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Dexamethasone, other corticosteroids help hospitalized COVID-19 patients, research finds

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Sept. 2 (UPI) — The corticosteroid dexamethasone reduces the need for ventilator support in patients hospitalized with COVID-19, according to a study published Wednesday by JAMA.

Those treated with the drug while in hospital intensive care units needed mechanical ventilators to help them breathe up to three days less, on average, than patients who did not receive it, the data showed.

Dexamethasone, which is administered via intravenous injection, first received approval for use in people with endocrine and rheumatic disorders from the U.S. Food and Drug Administration in 2003.

It is one of several corticosteroids — hydrocortisone is another — that have shown promise in improving symptoms in people hospitalized with severe COVID-19.

“It is relatively rare in medicine that you find drugs where the evidence of their effectiveness in saving lives is so consistent,” Dr. Derek Angus, who was part of a study on the use of hydrocortisone in seriously ill patients, also published Wednesday, said in a statement.

“People on ventilators or oxygen and under intensive care should definitely be given corticosteroids,” said Angus, professor and chair of the Department of Critical Care Medicine at the University of Pittsburgh.

The findings build on those of the “Recovery” trial, a British study that found the steroid dexamethasone reduced deaths by about one-third in COVID-19 patients on ventilators and by about one-fifth among people who needed oxygen but were not on ventilators.

A separate study, published in July by the Journal of Hospital Medicine, found that hospitalized COVID-19 patients with high levels of inflammation in their lungs saw a 75% reduction in their risk for death after receiving steroid treatment. However, the study did not specify which steroids were used.

For the new dexamethasone study, researchers at 41 hospitals in Brazil administered the drug to 151 patients with the virus who were being treated in ICUs. Over a 28-day period, those given the steroid had 6.6 ventilator-free days, while patients who did not receive it had 4.4, the data showed.

Dexamethasone treatment did not significantly reduce patient days spent in the ICU, the researchers said. During the study, 85 patients who received the drug died, compared to 91 of the 148 patients who did not, they said.

Meanwhile, the new hydrocortisone study found a 93% probability that giving patients a seven-day IV course of the drug would result in better outcomes than not giving the steroid.

Based on the results of studies to date, the World Health Organization issued new guidance Wednesday recommending the use of corticosteroids for “patients with severe and critical COVID-19” only. The drugs are “readily available globally at a low cost,” the WHO said.

“We’ve found clear, reliable evidence in high-quality clinical trials of how we can tackle this devastating disease,” Dr. Anthony Gordon, another co-author on the hydrocortisone study, said in a statement.

“We now have more than one choice of steroid treatment for those who need it most,” said Gordon, professor of anesthesia and critical care at Imperial College London.

“Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues,” he said.



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CDC: Youth vaping down, though still popular with young people

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The number of U.S. youths who use e-cigarettes fell from 5.4 million in 2019 to 3.6 million this year — but vaping remains a dangerous epidemic among children and teens, a new government report shows.

“Although the decline in e-cigarette use among our nation’s youth is a notable public health achievement, our work is far from over,” Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said in an agency news release. “Youth e-cigarette use remains an epidemic, and [the] CDC is committed to supporting efforts to protect youth from this preventable health risk.”

The analysis of National Youth Tobacco Survey data also found that 8 in 10 current youth vapers use flavored e-cigarettes. The use of fruit, mint and menthol flavors of e-cigarettes was common among young users.

The survey of U.S. middle schoolers and high school students was conducted from Jan. 16 to March 16, and the findings were analyzed by researchers from the CDC and the U.S. Food and Drug Administration.

The data show that 19.6% of high school students and 4.7% of middle school students used e-cigarettes in 2020, down from 27.5% and 10.5%, respectively, in 2019.

As in 2019, pre-filled pods/cartridges were the most commonly used device type among youth e-cigarette users in 2020. However, from 2019 to 2020, disposable e-cigarette use increased from 2.4% to 26.5% — a 1,000% increase — among high school e-cigarette users and from 3% to 15.2% — a 400% increase — among middle school e-cigarette users.

The findings were published Sept. 9 in the CDC’s Morbidity and Mortality Weekly Report.

“These findings reinforce the importance of continuing to focus on the strategies that work to reduce youth tobacco product use while keeping pace with emerging trends in tobacco products,” said Dr. Karen Hacker, director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“Implementing these strategies at the national, state and local levels is integral to preventing and reducing youth tobacco product use, including e-cigarettes,” Hacker added in the release.

While the decline in youth vaping is good news, “the FDA remains very concerned about the 3.6 million U.S. youth who currently use e-cigarettes and we acknowledge there is work that still needs to be done to curb youth use. Youth use of e-cigarettes remains a public health crisis and we will do everything possible to stop it, including new actions we are taking today,” FDA Commissioner Dr. Stephen Hahn said in an FDA news release.

“The findings come as we mark today’s premarket review submission deadline, a milestone for ensuring new tobacco products, including many already on the market, undergo a robust scientific evaluation by the FDA. Scientific review of new products is a critical part of how we carry out our mission to protect the public — especially kids — from the harms associated with tobacco use,” Hahn said.

More information

The U.S. Surgeon General has more on the risks of e-cigarettes to youth.

Copyright 2020 HealthDay. All rights reserved.



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More using pot for depression, but it may not help, researchers say

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Folks struggling with depression are much more likely to turn to marijuana to ease their symptoms these days, and that’s not necessarily a good thing, researchers report.

Depressed people are more than twice as likely to have used pot within the last month and three times more likely to use it nearly every day in 2015-2016, a far higher number than 10 years before, the new study found.

Experts say this boom in use among the depressed is probably linked to the spread of marijuana legalization across the United States, particularly for medical purposes.

“Its accessibility has increased over the specific time period that this study measures,” noted Michael Wetter, director of adolescent and young adult medicine with the UCLA David Geffen School of Medicine.

The problem is that previous studies have shown pot actually can worsen mood disorders like anxiety or depression, said Dr. Elie Aoun, assistant professor of clinical psychiatry with the Columbia University College of Physicians and Surgeons.

Marijuana does not change anything in the underlying brain pathology that contributes to depression,” Aoun said. “It just numbs your feelings so you can get through a couple of hours without thinking about your problems. When the effect dissipates, you’re going to be more depressed than you were before.” He and Wetter were not part of the research.

The new study relied on data drawn from the National Health and Nutrition Examination Survey, a federal poll regularly conducted by the U.S. Centers for Disease Control and Prevention.

The researchers, led by Deborah Hasin, from Columbia University Medical Center, analyzed responses from two periods — 2005-2006 and 2015-2016 — to identify people with symptoms of depression and track their self-reported marijuana use.

A depressed person had 2.3 times greater odds of reporting any cannabis use during the previous month in 2015-2016, a nearly threefold increase in risk from the decade before, researchers found.

The odds of daily use were nearly 3.2 times higher, an almost sixfold increase from 2005-2006.

Because the study is observational, it can’t say in which direction this association runs — if depressed people are more likely to turn to pot, or if marijuana use fuels depression.

“I think it’s probably both of these things at the same time,” Aoun said. “Marijuana could be causing depressive symptoms. Also, people who are depressed who are looking for treatment are seeking out options to help reduce the impact or burden of their depressive symptoms. When traditional treatment options are insufficient, they are turning to marijuana.”

THC, the chemical in pot that causes intoxication, has been shown to increase levels of dopamine in the brain, Wetter said. Dopamine is a “feel good” neurotransmitter that directly stimulates the pleasure centers in the brain.

That might make a depressed person feel better temporarily, but it’s really masking feelings that will return, Aoun said.

“Drugs don’t introduce new feelings that you don’t have in you,” Aoun said. “They just allow for disinhibition. If you’re depressed and you smoke marijuana, it’s not going to cure your depression.”

What’s more, these dopamine rushes alter your brain chemistry in ways that can exacerbate your depression.

“It requires more use in order to feel good,” Wetter said. “When you don’t have that, you will start to feel the symptoms of more increased depression. You experience the crash, if you will.”

Eleven states have adopted laws permitting recreational marijuana use, but Aoun said he’s more concerned about the 34 states that have passed laws allowing medical marijuana.

“When states are pushing for the legalization of medical marijuana without credible evidence, you’re sending so many wrong messages,” Aoun said.

Not enough medical research has been done to firmly establish marijuana’s health benefits, but legalization has nonetheless made pot into a seemingly legitimate alternative for folks struggling with a mood disorder, Aoun said.

He compared pot to insulin, a treatment for diabetes tested in large-scale research studies before it became available to patients.

“With marijuana, it’s been a completely different story where these decisions are really driven primarily by companies with a significant financial interest in promoting marijuana use,” Aoun said.

People with depression or anxiety would be better off talking to their doctor about taking an approved prescription medication, Wetter said.

“People will tend to say I would rather use something that is natural and organic versus something synthetic, like Prozac or an SSRI,” Wetter said. “It is organic, it is natural, so it can’t be bad for you. If you’re feeling bad and this makes you feel better, how can it be bad? How can it be wrong?”

The new study was published recently in JAMA Network Open.

More information

The U.S. National Institute on Drug Abuse has more about marijuana and psychiatric disorders.

Copyright 2020 HealthDay. All rights reserved.



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Abuse of unapproved anxiety drug phenibut on the rise

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A growing number of Americans may be having serious reactions after taking phenibut — an unapproved anxiety drug sold in some dietary supplements.

That’s the finding of a new study looking at calls to U.S. poison control centers. The numbers are not huge: Between 2009 and 2019, there were 1,320 calls related to phenibut.

But there was a sharp rise beginning in 2015, researchers found — going from a handful of calls each year to between 300 and 400 in 2018 and 2019.

More worrisome, the effects were sometimes life-threatening or fatal, said researcher Janessa Graves, an associate professor at Washington State University.

Overall, 80 people fell into comas and three died. Often, they had taken other substances as well. But even in cases where phenibut was used alone, 10% resulted in serious effects — including one death.

“This is reason for concern,” Graves said. “[Phenibut] is easily accessible, and it may be becoming more popular.”

The findings were published Sept. 4 in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Originally developed in the Soviet Union in the 1960s, phenibut was given to cosmonauts, with the aim of combating anxiety and insomnia. It has never been an approved drug in the United States, but it is present in some dietary supplements marketed for enhancing mood and brain power.

The U.S. Food and Drug Administration has ruled phenibut is not a dietary ingredient and cannot be listed as such in dietary supplements. But phenibut supplements are widely available online, Graves noted.

There have also been reports of people abusing the drug for euphoric effects. A recent study of Minnesota poison centers found that in nearly half of calls related to phenibut, the person had used it with “abuse as the reason.”

The drug is similar to a brain chemical called GABA, which has a calming effect on the central nervous system. That can also cause side effects like sedation, reduced levels of consciousness and depressed breathing.

Previous research has uncovered signs that phenibut use is trending upward in the United States, Graves said. So her team tried to get a bigger picture, by analyzing a national database on calls to poison control centers.

From 2009 to 2014, they found there was a small number of calls each year related to “phenygam” or 4-amino-3-phenylbutyric acid — alternative names for phenibut.

Starting in 2015, poison control centers were able to use the term “phenibut.” After that, there was a steady, steep rise in calls related to the drug.

It’s not clear how much of that could be related to rising popularity, Graves said.

Based on internet search trends, public interest in phenibut has remained fairly stable in the past several years, said Pat Aussem, of the nonprofit Partnership to End Addiction.

“That said,” she added, “the sharp rise in calls to poison control centers is concerning, and may be attributable to people searching for and using anti-anxiety supplements without knowing their safety profiles.”

Consumers should not assume that dietary supplements are “safe,” stressed Aussem, who was not involved in the study.

She said phenibut would be particularly dangerous in combination with other substances that depress the central nervous system — including alcohol, opioids or benzodiazepines, like Xanax or Ativan.

In this study, 40% of adults and 30% of people under age 18 had used phenibut with other substances.

The findings highlight a bigger issue, according to Dr. Peter Lurie, president of the Center for Science in the Public Interest, a consumer advocacy group.

In the United States, dietary supplements are largely unregulated, Lurie said, and the FDA has limited resources to take action against companies that put unapproved drugs into supplements — or make unproven health claims.

The CSPI recently urged the FDA to take stronger steps against manufacturers and stores that sell supplements with an unapproved antidepressant called tianeptine.

The FDA has sent warning letters to a number of U.S. companies that market tianeptine or phenibut supplements. But the products are still readily available.

One of the concerns, Lurie said, is that consumers will be lured away from therapies — medication or not — that are proven to help anxiety and depression.

Graves and Aussem made the same point.

“In this age of COVID-19,” Aussem said, “many people are trying to cope with anxiety and may wish to find a ‘natural’ product to alleviate their symptoms.”

But, she said, “talking to a health care provider about their concerns is the safest approach.”

More information

The U.S. Food and Drug Administration has more on dietary supplements.

Copyright 2020 HealthDay. All rights reserved.



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