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Steroid-sparing therapies reduce fistula risk by 60% in young people with Crohn’s, study finds

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June 9 (UPI) — Steroid-sparing treatments can prevent young people with Crohn’s disease from developing perianal fistulas, an abnormal opening through the wall of the intestine near the rectum, according to a study published Tuesday by JAMA Network Open.

Children and young adults treated with steroid-sparing therapies were nearly 60 percent less likely to develop perianal fistulas than those who weren’t, researchers at the University of Michigan reported.

One in three people with Crohn’s disease develop a perianal fistula, which can be painful, difficult to treat and may become debilitating, the researchers said.

These fistulas, which are much more common in children, are caused by severe inflammation in the digestive tract. The inflammation creates an abnormal opening through the wall of the intestine in the rectum area and connects to other neighboring tissues in the body or to the skin, researchers said.

Fistulas provide a path for stool to invade tissues and cause severe complications, with the most common area for fistula development in the area of the rectum or anus.

“Perianal fistulas have a devastating effect on quality of life for people with Crohn’s disease,” study author Dr. Jeremy Adler said in a statement.

“But we found that effective therapy ahead of time may significantly reduce the risk of developing them in the first place,” Adler, a pediatric gastroenterologist and researcher at Michigan Medicine C.S. Mott Children’s Hospital, said.

For the study, researchers analyzed national data on 2,214 privately insured people between the ages of 5 and 24 who had Crohn’s disease.

Fifty-six percent of study participants began steroid-sparing therapy — including the drugs azathioprine, methotrexate or infliximab — before developing perianal fistulas, they said.

Overall, 20 percent of study participants developed perianal fistulas within two years after receiving a Crohn’s diagnosis, the researchers said. But those on steroid-sparing therapies had fewer complications, including perianal fistulas, they said.

In addition, steroid-sparing therapies appeared to reduce the severity of fistulas in those who did develop them, the researchers found.

Those who developed fistulas after steroid-sparing treatment were also 55 percent less likely to undergo surgery to create an ostomy, they said.

Roughly 800,000 people in the United States have Crohn’s disease, and about one in four were diagnosed as children or young adults, according to the National Organization for Rare Disorders.

Overall, Crohn’s disease affects roughly 60,000 children in the United States and can trigger abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition, Adler and his colleagues said.

Roughly one in three patients develops a fistula, and about 70 percent of these patients eventually undergo surgery. Up to 20 percent may require permanent diverting ostomy, like a colostomy bag, researchers say.

“Children are almost twice as likely to develop perianal fistulas than adults,” Adler said.

Steroid-sparing immune suppressive drugs have been used to treat Crohn’s for decades and can be effective in healing fistulas, researchers say.

Although guidelines from medical societies recommend steroid-sparing therapy, data show that nearly half of patients don’t use them, which researchers say may be due to cost.

“We need to advocate for broader use of drugs that are known to be effective in treating and controlling Crohn’s disease and that may help prevent lifelong complications for young patients,” Adler said.

“Our research supports efforts to provide the best known therapy as early as possible to improve chances of altering disease course and preventing complications.”



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Study: NSAID pain relievers don’t increase risk for severe COVID-19

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Sept. 8 (UPI) — People who use non-steroidal anti-inflammatory drugs, or NSAIDs, to treat pain are not at risk for more severe illness from COVID-19, according to a study published Tuesday by the journal PLOS Medicine.

Among users of NSAID pain relievers like ibuprofen and diclofenac infected with the new coronavirus, nearly 25% needed to be hospitalized, 5% required admission to the intensive care unit and 6.3% died, the data showed.

To compare, for those who did not use these drugs but tested positive for COVID-19, 21% were hospitalized, 5% needed ICU care and 6.1% died.

In the early phases of the pandemic, there were concerns that the use of the painkiller ibuprofen may lead to a more severe course of coronavirus disease, the researchers, from the University of Southern Denmark and Aarhus University Hospital in Denmark, said.

“Considering the available evidence, there is no reason to withdraw well-indicated use of NSAIDs during the pandemic,” they wrote.

“However, the well-established adverse effects of NSAIDs, particularly their renal, gastrointestinal and cardiovascular effects, should always be considered, and NSAIDs should be used in the lowest possible dose for the shortest possible duration for all patients,” they said.

Ibuprofen and other NSAIDs are some of the most commonly used medications in the United States, with an estimated 30 million doses consumed and 70 million prescriptions administered annually, according to the American College of Rheumatology.

For this study, the researchers obtained data on all 9,326 Danish residents who tested positive for COVID-19 between Feb. 27 and April 29, including NSAID use, hospitalization, ICU admission and need for mechanical ventilation and acute renal replacement therapy.

Overall, 248 people — or just under 3% — of the patients included in the analysis had filled a prescription for NSAIDs within 30 days of their positive virus test, according to the researchers.

There was no association between disease severity and NSAID use, the researchers said.

Another study published Aug. 12 had similar findings.



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Low-dose electrical stimulation helps adults with dyslexia read, study finds

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Sept. 8 (UPI) — Electrical stimulation of the brain improves reading accuracy in adults with dyslexia, according to a study published Tuesday by PLOS Biology.

Transcranial alternating current stimulation, a non-invasive procedure that delivers low-dose electricity to the brain over a period of 20 minutes, was found to improve phonological processing — or ability to discern how words sound or are pronounced — and reading accuracy in 15 adults with dyslexia, the researchers said.

The beneficial effect on phonological processing was most pronounced in those individuals who had poor reading skills, while a slightly disruptive effect was observed in very good readers, they said.

Dyslexia, known commonly as a reading disorder, affects up to 10% of the population, and is characterized by lifelong difficulties with written material,” according to the researchers, who are from the University of Geneva in Switzerland.

Although several possible causes have been proposed for dyslexia, the predominant one is a phonological deficit, or a difficulty in processing word sounds, the researchers said.

The phonological deficit in dyslexia is associated with changes in rhythmic or repetitive patterns of electrical activity in the brain, specifically “low-gamma” oscillations, measuring at 30 hertz or volts, in the left auditory cortex, they said.

However, studies have yet to prove that these these oscillations affect a person’s ability to process word sounds and cause dyslexia, the researchers said.

For this study, the researchers applied transcranial alternating current stimulation over the left auditory cortex in 15 adults with dyslexia and 15 fluent readers for 20 minutes.

At a dose of 30 hertz or volts, the approach resulted in significant improvement in reading accuracy in those with dyslexia, the researchers said.

However, the same improvements were not seen following application of a higher, 60-hertz dose, they said.

The results demonstrate for the first time that low-gamma oscillatory activity causes deficits in phonemic processing and may pave the way to non-invasive treatments aimed at normalizing oscillatory function in auditory cortex in people with dyslexia, the researchers said.

They plan “to investigate whether normalizing oscillatory function in very young children could have a long-lasting effect on the organization of the reading system [and] explore even less invasive means of correcting oscillatory activity,” study co-author Silvia Marchesotti, a post-doctural researcher at the University of Geneva, said in a press release.



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Surgery may help sleep apnea patients who struggle with CPAP

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Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



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