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Saturday, April 27, 2024
Heart disease

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New research has identified a possible mechanism for blood clotting issues in some COVID-19 patients.

A new study suggests a possible mechanism for the elevated presence of blood clots in COVID-19 patients.

The research, published in the journal Circulation, may help clinicians develop more effective treatments for COVID-19.

The sudden emergence and rapid global spread of the new coronavirus have meant clinical responses have focused on supporting those with severe infections, supplemented with emergency societal interventions, such as widespread social distancing, to reduce infection rates.

Because SARS-CoV-2 is a new virus, previous treatments developed for similar strains will not necessarily work. Instead, possible therapies need to be identified in theory, tested and, once safe, implemented in the real world. However, this all takes time.

SARS-CoV-2 is mainly a danger because for some patients — particularly those with certain underlying health conditions, compromised immune systems, or who are later in life — a type of severe acute respiratory syndrome can develop, similar to pneumonia.

COVID-19, the disease caused by the virus, makes a person’s lungs inflamed.

COVID-19 and coagulation

According to an interview in The Guardian with Prof. John Wilson, president-elect of the Royal Australasian College of Physicians, if this inflammation is severe, inflammatory material can collect in the bottom of a person’s lungs. This can make it difficult for them to gain enough oxygen into their blood, cause organs to shut down, and potentially lead to death.

However, in addition to this pneumonia-like reaction, clinicians have also noticed that patients with COVID-19 can develop organ damage in a way not directly linked to a lack of oxygen in the blood. This is particularly common in the kidneys and heart.

There is some evidence that a problem with blood coagulation causes this organ damage. Coagulation is the process where a person’s blood thickens. It is crucial in stopping a person from bleeding if they get a cut.

However, if a person’s blood coagulates too much or too little, they can have serious issues: too little, and they can develop internal or external bleeding, as seen in hemophilia. Too much and they could develop blood clots that can cause a stroke or heart attack.

The authors of the recent study note that COVID-19 may increase coagulation in some people’s blood, which consequently causes organ damage as blood vessels become blocked. However, it is not yet clear how or why this occurs, which impedes the development of effective treatments.

Neutrophils and platelets

In the study, the researchers studied 62 patients, including autopsies on five of whom had died. Of these individuals, 38 had confirmed COVID-19.

After conducting multidimensional flow cytometry — a way of measuring the presence of particular cells in a fluid — and comparing these results to the control groups, the researchers identified a significant number of neutrophils and platelets in the subjects.

Neutrophils are a type of immune cell that combat pathogens entering the body, such as the SARS-CoV-2 virus, while platelets are a type of blood cell necessary for coagulation.

The researchers found that these two cells seemed to react to and activate one another, resulting in excessive coagulation, blockage of blood vessels, and serious damage to nearby tissue.

Furthermore, when activated, the neutrophils exude web-like structures designed to help them trap bacteria, but experts believe they exacerbate the blocking of blood vessels.

According to Dr. Konstantin Stark, of the University Hospital Ludwig-Maximilian-University Munich, Germany, and a co-author of the paper:

“These findings contribute to a better understanding of the pathophysiology that underlie disease progression in COVID-19. The study also identifies immunothrombosis as a promising target for the prevention and treatment of lung failure and thrombotic complications that arise in cases of COVID 19.”

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Thanks to advanced medical treatments, women diagnosed with breast cancer today will likely survive the disease. However, some treatment options put these women at greater risk for a number of other health problems.

A new study out of Brazil shows that postmenopausal women with breast cancer are at greater risk for developing heart disease. Results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

Cardiovascular disease remains the main cause of death in postmenopausal women, and women treated for breast cancer are at greater risk of developing heart disease than those not diagnosed with breast cancer. These cardiovascular effects may occur more than five years after radiation exposure, with the risk persisting for up to 30 years.

The goal of the new study was to compare and evaluate risk factors for cardiovascular disease in postmenopausal women who are survivors of breast cancer and women without breast cancer. The researchers found that postmenopausal women who are survivors of breast cancer showed a markedly stronger association with metabolic syndrome, diabetes, atherosclerosis, hypertriglyceridemia, and abdominal obesity, which are major risk factors for cardiovascular disease. The risk of cardiovascular mortality similarly increased to match death rates from the cancer itself.

Findings were published in the article “High risk for cardiovascular disease in postmenopausal breast cancer survivors.”

“Heart disease appears more commonly in women treated for breast cancer because of the toxicities of chemotherapy, radiation therapy, and use of aromatase inhibitors, which lower estrogen. Heart-healthy lifestyle modifications will decrease both the risk of recurrent breast cancer and the risk of developing heart disease,” says Dr. JoAnn Pinkerton, NAMS executive director. “Women should schedule a cardiology consultation when breast cancer is diagnosed and continue with ongoing follow-up after cancer treatments are completed.”

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A review suggests smoking and vaping could increase the severity of COVID-19 due to blood vessel damage and a higher risk of stroke.

“There is a growing body of evidence to suggest that, as well as the respiratory symptoms of COVID-19, the disease can also cause, among others, neurological effects.”

A recent report from a neurological hospital in the United Kingdom identifies cases of delirium, brain inflammation, nerve damage, and stroke in COVID-19 patients.

Reports of stroke in COVID-19 are particularly prevalent. Some reports estimate that 30% of critically ill COVID-19 patients experience blood clots. And if they occur in the brain, they may trigger a stroke.

Researchers from Texas Tech University Health Sciences Center previously found that smoking and vaping increases the risk of viral infection. They have now published a review on how these activities might affect the risk of neurological dysfunction in COVID-19, particularly from damage to blood vessels in the brain.

They found that both smoking and vaping could increase the risk of stroke in COVID-19 due to damage to the blood-brain barrier and a higher risk of blood clots.

The details are published in the International Journal of Molecular Sciences.

Higher risk of blood clots

Smoking causes well-known damage to the lungs and respiratory system. Previous research has shown that it also makes a person more vulnerable to influenza.

Smoking can also affect the vascular system in the brain, prompting the researchers to review the evidence on how this activity might influence the neurological symptoms of people who contract COVID-19.

They first looked at the evidence on SARS-CoV-2 and neurological disorders, including stroke. They found one study which showed that 36.4% of COVID-19 patients had neurological symptoms. Another paper found five cases of sudden stroke in COVID-19 patients aged 30–40 years due to abnormal blood clotting in their large arteries.

But how does this relate to smoking? The researchers explain that when the body is deprived of oxygen, which occurs with smoking, the amount of clotting factors in the blood increase.

In combination with COVID-19, which also increases blood-clotting proteins, the risk of stroke rises.

“COVID-19 seems to have this ability to increase the risk for blood coagulation, as does smoke. This may ultimately translate in higher risk for stroke.” – Luca Cucullo, Ph.D., Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center

What about vaping?

Although there is less evidence around vaping, the authors found studies that show vape aerosol components can harm blood vessels in the brain.

Vaping also appears to affect the blood-brain barrier, the defensive structure which protects the brain from toxins and pathogens in the blood.

The researchers also found specific evidence that long-term vaping may increase the risk of stroke.

Vaping may also make a person more vulnerable to COVID-19 by increasing the number of ACE2 receptors expressed in the body, which are used by the novel coronavirus to infect cells. Smoking can also increase expression of the ACE2 receptor, and damages the blood-brain barrier.

More research needed

The authors conclude that smoking and vaping may increase the severity of COVID-19 by increasing expression of the ACE2 receptor, which allows the virus to infect more cells. They were also found to damage the blood-brain barrier, which increases the risk of neurological complications.

There is an elevated risk of stroke in COVID-19 patients who smoke due to increased blood clotting factors in the blood.

However, the authors say more research is needed, including comparisons of autopsy samples from COVID-19 patients who did or did not smoke, and further animal studies.

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A new study shows that a compound in pickled capers activates channels that are important for the activity of the heart and brain. The findings could potentially lead to the design of new drugs for epilepsy and arrhythmia.

People have practiced traditional or folk medicine — which the Western world generally considers alternative medicine — for centuries, and it remains the mainstay of healthcare in many countries.

Much traditional medicine relies on the use of plants, which have been the basis of medical treatments for thousands of years. Sometimes, researchers examine this traditional knowledge, interpret it in modern scientific terms, and then translate it into Western medicine.

Aspirin, for example, comes from willow plants and has played a role in medicine since ancient Egyptian times, long before people understood its mechanism of action.

A new study from the University of California, Irvine School of Medicine shows a similar story for capers, which people around the world consume and also use in traditional medicine.

The study, which appears in Communications Biology, finds that a compound in pickled capers activates potassium channels that regulate the activity of the heart and brain.

The researchers say that their findings could aid the design of new drugs for epilepsy and arrhythmia (abnormal heart rhythms).

A food with ancient origins

The authors of the study note that humans have been eating capers for more than 10,000 years. Findings in soil deposits in Syria and late Stone Age cave dwellings in modern day Greece and Israel have shown this to be true.

The ancient Roman cookbook “Apicius” also mentions capers. People continue to use them in traditional medicine for their antihelminthic, anticancer, antidiabetic, and anti-inflammatory properties and their possible circulatory and gastrointestinal benefits.

The research team behind the current study has now shown how capers act on the body, which includes activating a potassium channel important for heart and brain activity.

The researchers started looking at capers based on the results from a screen of plant extracts. They screened a range of extracts for activity on a family of potassium channels called KCNQ channels.

The KCNQ family of potassium channels plays several important roles in the body, including regulating the heartbeat, the contraction of muscles, and the function of the gastrointestinal tract. Their dysfunction is associated with certain diseases, including diabetes, arrhythmia, and epilepsy.

The importance of pickling

The researchers used an extract from pickled capers, the most common form in the United States, and found that a 1% extract was able to activate the channels.

The pickling process causes the formation of quercetin, which is the compound that activates KCNQ channels.

Further experiments with quercetin found that it binds to a part of the channels responsible for sensing electrical activity. This binding causes the channels to open when they would otherwise be closed, which may underlie the medicinal properties of capers.

Although capers are the richest natural source of quercetin, the authors note that other plant-derived compounds, such as E-2-dodecenal (present in cilantro), are more potent activators of KCNQ channels.

However, the authors also found that these compounds can work together. So, while eating capers alone may not have a significant effect, eating them together with other specific foods, such as cilantro, could increase their benefits.

Quercetin is also very common in food, being present in apples, berries, celery, chili peppers, and onions, as well as green tea and red wine. The compound may, therefore, accumulate in the body over time to provide benefits. Research has also shown that adding quercetin to food is safe, although this practice does not currently exist in the U.S.

Drugs to treat epilepsy and arrhythmia

Outside of food, the researchers say that their findings could help medicinal chemists design new drugs.

“Increasing the activity of KCNQ channels in different parts of the body is potentially highly beneficial. Synthetic drugs that do this have been used to treat epilepsy and show promise in preventing abnormal heart rhythms.” – corresponding author Geoffrey Abbott, Ph.D.

Researchers are also investigating capers for their potential benefits against cancer, diabetes, and various inflammatory, circulatory, and gastrointestinal diseases. Understanding how capers act on the body on a molecular level could, therefore, lead to a wide range of new treatments.

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Medical experts have warned that non-communicable diseases (NCDs) such as hypertension, diabetes, cancer, cardiovascular diseases are responsible for the majority of Coronavirus disease (COVID-19) deaths in the country.

President, NCD Alliance Nigeria, Olorogun Dr. Sonny F. Kuku, in his opening remarks during a webinar on, “Non-communicable Diseases and COVID-19 in Nigeria – The response”, held Tuesday, July 21, 2020, said: “… We are only seeing the tip of the iceberg and unfortunately, people with NCDs are at greater risk. It is impacting the poorest people and most vulnerable. People with hypertension, diabetes and heart disease are the most vulnerable. We are now seeing stroke as symptom. This means COVID-19, which is an infectious disease is manifesting as an NCD in the form of stroke…”

Vice President, Scientific Affairs, NCDs Alliance Nigeria, Dr. Kingsley Akinroye, has said blamed the situation on the nation’s years of lack of commitment to the course of NCDs. The cardiologist said NCDs account for 29 per cent of deaths in Nigeria.

Akinroye, at the launch of the New Civil Society Solidarity Fund on NCDs in response to COVID-19, harped on the need to strengthen the healthcare system, intensify awareness, increase access to care and treatment, and vote more money for NCDs care and management.

However, the NCD Alliance Nigeria and 19 other global and national NCD Alliances have been awarded $300,000.

Akinroye added that regional and national NCD Alliance including NCD Alliance Nigeria would get $15,000 to address the critical needs of people living with NCDs during the pandemic through advocacy and communication activities that would support stronger organisational stability and resilience

According to the cardiologist, COVID-19 shows many connections between it and NCDs stating that people living with NCDs are more vulnerable to COVID-19 with a substantially higher risk o becoming severely ill or dying from the virus.

The expert said that actions taken to control NCDs in Nigeria include the launch o the First Multi-Sectoral Action Plan or Prevention and Control o NCDs by the Federal Ministry of Health (FMoH) and the NCD Alliance Nigeria Publication of the Handbook on Civil Society Organisation in NCDs.

“Activities in Nigeria will include the development of a database of people living with NCDs in Lagos, Osun, and Federal Capital Territory and by NCD area of focus. Also, establishment and support for people living with NCDs with skills and knowledge, and connect them to NCD Alliance Nigeria, federal Ministry o Health, World Health Organisation and State Ministry of Health in the four states,” he added.

Akinroye further stated that they would build capacity for people living with NCDs on advocacy for their rights to health, prevention, access to treatment and care; provision of support and empowerment

He explained that NCD Alliance Nigeria would develop a directory and a database in the states by area of focus cardiovascular disease, diabetes, cancer, sickle cell disease, respiratory diseases and mental health and also develop advocacy communication materials targeting Lawmakers, Policymakers and opinion leaders that are persuasive and effective to improve prevention, care and access to treatment for people living with NCDs.

The expert, however, tasked the Presidential Taskforce on COVID-19 to mobilise for more testing and awareness amongst the grassroots and also provide free hypertensive and diabetic drugs or the vulnerable population.

Executive Director, NCD Alliance Nigeria, Prof. Akin Osibogun, also presented a paper on “NCDs in Nigeria and COVID-19: The Nigerian experience.”

Osibogun is a consultant public health physician/epidemiologist, a member of Lagos State COVID-19 Response Team and former Chief Medical Director (CMD), Lagos University Teaching Hospital (LUTH) Idi Araba.

Member, Nutrition Committee, Nigerian Heart Foundation (NHF) and Food Scientist, Prof. Isaac Adebayo Adeyemi, spoke on “COVID-19 and Nutrition: Gathering evidence.”

Akinroye delivered a paper on “People Living with NCDs in Nigeria and COVID-19.”

Adeyemi, who is Vice chancellor of Bells University of Technology Ota, Ogun State, and the pioneer Deputy Vice-Chancellor, Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Oyo State, said functional foods are important to boost the immune system.

Adeyemi said that a well functioning immune system is key to providing robust defence against pathogenic organisms. Adeyemi noted that mortality in people living with NCDs is likely the result of immune decline or impaired immune response.

The expert said that energy is required to fight the virus likewise, protein to produce essential antibodies.

He encouraged intake of Phytochemicals like quercetin from onions, phloretin and also Epigallocatechin gallate (EGCG) as well as conventional foods containing bioactive food compounds like vegetables, fruits, grains, dairy, fish and meat.

“Eat fresh and unprocessed food every day like fruits and vegetables, legumes and whole grains and animal products. Eat a moderate amount o fats and oils. Eat at home to reduce your rate of contact with other people,” he added.

Adeyemi urged the consumption of plant food such as grains, legumes and oilseeds, fruits and vegetables containing vitamins, minerals, fibre and phytochemicals.

He, however, stressed on the need to avoid the intake of caffeine, trans fat while also limiting the intake of salt because they are predisposing factors that contribute to morbidity o patients with COVID-19.

According to a study published in Scholars Journal of Applied Medical Sciences and titled “COVID-19 and Nutrition: Review of Available Evidence”, nutritional support is indicated for depleted patients with respiratory diseases because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance.

The researchers noted: “A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Furthermore, weight loss and malnutrition opens the door of infection reoccurrence. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism.

“Dietary management of pre-existing diseases has been suggested as a strategy to minimise the potential risk of COVID-19 infection in conditions such as irritable bowel syndrome, Crohn’s and Colitis. WHO, dietetic associations and dietitians have been calling for patients with pre-existing conditions to continue abiding by their dietary advice and nutritional therapy steps received from their dietician if tested positive for COVID-19.”

Meanwhile, according to a World Health Organisation (WHO) survey, prevention and treatment services for NCDs have been severely disrupted since the COVID-19 pandemic began. The survey, which was completed by 155 countries during a three-week period in May, confirmed that the impact is global, but that low-income countries are most affected.

This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.

Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, said: “The results of this survey confirm what we have been hearing from countries for a number of weeks now.

“Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

The main finding is that health services have been partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.

Rehabilitation services have been disrupted in almost two-thirds (63 per cent) of countries, even though rehabilitation is key to a healthy recovery following a severe illness from COVID-19.

In the majority (94 per cent) of countries responding, ministries of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.

The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50 per cent of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic.

But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20 per cent) reporting disruptions, one of the main reasons for discontinuing services was a shortage of medicines, diagnostics and other technologies.

Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country. Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.

Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72 per cent of high-income countries reported inclusion compared to 42 per cent of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports.

Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan.

Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at the highest risk to continue receiving treatment for NCDs. Among the countries reporting service disruptions, globally 58 per cent of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries, this figure is 42 per cent. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting.

Also encouraging is that more than 70 per cent of countries reported collecting data on the number of COVID-19 patients who also have an NCD.

Director of the Department of NCDs at WHO, Dr. Bente Mikkelsen, said: “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with NCDs.

“What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses. It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 – but that innovative ways are found to implement those plans. We must be ready to ‘build back better’- strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”

According to the WHO, NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85 per cent of these “premature” deaths occur in low- and middle-income countries.

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There are concerns as the United States Food and Drug Administration (FDA), last week, authorised the marketing of IQOS, Philip Morris International’s (PMI) electrically heated tobacco system, as a modified risk tobacco product (MRTP). In doing so, the agency found that an IQOS exposure modification order is appropriate to promote the public health.

The FDA authorised the marketing of IQOS with the following information: “The IQOS System heats tobacco but does not burn it. This significantly reduces the production of harmful and potentially harmful chemicals.”

Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system reduces the body’s exposure to harmful or potentially harmful chemicals.

The agency concluded that the available scientific evidence demonstrates that IQOS is expected to benefit the health of the population as a whole, taking into account both users of tobacco products and persons who do not currently use tobacco products

The FDA’s decision further builds on the emerging independent international scientific consensus that IQOS is a better choice than continuing to smoke, and follows the FDA’s April 2019 decision authorizing the commercialization of IQOS in the U.S.

The FDA’s decision provides an important example of how governments and public health organizations can regulate smoke-free alternatives to differentiate them from cigarettes in order to protect and promote the public health

This decision follows a review of the extensive scientific evidence package PMI submitted to the FDA in December 2016 to support its MRTP applications.

Commenting on the FDA’s announcement, PMI’s Chief Executive Officer, André Calantzopoulos, said: “The FDA’s decision is a historic public health milestone. Many of the tens of millions of American men and women who smoke today will quit—but many won’t. Today’s decision makes it possible to inform these adults that switching completely to IQOS is a better choice than continuing to smoke. FDA determined that scientific studies show that switching completely from conventional cigarettes to IQOS reduces exposure to harmful or potentially harmful chemicals.

“IQOS is a fundamentally different product than combustible cigarettes and must be regulated differently, as the FDA has recognized. Now—more than ever—there is an urgent need for a fundamentally different conversation on a cooperative approach to achieve a smoke-free future. The FDA’s decision provides an important example of how governments and public health organizations can regulate smoke-free alternatives to differentiate them from cigarettes in order to promote the public health…”

Meanwhile, a new Access Initiative for Quitting Tobacco aims to help the world’s 1.3 billion tobacco users quit. Stopping smoking is more important than ever as evidence reveals that smokers are more likely than non-smokers to have severe outcomes from COVID-19.

The project gives people free access to nicotine replacement therapy and to Florence, a digital health worker, based on artificial intelligence that dispels myths around COVID-19 and tobacco and helps people develop a personalized plan to quit tobacco.

It is being led by the World Health Organization (WHO), together with the UN Interagency Task Force on Non-communicable Diseases, PATH and the Coalition for Access to NCD Medicines and Products, with support from the private sector.

The Secretariat of the WHO FCTC, salutes this initiative. The Head of the Convention Secretariat commented, “This will contribute to Parties’ implementation of Article 14 of the Convention, regarding measures concerning tobacco dependence and cessation. And, as previously said: there has never been a more appropriate time to support people in their efforts to quit tobacco use.”

Director of Health Promotion, Dr. Ruediger Krech, said that, “We welcome the support of pharmaceutical and tech companies to improve people’s health and save lives during COVID-19. The partnership highlights what we can achieve when we work together both to end the pandemic and, moving forward, to build back better.”

WHO received its first-ever donation of nicotine replacement therapies for the project from Johnson & Johnson Consumer Health. The manufacturer has donated 37,800 nicotine patches to help 5,400 people in Jordan quit smoking. These efforts will help WHO respond to the ongoing pandemic and improve health outcomes.

Florence was created with technology developed by San Francisco and New Zealand based Digital People Company, Soul Machines, with support from Amazon Web Services and Google Cloud.

Jordan, which has some of the highest tobacco use rates in the world, will be the first pilot country with additional companies and countries to join in discussion. HRH Princess Dina Mired of Jordan, President for the International Union of Cancer Control said, “I am pleased that Jordan is part of this initiative, which will help advocate for tobacco control and support civil society organizations in their continued efforts for a healthier smoke-free future for Jordan.”

Just last week the Government of Jordan adopted a ban on smoking and vaping indoors in public places. The link between smoking and COVID-19 make it essential for governments to pass comprehensive tobacco control laws that will protect the health of their people during this pandemic and beyond.

Although around 60 per cent of tobacco users worldwide say they want to quit, only 30 per cent of them have access to the tools that can help them do so The Access Initiative for Quitting Tobacco is designed to deliver tobacco cessation services that will help people overcome both physical and mental addictions to tobacco.

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Close up of woman hands using lancet on finger to check blood sugar level by Glucose meter. Use as Medicine, diabetes, glycemia, health care and people concept.

A study of more than 4,000 people shows that gut bacteria fluctuate throughout the day and that this occurs to a lesser extent in people with type 2 diabetes. Doctors could potentially use these patterns to predict and diagnose diabetes.

Circadian rhythms, which people sometimes refer to as the “body clock,” regulate patterns of sleep, alertness, temperature, and blood pressure, among other factors. These daily biological rhythms likely evolved to coordinate with light and food availability, but they also regulate internal metabolic processes.

Circadian rhythms are important to human health, and experts believe their long-term disruption to have various adverse consequences.

The possible health effects include obesity and type 2 diabetes. A growing body of evidence indicates a connection between circadian disruption and insulin resistance.

Building on this, a new study appearing in Cell Host & Microbe shows that diabetes is also associated with changes to the daily rhythms of the gut microbiome.

A team of researchers that the Technical University of Munich in Germany led showed that people with type 2 diabetes have fewer daily fluctuations in some of their gut bacteria and that these changes may serve to predict and diagnose the condition.

The rhythm of the microbiome

For many years, scientists have known that the circadian clock is crucial to human physiology. However, it is only recently that they have discovered its role in relation to the microbiome, which is the community of bacteria, viruses, and fungi that live in and on people — for instance, on the skin or in the gut.

Recent studies, for example, show that the community of gut bacteria fluctuates during the day, just like other circadian processes.

Some researchers believe that these regular changes to the microbiome are likely beneficial and that the loss of this daily rhythm could contribute to metabolic disorders, perhaps explaining the connection between circadian rhythms and diabetes.

To investigate this further, the team started by analyzing the microbiomes of almost 2,000 people over a period of 24 hours. Their results confirmed the regular oscillations of gut bacteria.

They then focused the study to include only the people with metabolic disorders, including obesity (defined as a body mass index, or BMI, of 30 or above), prediabetes, and type 2 diabetes.

They found that people with obesity and type 2 diabetes lost the rhythmic patterns of their gut bacteria. They also noted specific changes to the gut bacteria in people with diabetes.

A new diagnostic tool?

Using a dataset of 2,039 people, the team started to detect particular changes to the microbiome that could serve as biomarkers to diagnose type 2 diabetes.

“When certain gut bacteria do not follow a day-night rhythm, so if their number and function does not change over the course of the day, this can be an indicator for [type 2 diabetes],” – Silke Kiessling, co-author of the study

The researchers found 13 types of bacteria that did not change during the day in people with diabetes. They used these bacteria to train a mathematical model to detect whether a person has diabetes.

“Mathematical models also show that this microbial risk signature consisting of arrhythmic bacteria helps diagnosing diabetes,” explains first author Sandra Reitmeier.

When they tested the model on a new group of 699 people, it was able to predict not only who received a diagnosis of type 2 diabetes but also who was at risk of developing the condition.

The model was most effective in combination with BMI, which confirms the importance of obesity in diabetes onset.

“Apart from bacteria and their variations over the course of the day, other parameters, such as [BMI], play a role in being able to better predict a person’s future medical conditions,” adds senior author Prof. Dirk Haller.

Cause or effect?

The findings so far show a clear association between daily variations in the microbiome and type 2 diabetes, but they do not say anything about why the two are connected.

In the final part of their study, the researchers tried to answer this question by looking at changes to metabolism. They found 26 metabolic pathways that were associated with the lack of a microbial rhythm.

The same association existed for 19 of these pathways (73%) in a separate group of people with type 2 diabetes. These pathways included several that are known to influence sensitivity to insulin.

These common metabolic pathways suggest that the two states are functionally connected, although it is too early to say whether a disrupted microbiome actually causes diabetes.

While scientists do not yet fully understand the link between the microbiome and diabetes, the findings from this study suggest that a microbial risk score could be a new way to diagnose and predict the onset of type 2 diabetes.

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Close-up of scientist hands with microscope

A recent stem cell study has shown that SARS-CoV-2, the novel coronavirus, can infect heart cells via the same receptor present in the lungs. This may be responsible for the cardiac complications associated with COVID-19.

Experts initially thought that COVID-19 was a respiratory disease, with symptoms including cough, shortness of breath, and pneumonia. However, more recent evidence into COVID-19 shows that the disease can also cause neurological and cardiac symptoms.

Physicians have reported changes to the circulatory system in people with COVID-19, sometimes leading to blood clots, as well as cardiac complications, such as changes to the heart rhythm, damage to heart tissue, and heart attacks.

Although there is widespread agreement that COVID-19 is a risk to the heart, whether these symptoms are due to the virus directly or a consequence of other disease processes, such as inflammation, has been unclear.

In a new study appearing in the journal Cell Reports Medicine, scientists have helped resolve this mystery by showing that SARS-CoV-2 can infect heart cells and change their function.

Their findings, from experiments in human stem cells, suggest that the cardiac symptoms of COVID-19 may be the direct result of the infection of heart tissue.

SARS-CoV-2 behaviour in heart cells

The scientists used a type of stem cell called induced pluripotent stem cells (iPSCs) to generate heart cells.

Scientists can create iPSCs from a person’s skin cells and then reprogram them to become any cell type in the body. They provide a useful tool for research into human disease and a way to test new treatments.

In this study, the team programmed the iPSCs to become heart cells and later incubated them with SARS-CoV-2. Using microscopes and genetic sequencing techniques, the researchers found that SARS-CoV-2 could directly infect the heart cells.

They also showed that the virus can rapidly divide inside heart cells, which caused changes to the heart’s ability to beat after a period of under 3 days.

“We not only uncovered that these stem cell-derived heart cells are susceptible to infection by [the] novel coronavirus, but that the virus can also quickly divide within the heart muscle cells,” explains first study author Dr. Arun Sharma, a research fellow at the Regenerative Medicine Institute of Cedars-Sinai Medical Center in Los Angeles, CA.

The role of the ACE2 receptor

Additional experiments focused on the different genes expressed by heart cells before and after the virus infected them. These studies showed activation of the innate immune response and antiviral clearance pathways to help fight the virus.

However, how does the virus get into the heart in the first place? The researchers suggest that one way in which it gains access may be by using angiotensin-converting enzyme 2 (ACE2). This is the same receptor the virus uses to infect cells in the lungs.

Importantly, studies have shown that treatment with an ACE2 antibody can help stop SARS-CoV-2 from replicating and save cells in the heart.

“By blocking the ACE2 protein with an antibody, the virus is not as easily able to bind to the ACE2 protein, and thus cannot easily enter the cell. This not only helps us understand the mechanisms of how this virus functions, but also suggests therapeutic approaches that could be used as a potential treatment for SARS-CoV-2 infection.” – Dr. Arun Sharma

The importance of these findings

The researchers suggest that scientists could use stem cell-derived heart cells to screen new drugs and find compounds able to stop the infection of heart cells.

“This key experimental system could be useful to understand the differences in disease processes of related coronaviral pathogens SARS and MERS,” adds study author Dr. Vaithilingaraja Arumugaswami, an associate professor at the University of California, Los Angeles.

There are some limitations to this approach, however. These include the fact that stem cell-derived heart cells are not exactly the same as the real thing.

The researchers also studied the cells in a dish, an isolated system lacking the immune interactions that would occur in the human body.

Nevertheless, the experiments clearly showed that the cells became infected with SARS-CoV-2, which is in line with some clinical data showing the virus in the hearts of people who died from COVID-19.

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A new research published last week in the Journal of Physiology showed that 12 weeks of easy-to-administer passive stretching helps improve blood flow by making it easier for your arteries to dilate and decreasing their stiffness.

Passive stretching differs from active stretching in that the former involves an external force (another person or gravity) stretching you, whereas active stretching is performed on your own. The changes they observed in blood vessels could have implications for diseases, including the number one global killer, heart disease.

Researchers at the University of Milan assigned 39 healthy participants of both sexes to two groups. The control group didn’t undergo any stretching. The experimental group performed leg stretches five times a week for 12 weeks. Researchers evaluated the effect of passive stretching on the blood flow locally and in the upper arm. They found that the arteries in both the lower leg and upper arm had increased blood flow and dilation when stimulated, along with decreased stiffness.

Both of these changes may have implications for diseases such as heart disease, stroke and diabetes as they are characterized by changes in blood flow control, due to an impaired vascular system.

If this study is replicated in patients with vascular disease, it could indicate whether or not this training method could serve as a new drug-free treatment for improving vascular health and reducing disease risk, especially in people with lower mobility.

Moreover, stretching may also be used during hospitalisation or after surgical interventions, to preserve the vascular health when patients have low mobility. Carers or family members can also perform it at home.

An author on the paper, Emiliano Ce, said this new application of stretching is especially relevant in the current pandemic period of increased confinement to homes, where the possibility of performing beneficial training to improve and prevent heart disease, stroke and other conditions is limited.

Also, another research suggests that exercise can slow or prevent the development of macular degeneration and may benefit other common causes of vision loss, such as glaucoma and diabetic retinopathy.

The new study from the University of Virginia School of Medicine found that exercise reduced the harmful overgrowth of blood vessels in the eyes of lab mice by up to 45 per cent. This tangle of blood vessels is a key contributor to macular degeneration and several other eye diseases.

The study represents the first experimental evidence showing that exercise can reduce the severity of macular degeneration, a leading cause of vision loss, the scientists report. Ten million Americans are estimated to have the condition.

Researcher at the UVA’s Center for Advanced Vision Science, Dr. Bradley Gelfand, said: “There has long been a question about whether maintaining a healthy lifestyle can delay or prevent the development of macular degeneration. The way that question has historically been answered has been by taking surveys of people, asking them what they are eating and how much exercise they are performing.

“That is basically the most sophisticated study that has been done. The problem with that is that people are notoriously bad self-reporters … and that can lead to conclusions that may or not be true. This [study] offers hard evidence from the lab for very first time.”

Enticingly, the research found that the bar for receiving the benefits from exercise was relatively low — more exercise didn’t mean more benefit. “Mice are kind of like people in that they will do a spectrum of exercise. As long as they had a wheel and ran on it, there was a benefit,” Gelfand said. “The benefit that they obtained is saturated at low levels of exercise.”

An initial test comparing mice that voluntarily exercised versus those that did not found that exercise reduced the blood vessel overgrowth by 45 per cent. A second test, to confirm the findings, found a reduction of 32 per cent.

The scientists aren’t certain exactly how exercise is preventing the blood vessel overgrowth. There could be a variety of factors at play, they say, including increased blood flow to the eyes.

Gelfand, of UVA’s Department of Ophthalmology and Department of Biomedical Engineering, noted that the onset of vision loss is often associated with a decrease in exercise. “It is fairly well known that as people’s eyes and vision deteriorate, their tendency to engage in physical activity also goes down,” he said. “It can be a challenging thing to study in older people. … How much of that is one causing the other?”

The researchers already have submitted grant proposals in hopes of obtaining funding to pursue their findings further.

“The next step is to look at how and why this happens, and to see if we can develop a pill or method that will give you the benefits of exercise without having to exercise,” Gelfand said. “We’re talking about a fairly elderly population [of people with macular degeneration], many of whom may not be capable of conducting the type of exercise regimen that may be required to see some kind of benefit.” (He urged people to consult their doctors before beginning any aggressive exercise program.)

Gelfand, a self-described couch potato, disclosed a secret motivation for the research: “One reason I wanted to do this study was sort of selfish. I was hoping to find some reason not to exercise,” he joked. “It turned out exercise really is good for you.”

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An estimated 1.7 billion people — more than 20 percent of the world’s population — risk becoming severely infected with COVID-19 due to underlying health problems such as obesity and heart disease, analysis showed Tuesday.

The novel coronavirus, which has killed more than 420,000 people globally during the first wave of the pandemic, adversely effects patients suffering from co-morbidities.

A team of experts from the London School of Hygiene and Tropical Medicine analysed global data sets of illnesses including diabetes, lung disease and HIV used these to estimate how many people are at heightened risk of serious COVID-19 infection.

They found that one in five people have at least one underlying health problem putting them in greater danger.

While not all of those would go on to develop severe symptoms if infected, the researchers said around 4 percent of the global population — around 350 million) would likely get sick enough to require hospital treatment.

“As countries move out of lockdown, governments are looking for ways to protect the most vulnerable from a virus that is still circulating,” said Andrew Clark, who contributed to the study.

“This might involve advising people with underlying conditions to adopt social distancing measures appropriate to their level of risk.”

Clark said the findings could help governments make decisions on who receives a COVID-19 vaccine first when one becomes available.

Consistent with other studies about COVID risk, the authors found that older people are in greater danger of getting seriously unwell from the virus.

Less than 5 percent of people aged under 20 have an underlying risk factor, compared with two thirds of over 70s.

Countries with younger populations have fewer people with at least one underlying condition, but risks vary globally, according to the analysis.

Small island states such as Fiji and Mauritius have among the highest rates of diabetes — a known COVID-19 risk factor — on Earth, for example.

And countries with the highest prevalence of HIV/AIDS, such as eSwatini and Lesotho, also need to be vigilant, said authors of the research published in The Lancet.

In Europe, more than 30 percent of people have one or more health conditions, it showed.

Writing in a linked comment, Nina Schwalbe from Columbia University Mailman School of Public Health, said the study showed “it is time to evolve from a one-size-fits-all approach to one that centres on those most at risk.”

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