Hypertension

Athletic young man rubbing muscles of lower back after jogging

Researchers have discovered a possible way to increase levels of natural opioids in the brain. The new approach involves blocking an opioid receptor that normally inactivates these molecules.

Synthetic opioids, such as fentanyl, naloxone, and morphine, are powerful pain relief medications. They can also cause dependence, are highly addictive, and potentially fatal in overdose.

According to the National Institute on Drug Abuse, every day in the United States, 128 people die after overdosing on opioids.

The Centers for Disease Control and Prevention (CDC) estimate that the total economic burden of prescription opioid overdose, abuse, and dependence in the U.S. was $78.5 billion in 2013. The figure includes costs investigators associate with healthcare, criminal justice, and lost productivity.

While efforts to develop a nonaddictive synthetic opioid are making progress, an international team of scientists, which the Luxembourg Institute of Health (LIH) leads, is working on a radically different approach.

They have discovered a potential way to increase levels of the body’s own opioids. These natural opioids help to relieve pain and can also alleviate stress, anxiety, and depression.

Endogenous opioids

There are three types of endogenous opioid — endorphins, enkephalins, and dynorphins. Endorphins are responsible for the ‘runner’s high’ that people can experience after vigorous exercise.

Endogenous opioids inhibit the transmission of pain signals in the central nervous system by binding to one of the four kinds of opioid receptors on nerve cells.

Synthetic opioids, such as fentanyl, bind to the same receptors, but they bind much more strongly than endogenous opioids.

LIH, in collaboration with scientists at the University of Bonn in Germany and the University of Liège in Belgium, has now identified a fifth opioid receptor that behaves differently.

The researchers believe that one of the functions of the receptor known as ACKR3 is to regulate or “fine-tune” levels of opioids in the brain.

In laboratory experiments with nerve cells, they discovered that when opioids bind to ACKR3, the receptor “scavenges” them, dragging them inside the cell.

The researchers believe that by removing opioid molecules and preventing them from binding to the other four receptors, ACKR3 indirectly increases pain signaling.

“Interestingly, we found that ACKR3 does not trigger the distinctive chain of molecular signaling events that results in painkilling effects,” explains Max Meyrath of LIH, who is co-first author of the study.

“Instead, ACKR3 functions as a ‘scavenger’ that sequestrates the opioids that would otherwise bind to the classical receptors.”

Receptor blocker

In further experiments, the team designed a molecule it calls LIH383 to block ACKR3 selectively and prevent it from scavenging endogenous opioids.

Using brain tissue from rats, the scientists confirmed that LIH383 could boost levels of opioids, and hence reduce pain signaling.

“Our findings essentially brought forward a new and previously unknown mechanism to fine tune the opioid system and modulate the abundance of natural opioids by manipulating the fifth member of the opioid receptor family, ACKR3. We, therefore, set about developing a molecule that would be able to tightly bind to and block ACKR3, with the aim of potentiating the natural, beneficial effects of opioids on pain and negative emotions. This is how LIH383 was conceived.” – Dr. Martyna Szpakowska, co-first author

The scientists published their research in the journal Nature Communications.

Dr. Andy Chevigné at LIH, who is the senior author of the study, says: “We expect LIH383 to act as a precursor for the development of a new class of drugs against pain and depression, thus offering an innovative and original therapeutic strategy to tackle the opioid crisis.”

Dual role

Remarkably, LIH383 may also have potential as an anticancer agent.

Long before biologists found ACKR3 to be an opioid receptor, they were familiar with it as a receptor for chemokines. These are a family of immune signaling molecules; some of them are involved in controlling the migration of cells during normal development.

They are also involved in promoting cancer growth and ‘metastasis,’ which is the spread of tumors around the body.

High concentrations of the receptor occur in tumors, such as breast cancer and an aggressive form of brain cancer known as glioblastoma. Scientists associate them with resistance to chemotherapy and poor prognosis.

“As an ACKR3 modulator that interacts and ‘interferes’ with ACKR3, LIH383, therefore, also holds promise for the treatment of metastatic cancers, leveraging on our remarkable discovery of the dual chemokine-opioid ‘scavenging’ activity of this receptor,” says Dr. Chevigné.

The team’s research was a lab-based proof-of-principle study. Much more work remains before they can test a drug that blocks ACKR3 on people in clinical trials.

A new study has shown that three-Quarters of the 200 million Nigerians are at risk of Non-Communicable Diseases, NCDs, amidst coronavirus pandemic.

The study also found that men are more at risk than women.

The year-long study which commenced in 2019, by WellNewMe in collaboration with Novartis was aimed at determining Nigerians risks for developing chronic diseases as part of the disease activities for World Hypertension Day.

According to the World Health Organisation (WHO), people with noncommunicable diseases (NCDs), such as hypertension, cardiovascular diseases, diabetes, or cancer are at higher risk of complications of COVID-19.

The result of the study released weekend revealed that a total of 1,900 people were enrolled for the pilot, and 1,269 of them completed the assessment as part of the pilot.

The participants were drawn from different parts of Nigeria including the Federal Capital Territory, Abuja, which majority of them coming from Lagos 30 percent, Oyo 8 percent, Abuja FCT 8 percent, Ogun 7 percent, and Rivers 5 percent.

Three-quarters of those who completed the assessment were found to have an increased risk of developing a chronic disease.

It was also found that risk increases as the age increases, while all of those aged 50 and above have an increased risk.

The results also showed that 43 percent of women seem more at risk than 36 percent of men for developing hypertension, while the risk increases as the age of the pilot enrolee increased.

With diabetes, it was found that almost three-quarters of those assessed had an increased risk of having diabetes with 10 percent having a high risk while men were more at risk than women. The diabetes risk also increases as the age of the pilot enrolee increases.

Some of the other interesting anecdotes from the pilot revealed that men were four times more likely to be at risk for developing the cardiac disease, and in Rivers, 85 percent of the adults assessed had an increased risk for developing chronic disease.

Commenting on the study, Co-founder of WellNewMe and author of the pilot report, Dr. Obi Igbokwe, said:” report of the pilot, while not extensive does lends importance to considerations by the Nigerian health authorities when designing the country’s response to the COVID-19 pandemic, that they need factor in NCDs as well.”

Igbokwe further explained that “As patients with chronic diseases are at greater risk of the coronavirus, that in itself presents an extra burden on our already struggling health services across the country. It is also of great importance, that even when the pandemic has passed, we will still have to deal with the burden of tackling these chronic diseases which by all accounts are here to stay.”

Meanwhile, WellNewMe has designed an algorithm-based health risk assessment platform that encompasses psychological, physical, and social domains that are known to influence NCD risk and prognosis in cases of established disease.

Being a global leader in the cardiovascular healthcare space, Novartis is mobilizing the setup of these cardiovascular risk assessment stations at various pharmacies across the country with the aim of reaching a thousand patients.

The platform incorporates the ability for healthcare providers (HCPs) to standardize their approach to cardiovascular disease management by using an algorithmic process and harnessing relevant data to ensure a set of potential outputs that result in better outcomes for the patient.

WHO Regional Director for Europe, Dr. Hans Henri P. Kluge had also said that the prevention and control of NCDs have a crucial role in the COVID-19 response and if not adapted to encompass prevention and management of NCD risks, countries will fail many people at a time when their vulnerability is heightened.

Surveys from around the world show that men everywhere find it difficult to open up about mental health, though they are significantly more at risk of attempting suicide than women. In this Special Feature, we look at why this may be and how to address this issue.

In high-income countries, three times as many men as women die by suicide, according to a World Health Organization (WHO) report from 2018.

The American Foundation for Suicide Prevention also cite 2018 data, noting that in that year alone, “Men died by suicide 3.56 [times] more often than women” in the United States.

And Mental Health America, a community-based nonprofit, reference data suggesting that more than 6 million men in the U.S. experience symptoms of depression each year, and more than 3 million experience an anxiety disorder.

Despite these staggering figures, the National Institute of Mental Health (NIMH) report that men are less likely than women to have received formal mental health support in the past year.

Why is this the case? Recent research offers some explanations and proposes ways of remedying the situation.

Stigma around men’s mental health

In their 2018 report, the WHO emphasize that cultural stigma surrounding mental health is one of the chief obstacles to people admitting that they are struggling and seeking help.

And this stigmatization is particularly pronounced in men.

“Described in various media as a ‘silent epidemic’ and a ‘sleeper issue that has crept into the minds of millions,’ with ‘chilling statistics,’ mental illness among men is a public health concern that begs attention.”

Thus begins a study from The University of British Columbia (UBC), in Vancouver, Canada, published in 2016 in Canadian Family Physician.

Its authors explain that prescriptive, ages-old ideas about gender are likely both part of the cause behind the development of mental health issues in men and the reason why men are put off from seeking professional help.

Another study from Canada — published in Community Mental Health Journal in 2016 — found that, in a national survey of English-speaking Canadians, among 541 respondents with no direct experience of suicidal ideation or depression, more than one-third admitted to holding stigmatizing beliefs about mental health issues in men.

And among this group, male respondents were more likely than females to hold views such as: “I would not vote for a male politician if I knew he had been depressed,” “Men with depression are dangerous,” and “Men with depression could snap out of it if they wanted.”

Among 360 respondents with direct experience of depression or suicidal ideation, more male than female respondents said that they would feel embarrassed about seeking formal treatment for depression.

One contributor who spoke to Medical News Today also pointed out that it is not easy for men to be open with their peers about mental health struggles.

“Talking about mental health isn’t something that tends to come up readily in particular social environments, such as when playing football,” he told us.

“Often, the relationships there are tied into the game and little else away from the pitch, which is a real shame,” he added.

Further stumbling blocks for men of color

Men of color and men of diverse racial and ethnic backgrounds face additional challenges when it comes to looking after their mental health.

According to Prof. Norman Bruce Anderson, former CEO of the American Psychological Association — in the U.S., Black and Latino men are six times more likely to be murdered than their white peers.

Prof. Anderson also notes that American Indian men are the demographic most likely to attempt suicide and that Black men are most likely to experience incarceration.

According to Dr. Octavio Martinez Jr., executive director of the Hogg Foundation for Mental Health, the effect of these disparities on the mental health of people of color and of diverse ethnic and racial backgrounds is “a double whammy.”

“Add the stigmatization of help-seeking behavior by men of all races to the unique stressors faced by men and boys of color, and it’s no wonder men and boys of color are at higher risk for isolation and mental health problems. These challenges can manifest as substance use or acting out through violence and aggression — which can lead to more stigma and a continuation of the cycle.”

On top of this, the authors of a study published in 2015 in the Journal of Health Care for the Poor and Underserved point out that “Medical experimentation on African Americans during slavery laid a foundation of mistrust toward healthcare providers.”

All of these issues taken together lay a further barrier to people of color seeking and accessing care for mental health when they need it.

Men may have different symptoms

Specialists also point out that men and women can experience different symptoms of the same mental health issues. This, they say, may be partly a “side effect” of divergent views of mental health.

For instance, NIMH specialists explain that “Some men with depression hide their emotions and may seem to be angry, irritable, or aggressive, while many women seem sad or express sadness.”

They also note that some symptoms of depression are physiological, such as a racing heart, digestive issues, or headaches, and men “are more likely to see their doctor about physical symptoms than emotional symptoms,” according to the NIMH.

The organization also note that self-medicating with alcohol and other substances is a common symptom of depression among men and that this can exacerbate mental health problems and increase the risk of developing other health conditions.

So what can mental health professionals and policymakers do to ensure that men feel confident and comfortable seeking support and that they receive the appropriate care?

Better mental health education

The first step in addressing these issues, researchers argue, is enhancing education about mental health.

In the Canadian Family Physician study, the researchers emphasize the importance of “disrupting how men traditionally think about depression and suicide by breaking down the stigma that surrounds these topics” through nationwide campaigns.

They also explain that it is important to help men change the idea of receiving support from “a mark of weakness” to a necessary step in maintaining one aspect of health that is as important as any other.

Anecdotal evidence supports these suggestions. One MNT respondent, for instance, told us that:

“[One] area I feel needs improvement is education. […] I had spells of bad mental health in my childhood. It wasn’t until my teenage years, when I became aware of my mother’s and grandfather’s history of mental health problems, that I realised what was going on with me. As a child, feeling anxious and/or depressed for no apparent reason was terrifying and only made my symptoms worse.”

“Also, not knowing what was going on made me embarrassed, and I usually wouldn’t tell anyone what was going on with me,” this contributor went on to say.

“I don’t know for sure, but if there had been education about mental health in my childhood, I reckon my symptoms wouldn’t have scared me as much, and I would have been more open about talking about it with my parents, teachers, healthcare professionals, etc.”

Another step in providing better support for men, the UBC researchers say, is “changing the landscape” of care for mental health by offering community-based programs that help counter risk factors for mental health problems, such as a sense of isolation among older people.

But no intervention is complete until it accounts for the groups that face systematic marginalization, such as men of color and those of diverse ethnic and racial backgrounds.

Specialists have found that Black men in the U.S. are more likely to seek support in informal settings, such as places of worship. Based on this, they have suggested “community-based participatory research” as an important first step.

This approach will require researchers to gain trust and seek collaboration from Black Americans in finding out what needs to change to make formal support more accessible.

Dr. Martinez, referring to a report from 2014, also emphasizes the importance of community-based approaches.

He promotes interventions aimed to encourage men and boys of color and of diverse backgrounds to connect on a personal level. “Stigma fades when men and boys see resilience and mental health self-care modeled by their fathers, brothers, teachers, faith leaders, and friends,” he says.

“Seek ways to demonstrate the connection between individual mental health and popular traditions of mentorship, cultural pride, self-emancipation and community action among men.”

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

Walnuts may not just be a tasty snack, they may also promote good-for-your-gut bacteria. New research suggests that these “good” bacteria could be contributing to the heart-health benefits of walnuts. In a randomized, controlled trial, researchers found that eating walnuts daily as part of a healthy diet was associated with increases in certain bacteria that can help promote health. Additionally, those changes in gut bacteria were associated with improvements in some risk factors for heart disease.

Kristina Petersen, assistant research professor at Penn State, said the study — recently published in the Journal of Nutrition — suggests walnuts may be a heart- and gut-healthy snack.

“Replacing your usual snack — especially if it’s an unhealthy snack — with walnuts is a small change you can make to improve your diet,” Petersen said. “Substantial evidence shows that small improvements in diet greatly benefit health. Eating two to three ounces of walnuts a day as part of a healthy diet could be a good way to improve gut health and reduce the risk of heart disease.”Previous research has shown that walnuts, when combined with a diet low in saturated fats, may have heart-healthy benefits. For example, previous work demonstrated that eating whole walnuts daily lowers cholesterol levels and blood pressure.

According to the researchers, other research has found that changes to the bacteria in the gastrointestinal tract — also known as the gut microbiome — may help explain the cardiovascular benefits of walnuts.“There’s a lot of work being done on gut health and how it affects overall health,” said Penny Kris-Etherton, distinguished professor of nutrition at Penn State. “So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease.”

For the study, the researchers recruited 42 participants with overweight or obesity who were between the ages of 30 and 65. Before the study began, participants were placed on an average American diet for two weeks. After this “run-in” diet, the participants were randomly assigned to one of three study diets, all of which included less saturated fat than the run-in diet. The diets included one that incorporated whole walnuts, one that included the same amount of alpha-linolenic acid (ALA) and polyunsaturated fatty acids without walnuts, and one that partially substituted oleic acid (another fatty acid) for the same amount of ALA found in walnuts, without any walnuts.

In all three diets, walnuts or vegetable oils replaced saturated fat, and all participants followed each diet for six weeks with a break between diet periods. To analyze the bacteria in the gastrointestinal tract, the researchers collected fecal samples 72 hours before the participants finished the run-in diet and each of the three study diet periods. “The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” Petersen said. “One of those is Roseburia, which has been associated with protection of the gut lining. We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers also found that after the walnut diet, there were significant associations between changes in gut bacteria and risk factors for heart disease. Eubacterium eligens was inversely associated with changes in several different measures of blood pressure, suggesting that greater numbers of Eubacterium eligens was associated with greater reductions in those risk factors.

Additionally, greater numbers of Lachnospiraceae were associated with greater reductions in blood pressure, total cholesterol, and non-High Density Lipo-protein (HDL) cholesterol. There were no significant correlations between enriched bacteria and heart-disease risk factors after the other two diets.

Regina Lamendella, associate professor of biology at Juniata College, said the findings are an example of how people can feed the gut microbiome in a positive way. “Foods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber and bioactive compounds — for our gut microbiomes to feed on,” Lamendella said. “In turn, this can help generate beneficial metabolites and other products for our bodies.” Kris-Etherton added that future research can continue to investigate how walnuts affect the microbiome and other elements of health.

“The findings add to what we know about the health benefits of walnuts, this time moving toward their effects on gut health,” Kris-Etherton said. “The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels.”

Lung cancer is the second most common type of cancer in adults in the United States. It is also the leading cause of death from cancer.

Lung cancer treatment is much more effective when the disease is in its earlier stages. However, most people with lung cancer do not experience symptoms until the disease has spread.

Some people experience subtle symptoms of early stage lung cancer, but these symptoms more often stem from other health issues or factors such as smoking.

Below, we describe early symptoms of lung cancer, as well as risk factors and when to see a doctor.

Possible signs and symptoms of early stage lung cancer

According to the American Cancer Society (ACS), most types of lung cancer do not cause symptoms until they have spread to other areas.

However, some people experience subtle symptoms during the earlier stages of the disease.

The early lung cancer symptoms that we describe below usually result from some other cause. However, people who experience these symptoms should consider visiting their doctors as a precautionary measure.

Sudden weight loss

The American Society of Clinical Oncology report that weight loss is often the first noticeable sign of cancer.

They estimate that 40% of people who receive a cancer diagnosis experience unexplained weight loss during that time.

Cancer can cause weight loss for many reasons, including:

  • changes to immune function
  • changes to metabolism
  • changes to hormones
  • a sudden loss of appetite
  • difficulty swallowing

Shortness of breath

Shortness of breath and wheezing can also be early symptoms of lung cancer.

Some people may experience a slight cough in addition to shortness of breath. Others may have difficulty catching their breath but have no cough.

Cough

A slight cough that does not go away can indicate early stage lung cancer. Some people assume that this cough is only a result of smoking.

A person who regularly coughs because of another lung condition may notice changes in their cough, and these can likewise indicate lung cancer.

Also, a cough that produces blood may result from lung cancer or another issue with the lungs. Anyone who experiences this symptom should see a doctor.

General fatigue

Lung cancer can cause the number of red blood cells in the body to drop. The medical term for this issue is anemia.

Because red blood cells carry oxygen, a person with anemia may not take in enough oxygen to support their body’s needs. This can result in tiredness and fatigue. Severe fatigue can make it difficult to function on a day-to-day level.

Shoulder, chest, or back pain

Most people with lung cancer do not feel pain or other symptoms during the early stages. This is because there are very few nerve endings in the lungs.

However, pain can occur when lung cancer invades the chest wall, ribs, vertebrae, or certain nerves. For example, Pancoast tumors, which form at the very top of the lungs, often invade nearby tissues, causing shoulder pain.

As a tumor develops, a person may begin to feel pain in their:

  • arms
  • chest
  • back

Hoarse voice

A person with lung cancer or another respiratory disease may develop a hoarse, raspy voice.

This can happen if a tumor presses on the laryngeal nerve, which is located within the chest. When the nerve is compressed, it can paralyze a vocal cord, causing the voice to change.

Risks

According to the Centers for Disease Control and Prevention (CDC)cigarette smoking is still the biggest risk factor for lung cancer, accounting for 80–90% of lung cancer-related deaths.

Other risk factors for lung cancer include:

  • using other tobacco products, such as cigars or pipe tobacco
  • inhaling secondhand smoke
  • being exposed to radon gas, possibly from materials within the home
  • working with dangerous chemicals, such as asbestos, arsenic, or diesel
  • living in a highly polluted area
  • having other lung conditions, such as chronic obstructive pulmonary disease
  • having a family history of lung cancer

When describing risk, organizations and experts sometimes use the term “pack-year.” A pack-year refers to the number of cigarettes smoked per day each year. So a person with a 30 pack-year smoking history may have:

  • smoked one pack per day for 30 years
  • smoked two packs per day for 15 years

The ACS recommend yearly lung cancer screenings for people aged 55–74 who:

  • currently smoke or have quit smoking in the past 15 years
  • have at least a 30 pack-year smoking history
  • currently smoke and are receiving counseling to help them quit
  • are aware of the potential benefits and harms of screening
  • have access to a facility that has experience with lung cancer screening and treatment

Screening cannot detect every instance of lung cancer, but it does lower a person’s chance of dying from the disease.

Smokers vs. nonsmokers

According to the CDC, people who smoke are 15–30 times more likely to die from lung cancer than people who do not.

Meanwhile, according to statistics from 2013–2014, about 1 in 4 people who do not smoke, including children, are exposed to secondhand smoke. This increases their risk of developing the disease.

Quitting smoking at any age can lower the risk of lung cancer.

When to see a doctor

The symptoms above usually result from issues other than lung cancer. However, anyone who experiences any of the following issues should visit a doctor:

  • a cough that lasts longer than 2–3 weeks
  • a persistent cough that worsens
  • a cough that produces blood
  • aches or pains when breathing or coughing
  • persistent shortness of breath
  • persistent tiredness or fatigue
  • recurrent chest infections
  • unexplained weight loss

Summary

Lung cancer is the second most common form of cancer. It can affect anyone but is particularly prevalent among people who smoke.

Usually, lung cancer does not cause symptoms until it has spread. As a result, it is not always possible to detect lung cancer in its earliest stages.

Nonetheless, some people experience subtle symptoms during the initial stages. It is important to recognize these because treatment is typically more effective when a person receives it early.

Anyone who experiences early symptoms of lung cancer should see a doctor. In many cases, something other than cancer is the cause. Still, it is best to seek medical advice as a precaution.

Lower abdominal pain is pain that occurs below a person’s belly button. Bloating refers to a feeling of pressure or fullness in the abdomen, or a visibly distended abdomen. Sometimes, these symptoms occur together.

Though occasional lower abdominal pain and bloating are common, a person should speak to their doctor if it becomes a regular occurrence. In some cases, this combination of symptoms may indicate an underlying issue that requires medical treatment.

Keep reading for more information on some of the more common causes of abdominal pain and bloating. We also outline various treatment options for this combination of symptoms.

Causes of both abdominal pain and bloating

There are several causes of combined lower abdominal pain (LAP) and bloating. Some relatively harmless, or benign, causes include:

  • consumption of high fat foods
  • swallowing too much air
  • stress

In some cases, LAP and bloating can occur as a result of an underlying medical condition, such as:

  • constipation
  • food intolerances, such as lactose or gluten intolerance
  • gastroesophageal reflux disease (GERD), although this more commonly causes upper abdominal pain-gastroenteritis, which is inflammation of the gastrointestinal (GI) tract that causes vomiting and diarrhoea
  • diverticulitis, which is inflammation or infection of part of the large intestine
  • ileus, which is a condition that slows the function of the small and large intestine
  • delayed stomach emptying, or gastroparesis, which is a complication of diabetes mellitus
  • intestinal obstruction
  • inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

Other conditions that can cause LAP and bloating are specific to females. These include:

  • menstrual pain
  • endometriosis
  • ovarian cysts
  • pelvic inflammatory disease (PID)
  • pregnancy
  • ectopic pregnancy

LAP and bloating can also be due to conditions that do not necessarily affect the stomach, intestines, or reproductive organs. These conditions include;

  • drug allergies
  • side effects of certain medications
  • hernia
  • cystitis, or infection of the urinary tract infection
  • appendicitis, or inflammation of the appendix
  • kidney stones

When to see a doctor

If the cause of LAP and bloating is relatively benign, symptoms should go away within a few hours to days.

A person should see a doctor if:

  • their symptoms last longer than a few days
  • their symptoms begin to interfere with their daily life
  • they are pregnant and are unsure of the cause of LAP and bloating

People should seek immediate medical attention if vomiting or the inability to pass gas occur alongside LAP and bloating.

People who experience LAP and bloating along with one or more of the following symptoms should seek emergency medical attention:

  • sudden worsening of pain
  • fever
  • unusual vaginal discharge
  • bloody stool
  • unexplained weight loss
  • severe nausea and vomiting

Diagnosis

To make a diagnosis, a doctor will begin by carrying out a physical examination. An initial examination will involve applying pressure to the abdomen. This will help the doctor to check the location of pain and to feel for any abnormalities.

A doctor will also make a note of the person’s medical history, and any other symptoms they experience. They may also ask whether there is anything that triggers the pain or makes it worse.

Diagnostic tests, such as urine, blood, or stool tests, may also be necessary. These can help to identify signs of infection or other underlying conditions.

In some cases, a doctor may order one of the following imaging tests to check for abnormalities in the abdomen:

  • ultrasound
  • X-ray
  • CT or MRI

If the imaging tests come back normal, a doctor may perform a colonoscopy for a closer look inside the intestines.

Treatment

The following are some general home treatment options that may help to alleviate symptoms of LAP and bloating:

  • increasing fluid intake
  • exercising to help alleviate gas and bloating
  • taking over-the-counter (OTC) pain medications
  • taking OTC antacids

If home treatments do not work, a person should speak to their doctor about other treatment options. These will vary, depending on the cause of LAP and bloating. However, some examples include:

  • prescription medications to treat pain and bloating
  • antibiotics to help treat a bacterial infection
  • emergency surgery to remove a ruptured appendix

Prevention

There are some steps a person can take to help alleviate LAP and bloating. Two key steps include quitting smoking and avoiding trigger foods.

The following are examples of foods that may cause or contribute to LAP and bloating:

  • high fat foods
  • certain plant-based foods, such as cabbage, lentils, and beans
  • dairy products if a person is lactose intolerant
  • carbonated drinks
  • beer
  • chewing gum
  • hard candy

Also, people may benefit from increasing their intake of high fiber foods such as fruits, vegetables, and whole grains. This will help to prevent constipation and associated bloating.

If an underlying condition is the cause of LAP and bloating, then treating the condition should help to alleviate these symptoms.

Outlook

There are many potential causes of lower abdominal pain and bloating. Some causes are relatively benign and easy to treat, while others may be more serious.

Occasional lower abdominal pain and bloating are usually not a cause for concern. However, people should see a doctor if their symptoms worsen, last more than a few days, or disrupt their daily activities.

People who experience additional symptoms, such as vomiting, fever, or blood in the stool, should seek emergency medical attention.

In some cases, people can prevent lower abdominal pain and bloating by avoiding foods that may trigger these symptoms.

Asthma makes people’s airways hyperreactive, causing them to get smaller and often resulting in difficulty breathing. While it is not always possible to prevent asthma, people can try to avoid risk factors such as smoking, being overweight, and having prolonged exposure to air pollution.

According to the Centers for Disease Control and Prevention (CDC)asthma is responsible for around 10 deaths per day in the United States.

Although asthma affects both children and adults, adults are four times as likely to die from asthma-related complications than young people.

So, preventing asthma symptoms whenever possible is vital. The following are some avoidable asthma risk factors.

1. Smoking

Exposure to firsthand cigarette smoke can irritate the airways and make it more likely that a person with asthma will have more frequent and severe symptoms.

This is also true for secondhand smoke. Even when people smoke outside the home or in a car, the lingering smoke and chemicals can expose others to secondhand smoke.

Children whose mothers smoke cigarettes during pregnancy are also at greater risk of asthma than children whose mothers do not, according to the American Lung Association.

2. Obesity

Doctors are not yet sure of the underlying cause, but obesity seems to be linked with asthma. Scientists have a theory that obesity can cause inflammation in the body, including in the airways, leading to asthma.

Obesity increases the amount of specific inflammatory factors that can increase the number of white blood cells in the body. This may cause inflammation and airway irritation.

3. Air pollution

People who live in urban areas, where there is more smoke and smog, are more likely to have asthma. Smog is darker air pollution that tends to be present in bigger cities with more vehicles and factories.

Ozone, which is a major component of smog, can trigger asthma symptoms such as wheezing and shortness of breath.

As well as ozone, smog contains sulfur dioxide, which can irritate the airways and trigger asthma attacks.

4. Occupational exposures

Scientists have linked exposure to irritants such as pesticides to a higher risk of asthma. This risk extends beyond those who work with pesticides, such as farmers.

In fact, other at-risk groups include:

  • children of pesticide workers who store equipment near the home or wear clothes that carry pesticide residue
  • people who live near pesticide-treated areas or factories
  • people who live in agricultural areas where it is likely that pesticide spraying occurs indoors or outdoors

Exposure to harsh chemicals such as cleaning products may also be a risk factor for asthma. This is especially true for spray cleaning products distributed into the air.

5. Allergies

Allergens such as pet dander and pollen can trigger asthma attacks. People who have allergy-related conditions such as eczema and allergic rhinitis are more likely to have asthma.

As a result, avoiding allergic triggers can help prevent asthma reactions.

Examples of allergens that may trigger asthma include:

  • pet dander
  • dust mites
  • mold
  • pollens

If certain allergens trigger asthma symptoms, avoiding these triggers whenever possible is vital.

6. Respiratory infections

Children with asthma who have upper respiratory infections are more likely to experience wheezing. During an upper respiratory infection, such as a cold, the airways may be more prone to the wheezing that can lead to asthma symptoms.

While it is not always possible to prevent upper respiratory infections, it is vital to take steps to prevent illness in children. A caregiver can achieve this by encouraging frequent handwashing and avoiding exposure to people with colds or other respiratory infections.

Family history

Scientists have found more than 100 genes potentially responsible for asthma, according to a study paper in the Italian Journal of Pediatrics. However, no single gene by itself causes asthma.

Some research suggests that 35–95 percent of people with a family history of asthma will get the condition, according to a study paper in the journal Pediatrics & Neonatology.

Although it is not possible to change family history, people can be aware that others in their family have asthma and seek treatment if they start to have asthma-like symptoms.

Such people can also avoid common asthma triggers if they know they have a genetic predisposition to the condition.

Treatment and prevention

Some strategies to help prevent asthma symptoms include:

  • stopping smoking and refraining from smoking around others, especially children
  • avoiding public places where cigarette smoking occurs
  • limiting outdoor exposure on days with heavy smog or smoke
  • encouraging a diet high in fruit, vegetables, whole grains, and lean protein
  • encouraging childhood vaccinations that can prevent common respiratory infections that could lead to worsening asthma symptoms
  • avoiding allergens that trigger asthma attacks, such as pet dander, dust mites, mold, and pollen

A person should consider talking with their doctor if they think that allergens are triggering their asthma.

Recognizing asthma symptoms, such as wheezing, coughing that is worse at night, and shortness of breath, is vital because it can help people seek suitable treatments for the condition.

An estimated 75 percent of severe asthma attacks are preventable, according to the American Academy of Allergy, Asthma, & Immunology.

Doctors can prescribe many different treatment types and combinations to help a person treat their asthma. This includes inhalers to open up the airways, steroid medications to reduce inflammation, and other oral medications that help reduce airway reactivity.

If a person takes them consistently, medications alongside preventive efforts can help prevent asthma attacks from occurring.

Summary

Asthma can affect a person’s quality of life and cause serious respiratory distress that can sometimes be life-threatening. Knowing risk factors and triggers for the condition can help a person engage in preventive efforts.

If a person has asthma or concerns about risk factors, it is important that they talk with their doctor about how to consistently and effectively manage their symptoms.

Omega-3 fatty acids are fats commonly found in plants and marine life.

Two types are plentiful in oily fish:

Eicosapentaenoic acid (EPA): The best-known omega-3 fatty acid, EPA helps the body synthesize chemicals involved in blood clotting and inflammation (prostaglandin-3, thromboxane-2, and leukotriene-5). Fish obtain EPA from the algae that they eat.

Docosahexaenoic acid (DHA): In humans, this omega-3 fatty acid is a key part of sperm, the retina, a part of the eye, and the cerebral cortex, a part of the brain.

DHA is present throughout the body, especially in the brain, the eyes and the heart. It is also present in breast milk.

Health benefits

Some studies have concluded that fish oil and omega-3 fatty acid is beneficial for health, but others have not. It has been linked to a number of conditions.

Multiple sclerosis

Fish oils are said to help people with multiple sclerosis (MS) due to its protective effects on the brain and the nervous system. However, at least one study concludedTrusted Source that they have no benefit.

Prostate cancer

One study found that fish oils, alongside a low-fat diet, may reduce the risk of developing prostate cancer. However, another study linked higher omega-3 levels to a higher risk of aggressive prostate cancer.

Research published in the Journal of the National Cancer Institute suggested that a high fish oil intake raises the risk of high-grade prostate cancer by 71 percent, and all prostate cancers by 43 percent.

Post-partum depression

Consuming fish oils during pregnancy may reduce the risk of post-partum depression. Researchers advise that eating fish with a high level of omega 3 two or three times a week may be beneficial. Food sources are recommended, rather than supplements, as they also provide protein and minerals.

Mental health benefits

An 8-week pilot study carried out in 2007 suggested that fish oils may help young people with behavioral problems, especially those with attention deficit hyperactivity disorder (ADHD).

The study demonstrated that children who consumed between 8 and 16 grams (g) of EPA and DHA per day, showed significant improvements in their behavior, as rated by their parents and the psychiatrist working with them.

Memory benefits

Omega-3 fatty acid intake can help improve working memory in healthy young adults, according to researchTrusted Source reported in the journal PLoS One.

However, another study indicated that high levels of omega-3 do not prevent cognitive decline in older women.

Heart and cardiovascular benefits

Omega-3 fatty acids found in fish oils may protect the heart during times of mental stress.

Findings published in the American Journal of Physiology suggested that people who took fish oil supplements for longer than 1 month had better cardiovascular function during mentally stressful tests.

In 2012, researchers noted that fish oil, through its anti-inflammatory properties, appears to help stabilizeTrusted Source atherosclerotic lesions.

Meanwhile, a review of 20 studies involving almost 70,000 people, found “no compelling evidence” linking fish oil supplements to a lower risk of heart attack, stroke, or early death.

People with stents in their heart who took two blood-thinning drugs as well as omega-3 fatty acids were found in one study to have a lower risk of heart attack compared with those not taking fish oils.

The AHA recommend eating fish, and especially oily fish, at least twice a week, to reduce the risk of cardiovascular disease.

Alzheimer’s disease

For many years, it was thought that regular fish oil consumption may help prevent Alzheimer’s disease. However, a major study in 2010 found that fish oils were no better than a placebo at preventing Alzheimer’s.

Meanwhile, a study published in Neurology in 2007 reportedTrusted Source that a diet high in fish, omega-3 oils, fruit, and vegetables reduced the risk of dementia and Alzheimer’s.

Vision loss

Adequate dietary consumption of DHA protects people from age-related vision loss, Canadian researchers reported in the journal Investigative Ophthalmology & Visual Science.

Epilepsy

A 2014 study published in the Journal of Neurology, Neurosurgery & Psychiatry claims that people with epilepsy could have fewer seizures if they consumed low doses of omega-3 fish oil every day.

Schizophrenia and psychotic disorders

Omega-3 fatty acids found in fish oil may help reduce the risk of psychosis.

Findings published in Nature Communications details how a 12-week intervention with omega-3 supplements substantially reducedTrusted Source the long-term risk of developing psychotic disorders.

Health fetal development

Omega-3 consumption may help boost fetal cognitive and motor development. In 2008, scientists found that omega-3 consumption during the last 3 months of pregnancy may improve sensory, cognitive, and motor development in the fetus.

Foods

The fillets of oily fish contain up to 30 percent oil, but this figure varies. White fish, such as cod, contains high concentrations of oil in the liver but less oil overall. Oily fish that are rich in omega-3 fatty acids include anchovies, herring, sardines, salmon, trout, and mackerel.

Other animal sources of omega-3 fatty acids are eggs, especially those with “high in omega-3” written on the shell.

Vegetable-based alternatives to fish oil for omega 3 include:

  • flax
  • hempseed
  • perilla oil
  • spirulina
  • walnuts
  • chia seeds
  • radish seeds, sprouted raw
  • fresh basil
  • leafy dark green vegetables, such as spinach
  • dried tarragon

A person who consumes a healthful, balanced diet should not need to use supplements.

Risks

Taking fish oils, fish liver oils, and omega 3 supplements may pose a risk for some people.

  • Omega 3 supplements may affect blood clotting and interfere with drugs that target blood-clotting conditions.
  • They can sometimes trigger side effects, normally minor gastrointestinal problems such as belching, indigestion, or diarrhea.
  • Fish liver oils contain high levels of vitamins A and D. Too much of these can be poisonous.
  • Those with a shellfish or fish allergy may be at risk if they consume fish oil supplements.
  • Consuming high levels of oily fish also increases the chance of poisoning from pollutants in the ocean.

It is important to note that the FDA does not regulate quality or purity of supplements. Buy from a reputable source and whenever possible take in Omega 3 from a natural source.

The AHA recommend shrimp, light canned tuna, salmon, pollock and catfish as being low in mercury. They advise avoiding shark, swordfish, king mackerel, and tilefish, as these can be high in mercury.

It remains unclear whether consuming more fish oil and omega 3 will bring health benefits, but a diet that offers a variety of nutrients is likely to be healthful.

Anyone who is considering supplements should first check with a health care provider.

“I used to be a full-time patient at this facility,” says Michelle Eze, a drug abuse survivor, as she signs her name in the register for a check-up with her psychiatrist at Karu General Hospital in Abuja, Nigeria’s Federal Capital Territory(FCT).

“I’m so glad I sought help in time as I was dependent on drugs and it cost me so much. It negatively affected the relationship with my family and people around me. I was disowned and left to face this harsh world all by myself. Drug abuse is a problem we should all join hands and fight it.”

Michelle is now a full-time ambassador against drug abuse among women.

One out of every four people who uses drugs in Nigeria is a woman, according to a 2018 report by the United Nations Office on Drugs and Crime (UNODC).

Over 300,000 Nigerians are high-risk drug users

Approximately 376 000 people – or about 0.4% of the Nigerian population aged 15-64 – are reckoned to be high-risk drug users, according to the UNODC report. Nearly 90% of these users regularly take opioids – particularly pharmaceutical opioids such as tramadol codeine, or morphine – while the others take cocaine or amphetamines.

Over 20% of the high-risk drug users inject drugs, with women first injecting on average at 20 years old and men first injecting on average at around 21 years old. HIV prevalence among women who inject drugs is almost seven times higher than among men who inject, according to the 2010 National Agency for the Control of AIDS (NACA) Integrated Biological and Behavioural Surveillance survey.

“At Karu hospital, we receive roughly 15 patients every day and usually at least half of them report to be using one drug or another,” says Pius Wabass, a psychiatric nurse on the Karu General Hospital’s psychiatry ward.

“These patients are often so young – under 40 – and, of late, more women are checking into our facility. The misuse of drugs

has serious health repercussions. Medically, opioids are primarily used for pain relief, including anaesthesia, while amphetamines are powerful stimulators of the central nervous system used to treat some medical conditions.”

Efforts to respond to drug use in Nigeria

As countries including Nigeria make efforts to respond to drug use among the population, health experts note that there are some factors that affect women more than men. A lot of factors have been identified as putting women at increased risk, some are psychological, cultural, social and economic aspects of their lives. Another issue is the general perception that drug use is a male issue and women users are often reluctant to seek help. The Federal Ministry of Health (FMOH) is now addressing this.

“The FMoH has taken up this challenge and currently working with all stakeholders to respond to drug use among young people, especially women,” explains Dr Jimoh Salaudeen from the Food and Drug Division, FMOH. As part of the response, a women-specific drug treatment programme has been established at the federal neuropsychiatric hospital in Kware in Sokoto State and the ministry hopes to replicate such centres across the country.”

Dr Salaudeen continues: “There is a strong linkage between opioid use disorders and health conditions such as preterm births, stillbirths, poor foetal growth, maternal death and neonatal abstinence syndrome. This is why the Ministry of Health has prioritized sexual reproductive health, particularly for women, within the context of drug treatment and harm reduction.”

Working assiduously to reduce drug demand and harm in Nigeria

The FMOH, with the support of WHO, established the National Technical Working Group (NTWG) on drug demand and harm reduction in Nigeria in May 2019.

“The NTWG is working under the leadership of the Minister of Health and is actively engaged in implementing a comprehensive public health response to the challenge of drug use in the country,” says Dr Rex Mpazanje, WHO Cluster Coordinator for Communicable and Non Communicable Diseases.Close

“This effort also includes bringing together different stakeholders at the national and state level for a concerted response. This includes advocacy, capacity building and resource mobilization to ensure promotion of evidence-based prevention activities and the availability of drug treatment and harm reduction programmes at community level.”

Target 3.5 of the United Nations 2030 Sustainable Development Goals (SDGs) is to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. WHO Nigeria will continue to support to the Government of Nigeria in achieving this goal.

The behavioural medicine unit of the Karu General Hospital, Abuja. Many drug abuse patients are treated here.