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Retesting for COVID-19 four weeks after first symptoms may help limit spread, study says

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Sept. 2 (UPI) — People with confirmed COVID-19 should be retested four weeks after symptoms first appear to minimize their risk for spreading the virus, according to the authors of a study published Wednesday by BMJ Open.

In more than 1,100 infected adults in Italy, retesting four weeks later showed that 61% no longer had the virus in their systems, the research showed.

However, a second retest to confirm the initial findings showed that as many as one in five of these were “false negatives,” meaning the virus still was present.

These false negatives might have stopped self-isolating and unknowingly infected others had patients not been retested, the researchers said.

It takes an average of 30 days for the virus to clear from the body after the first positive test result and an average of 36 days after symptoms first appear, the study findings show.

“To avoid generating secondary cases, either the isolation period should be longer — 30 days from the start of symptoms — or at least one follow-up test should be done before ceasing isolation,” the researchers wrote.

It’s not yet known how infectious a person could be in the recovery phase, they said.

The World Health Organization recommends a 13-day isolation period for those with symptoms of the virus and 10 days for those without symptoms.

Earlier research has indicated that people may be contagious for as long as 37 days after COVID-19 symptoms resolve.

For this study, the team of Italian researchers tracked the progress of 4,480 residents of the Reggio Emilia province in the Emilia-Romagna region of Italy, all of whom tested positive for the virus between Feb. 26 and April 22.

By mid-April, Italy ranked third in the world for the number of cases and related deaths, and Emilia-Romagna was one of the country’s three coronavirus regional hotspots, the researchers said.

Of the 4,480 study participants, 1,259 achieved viral clearance by the end of May, as determined by at least one negative swab test after the initial positive test, and 428 died, the data showed.

The average time to viral clearance was 31 days from the first positive swab test.

The researchers then looked at the speed of viral clearance in 1,162 people out for whom at least 30 days had passed since the first positive swab by retesting them an average of three times — around 15 days after the first positive swab, 14 days after the second and nine days after the third.

Viral clearance was detected initially in 61% of the participants. However, a second test confirmed the finding in roughly 79% of them, the data showed.

The average time to viral clearance in this group was 30 days after the first positive swab and 36 days after the start of symptoms, the researchers said.

“[However], the evidence on the risk of transmission during the convalescent phase characterized by a positive [swab test] is weak, and current serological data have not provided any additional insight,” they wrote.



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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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Study: New COVID-19 antibody test provides fast, cheap way to identify donors

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Sept. 10 (UPI) — A widely available, inexpensive and easy-to-use test accurately identifies COVID-19 antibody levels in potential convalescent plasma donors, according to a study published Thursday by the Journal of Clinical Investigation.

The ELISA — or enzyme-linked immunosorbent assay — test has been used for decades and generates results faster than the virus neutralization titer tests currently being used, which are costly and only canbe processed by some labs, researchers said.

Using blood samples from more than 2,800 donors, the ELISA approach produced comparable results to virus neutralization titer tests at least 80% of the time.

The test successfully identified donors with COVID-19 antibody levels above a “magic number” of 1,350, which is thought by researchers to be the minimum amount needed to offer protection against the virus.

“Will there be modifications to this finding? Absolutely. That’s what science is — but I think we’re one step closer to understanding the level of antibodies needed to protect against this virus,” study co-author Dr. James M. Musser told UPI.

“I’ll put it this way: If I were being vaccinated today, I would want my titer to be above that 1,350 number,” said Musser, a pathologist at Houston Methodist Hospital.

Antibodies are proteins made by the human immune system to fight off infection. Because they are found in the blood, convalescent plasma — or the liquid component of blood — has long been used to treat infections, Musser said.

According to theory, plasma donated by people who have successfully fought off a virus can be collected and transfused into others to bolster their immune systems and, hopefully, protect them from serious illness.

In the case of COVID-19, the U.S. Food and Drug Administration last month issued an emergency use authorization for convalescent plasma donated by people who have recovered from the virus as a treatment in hospitalized patients — provided that donors have sufficient antibody levels.

However, because of limited access to virus neutralization titer tests, most donor plasma virus antibody levels remain unknown before transfusion.

For their analysis, Musser and his colleagues at Penn State, the University of Texas at Austin and the U.S. Army Medical Research Institute of Infectious Diseases developed an ELISA-based test that measures two known COVID-19 antibodies: anti-spike ectodomain and anti-receptor binding domain IgG.

They evaluated the ELISA test’s accuracy at measuring specific antibodies against COVID-19 using blood samples more than 2,800 employees at Houston Methodist Hospital.

Both the ELISA and virus neutralization titer tests revealed convalescent donors maintain high levels of immunity for several weeks, even after multiple donations, the researchers said.

In addition, donors who experienced shortness of breath while infected with COVID-19 and those who were hospitalized or had severe disease had higher levels of neutralizing antibodies, the tests showed.

They also identified 27 study participants with mild disease who had high enough antibody titers to donate usable plasma.

The FDA used the findings of this study as part of its evaluation for the emergency use authorization for convalescent plasma, Musser said.

“We think our findings give us a baseline or floor for the amount of antibodies needed to offer protection against the virus,” he said.

“More research still needs to be done, but this number will likely be an important part of identifying potential plasma donors and determining the effectiveness of any new vaccine.”



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