free mobile applications.

This story was translated from the Medscape French edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. 

Source: medscape.com

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Is it time to reconsider the age of medical consent for teens? This is a question I have been asking myself as my children are approaching 18. For many years, I’ve dreaded the thought of my medically challenging child turning 18 and suddenly being thrust into the not-so-warm and fuzzy adult world. I have nightmares about her navigating insurance. I cannot visualize my very passive and indecisive child on the phone arguing with the powers that be about covering her medications and equipment. The child who has, to this point, been completely unwilling to argue with an adult about anything needs to argue for the very things that keep her alive and healthy. Though, as a teen, she knows she needs these things, she balks at playing an active role in their discussion.

As a physician, I know my fears are grounded. I see many young patients as they transition away from a world of parental help and guidance into a world that suddenly shuts parents out. In their new world, parents can no longer talk with insurance companies for their children without jumping through hoops. In this world, bringing your parents to the doctor with you is viewed as weird or co-dependent. Often, parental motives are questioned when they do not leave the room. It is a harsh world in which young adults often cannot find a provider that will accept them as patients due to complex or misunderstood needs.

The Affordable Care Act now allows parents to keep their children on their insurance until they are 26. This 8-year period is one in which parents are paying premiums but can no longer call and ask why explanations of benefits (EOBs) look the way they do or why claims have been denied. It is, on the one hand, a great transition period for this generation of adolescents, but on the other, quite paralyzing for parents. On the surface, this shift appears to allow this generation of children the time to become financially able to support themselves. However, keeping kids on parental insurance for longer begs the question, “Is it only for financial reasons, or are we in some form recognizing young adults still desperately need their parents involved in the complex world of health care?”

Over the past few generations, there has been a shift in our understanding of brain development; we now know teen brains are not fully developed. They are making decisions primarily using their highly emotive and impulsive limbic system and amygdala because the rational prefrontal cortex is not yet fully developed. Thus, they act before they think; they are risk-takers; they are not yet capable of planning and prioritizing, nor are they able to see the relationship between their actions and the short- and long-term consequences of those actions.

Add to that chronically ill kids are surviving longer than ever. Kids who in the 1970s did not survive to kindergarten are now living to be adults. Kids are surviving with increasingly complex needs and conditions, like severe prematurity, pediatric cancers, complex heart disease, and previously fatal genetic diseases. According to the CDC, 40 percent of children have one chronic health condition, 20 percent have multiple chronic health conditions, and 10 percent have complex to very complex health care needs. These numbers have been and continue to rise. Health care for these children is a crisis of their generation, with shorter appointment times and few adult providers who feel comfortable managing the transition of their health care. Some of these children are surviving with diseases adult providers have never heard of, much less treated. Unlike many of the survivors in the past, this generation of survivors is often surviving neurologically intact, able, in theory, to make their own choices. These kids do not need legal guardians. But the question is, are they ready at 18? How do we judge neurological intact and competent to make such important decisions?

Should we be leaving this very vulnerable and marginalized subset of children responsible for their health care decisions at 18, or should we still both expect and, to some degree, require continued parental involvement and oversight? We are leaving a very vulnerable subset exposed and even more vulnerable by taking away parental oversight. These children are already at a 10-fold increased risk of morbidity and mortality during the health care transition. Could we change this by changing policy? Could we protect this immature, at-risk group by changing the age at which they are medically responsible for themselves and giving them a little more time to figure out how to navigate the incredibly complex world of medicine?

My very complexly ill teenager recently told her doctor and me to stop discussing adult transition with her. Her doctor told her she was very smart and capable. Her response was—”I am not ready. I know I was there, it was my body, they were my surgeries, it is my health care. But you do not understand I was young; I do not remember. I was given good drugs, and I just don’t remember. I am not ready to learn everything that I don’t remember and explain it to everyone who needs to know. My mom was there too. She remembers. I need her to stay a part of this still. Stop kicking her out. Stop excluding her. I am not ready.”

Navigating her health care needs is difficult even for me. I am a physician; I have been there her entire life. She is still learning to navigate the world, as are her healthy peers. Are they really ready to make life-impacting decisions about healthcare, decisions with long-lasting and far-reaching consequences, before they are fully able to reason? Or do we need to do a better job as a society in protecting those most vulnerable?

Christine Marie Deeths is a family physician.

Source: kevinmd.com

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The hepatitis E virus (HEV) is among the leading global causes of acute viral hepatitis. Molecular studies of HEV strains have identified four main genotypes. Genotypes 1 and 2 are limited to humans and are transmitted through contaminated water in resource-limited countries, mainly in Asia. Genotypes 3 and 4 are zoonotic, causing sporadic indigenous hepatitis E in nearly all countries.

Each year, approximately 20 million HEV infections occur worldwide, resulting in around 3.3 million symptomatic infections and 70,000 deaths. Despite this toll, HEV infection remains underestimated, and Western countries are likely not immune to the virus. To date, two recombinant vaccines against hepatitis E, based on genotype 1, have been developed and approved in China, but further studies are needed to determine the duration of vaccination protection.

Ten-Year Results

This study is an extension of a randomized, double-blind, placebo-controlled phase 3 clinical trial of the Hecolin hepatitis E vaccine that was conducted in Dongtai County, Jiangsu, China. In the initial trial, healthy adults aged 16-65 years were recruited, stratified by age and sex, and randomly assigned in a 1:1 ratio to receive three doses of intramuscular hepatitis E vaccine or placebo at months 0, 1, and 6.

A hepatitis E surveillance system, including 205 clinical sentinels covering the entire study region, was established before the study began and maintained for 10 years after vaccination to identify individuals with suspected hepatitis. In addition, an external control cohort was formed to assess vaccine efficacy. The primary endpoint was the vaccine’s efficacy in preventing confirmed hepatitis E occurring at least 30 days after the administration of the third vaccine dose.

Follow-up occurred every 3 months. Participants with hepatitis symptoms for 3 days or more underwent alanine aminotransferase (ALT) concentration measurement. Patients with ALT concentrations ≥ 2.5 times the upper limit of normal were considered to have acute hepatitis. A diagnosis of HEV-confirmed infection was made for patients with acute hepatitis presenting with at least two of the following markers: Presence of HEV RNA, presence of positive anti-HEV immunoglobulin (Ig) M antibodies, and at least fourfold increase in anti-HEV IgG concentrations.

For the efficacy analysis, a Poisson regression model was used to estimate the relative risk and its 95% CI of incidence between groups. Incidence was reported as the number of patients with hepatitis E per 10,000 person-years.

Immunogenicity persistence was assessed by measuring anti-HEV IgG in participants. Serum samples were collected at months 0, 7, 13, 19, 31, 43, 55, 79, and 103 for Qingdao district participants and at months 0, 7, 19, 31, 43, 67, and 91 for Anfeng district participants.

Efficacy and Duration

The follow-up period extended from 2007 to 2017. In total, 97,356 participants completed the three-dose regimen and were included in the per-protocol population (48,693 in the vaccine group and 48,663 in the placebo group), and 178,236 residents from the study region participated in the external control cohort. During the study period, 90 cases of hepatitis E were identified, with 13 in the vaccine group (0.2 per 10,000 person-years) and 77 in the placebo group (1.4 per 10,000 person-years). This indicated a vaccine efficacy of 86.6% in the per-protocol analysis.

In the subgroups evaluated for immunogenicity persistence, among those who were initially seronegative and received three doses of hepatitis E vaccine, 254 out of 291 vaccinated participants (87.3%) in Qingdao after 8.5 years and 1270 (73.0%) out of 1740 vaccinated participants in Anfeng after 7.5 years maintained detectable antibody concentrations.

The identification of infections despite vaccination is notable, especially with eight cases occurring beyond the fourth year following the last dose. This information is crucial for understanding potential immunity decline over time and highlights the importance of exploring various vaccination strategies to optimize protection.

An ongoing phase 4 clinical trial in Bangladesh, exploring different administration schedules and target populations, could help optimize vaccination strategies. The remarkable efficacy (100%) observed over a 30-month period for the two-dose schedule (doses are administered 1 month apart) is promising.

The observation of higher IgG antibody avidity in participants with infections despite vaccination underscores the importance of robust antibody responses to mitigate disease severity and duration. Several study limitations, such as lack of data on deaths and emigrations, a single-center study design, predominance of genotype 4 infections, and the risk for bias in the external control cohort, should be acknowledged.

In conclusion, this study provides compelling evidence of sustained protection of the hepatitis E vaccine over a decade. The observed persistence of induced antibodies for at least 8.5 years supports the long-term efficacy of the vaccine. Diverse global trials, further investigation into the impact of natural infections on vaccine-induced antibodies, and confirmation of inter-genotypic protection are needed.

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