Opioids of minimal benefit for low back pain
New research from The George Institute for Global Health and the University of Sydney has found that opioid painkillers, a common treatment for low back pain, provide minimal benefit. The findings of the systematic review, published in JAMA Internal Medicine, also demonstrate that many patients do not tolerate the medicine, with half of the trial participants withdrawing because of adverse effects to the medication or lack of effect. The study also found that even at high doses – above recommended levels – the drugs still provided little clinical benefit. “This result reinforces the recent US Centers for Disease Control and Prevention recommendation that if opioids are used, they should be combined with non-drug options such as physiotherapy or non-opioid painkillers, as appropriate,” Professor Chris Maher, head of the Musculoskeletal Division at The George Institute and a co-author on the review, said. “People have the mistaken belief that opioids are strong pain killers. When you look closely at the evidence from the low back pain trials, a completely different picture emerges.” In Australia, 40% of patients who see a GP for low back pain are prescribed an opioid painkiller. In 2012–2013, 2.9 of every 100 GP–patient encounters were for the management of back problems — 3.7 million visits to the GP each year.

Loss of Y chromosome linked to Alzheimer’s
A study of more than 3200 men found that loss of the Y chromosome (LOY) significantly increased the chances of developing Alzheimer’s. Previous research has linked LOY both with smoking and with cancer. The findings may indicate that losing the Y chromosome affects the immune system, thereby increasing susceptibility to disease, scientists believe. Lead researcher Professor Lars Forsberg, from the University of Uppsala in Sweden, said: “Having loss of Y is not 100 per cent predictive that you will have either cancer or Alzheimer’s. But in the future, loss of Y in blood cells can become a new biomarker for disease risk and perhaps evaluation can make a difference in detecting and treating problems early.” For more on this story visit doctorportal.

Air pollution link to stillbirths
Research published in Occupational & Environmental Medicine has found “suggestive evidence” between air pollution and heightened stillbirth risk. To date, two reviews of the available evidence have pointed to a link between air pollution and stillbirth. But the strength of the association found was weak and further evidence has since emerged, prompting the authors to carry out a systematic review of research published up to 2015. Thirteen studies were eligible for inclusion in the summary, which found an association between exposure to air pollution — particularly during the third term of pregnancy — and a heightened risk of stillbirth. Specifically, a 4 ug/m3 increase in exposure to small particulate matter of less than 2.5 um in diameter (PM2.5) was associated with a 2% increased risk of stillbirth, while exposure to nitrogen dioxide, carbon monoxide, PM10 and ozone were also linked to a heightened risk. The researchers, from Finland and Ghana, say that differences in study design and the type of pollutant assessed, made it impossible to include all 13 studies in the final analysis, leaving three register-based studies from the US and Asia. Most of these previous studies were unable to take account of potentially influential factors, such as obesity, infections, alcohol and occupation and stress, all of which have been associated with an increased risk of stillbirth. Moreover, they said, most of the existing evidence relies on air monitoring data, which doesn’t adequately capture variations in levels within the same city. Despite these caveats, the study authors concluded: “However, the existing evidence is suggestive of causality for air pollution and stillbirth without precise identification of the timing of exposure.”

Schizophrenia link to mums-to-be smoking
Smoking during pregnancy can increase the risk of a baby developing schizophrenia later in life, a study has found. Heavy nicotine levels in the mother’s blood were associated with a 38 per cent increased chance of schizophrenia, according to the findings published in the American Journal of Psychiatry. The study evaluated nearly 1000 cases of schizophrenia and matched controls among offspring born in Finland from 1983-1998 who were ascertained from the country’s national registry. “To our knowledge, this is the first biomarker-based study to show a relationship between foetal nicotine exposure and schizophrenia,” said senior researcher Professor Alan Brown, from the University of Columbia. “We employed a nationwide sample with the highest number of schizophrenia cases to date in a study of this type.” For more on this story, visit doctorportal.

“Cannavaping” healthy alternative for medicinal users
Swiss researchers, published in Scientific Reports, claim vaping cannabis oil instead of smoking pot offers a new and less hazardous way for medicinal cannabis users to consume the drug. Using e-cigarettes for the vaping of cannabis, a method the authors refer to as “cannavaping”, may provide a new route of administration for therapeutic cannabinoids. The researchers extracted cannabinoids from cannabis with butane gas to produce butane hashish oil (BHO) concentrate in an e-liquid, which could be atomised. Samples of the gases generated from three e-cigarettes were then collected and analysed. The authors found that cannavaping may result in the avoidance of inhaling significant amounts of toxic contaminants — such as volatile organic compounds (VOCs) and carbonyls — released during the combustion of regular cannabis cigarettes. The authors also believe that illegal cannavaping of BHO presents a low risk of becoming popular among cannabis smokers. The poor solubility of BHO in commercial liquid refills would prevent the manufacture of refills with the high BHO concentrations preferred by most recreational cannabis users. The authors note that as only one type of e-cigarette was assessed in this study, other devices, brands and e-liquids may produce different cannabinoids and levels of carbonyls and VOCs.

Measuring awareness after a brain injury
Measuring the amount of glucose-sugar consumed by the brain could indicate a brain injury patient’s current level of awareness, or the likelihood they will recover awareness within a year, say international researchers published in Current Biology. Using a common imaging technique, the study found that patients with glucose levels below a particular threshold appeared to be fully unconscious and did not recover consciousness at 1-year follow-up. In contrast, nearly all patients above the threshold either showed signs of awareness at the initial examination or had recovered responsiveness a year later. The researchers measured glucose metabolism using FDG-PET, an imaging technique in which glucose labeled with a radioactive tracer molecule is injected into the bloodstream. The labeled glucose makes it possible to capture and map glucose uptake in any organ of interest – in this case, the brain. Their results showed that the patients’ individual levels of behavioural responsiveness were strongly linked to their overall cerebral energy turnover. In fact, patients with glucose metabolism below a well defined threshold of 42% of normal cortical activity appeared to be fully unconscious and did not recover consciousness at 1-year follow-up. Overall, the researchers report, the cerebral metabolic rate of glucose accounted for the current level, or imminent return, of awareness in 94% of patients.

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