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Inhalers and other steroids linked to changes in the brain

<p dir="ltr">If you’ve been diagnosed with asthma, Chronic Obstructive Pulmonary Disorder (COPD), ezcema or even Crohn’s disease, you’ve likely been prescribed some form of medical steroid to treat it.</p> <p dir="ltr">However, Dutch scientists are calling for more awareness about potential side effects of using medical steroids, as well as research into alternative treatment options, after they found a link between using these medications and changes in the brain structure and volume.</p> <p dir="ltr">Glucocorticoids, a class of synthetic steroids found in inhalers and other medicines, fight inflammation in the body, making them highly effective for treating autoimmune diseases, where your body triggers inflammation by mistake and results in your immune system attacking healthy cells as if they were viruses or bacteria. </p> <p dir="ltr">This immunoprotective quality has made them one of the most frequently prescribed drugs globally.</p> <p dir="ltr">But, both systemic and inhaled steroid use is associated with abnormalities in brain structure and shrinkage of particular areas, according to previous research.</p> <p dir="ltr">With this research focusing on small groups of people with specific conditions, a team of Dutch researchers decided to investigate whether these side effects were seen in the broader population, with their findings published in the journal <em><a href="https://doi.org/10.1136/bmjopen-2022-062446" target="_blank" rel="noopener">BMJ Open</a></em>.</p> <p dir="ltr">Using data from the UK Biobank - a database of genetic and health information from half a million people available to researchers across the world - the team looked to see whether there were differences in the brains of users and non-users of glucocorticoids.</p> <p dir="ltr">After comparing the brain scans of 222 people who use systemic steroids, 557 using inhaled steroids, and 24,106 people who didn’t use either, they found that use of medical steroids was linked to less intact white brain matter in comparison to scans of non-users.</p> <p dir="ltr">The white matter in our brains is made up of bundles of nerve fibres covered in a fatty substance called myelin, which gives these areas their white colour. White matter is part of the central nervous system, helping to connect different areas of grey matter to each other and send messages between them. These parts of the brain affect how we learn and how our brains function.</p> <p dir="ltr">Participants in the study also filled out a questionnaire to assess aspects of their mood over the previous fortnight, as the team wanted to know if steroid use was also linked to changes in processing speed or emotional responses.</p> <p dir="ltr">They found that systemic use of steroids was associated with a larger caudate - a C-shaped structure in the brain that is involved in associative and procedural learning, working memory, speaking in multiple languages, cognition and emotional processing.</p> <p dir="ltr">Meanwhile, the use of inhaled steroids was linked to a smaller amygdala, another structure in the brain made of grey matter that is involved in processing emotions, particularly for strong emotions such as fear.</p> <p dir="ltr">From the questionnaire, the team found systemic steroid users performed worse than non-users when it came to the test measuring processing speed, and that they reported significantly more symptoms of depression, apathy, restlessness, fatigue and lethargy.</p> <p dir="ltr">Inhaled steroid users also reported more tiredness and lethargy, but to a lesser degree than systemic users.</p> <p dir="ltr">But, the researchers stress that their findings don’t necessarily mean that medical steroids cause the changes seen in the brain.</p> <p dir="ltr">“Although a causal relation between glucocorticoid use and changes in the brain is likely based on the present and previous studies, the cross-sectional nature of this study does not allow for formal conclusions on causality,” they caution.</p> <p dir="ltr">Instead, they say the relationship may explain some of the side effects associated with long-term use of the medications, including anxiety, depression, mania and delirium.</p> <p dir="ltr">“While it remains unclear whether the observed effect sizes have clinical consequences for the population of glucocorticoid users as a whole, these findings are remarkable given the common neuropsychiatric side effects of synthetic glucocorticoids,” the researchers write.</p> <p dir="ltr">They conclude that widespread reduction in the integrity of white matter in the brain is associated with both systemic and inhaled steroid use, and argue that this could be an underlying contributor to neuropsychiatric side effects that patients using these steroids can experience.</p> <p><span id="docs-internal-guid-954fbbed-7fff-5e9e-2f6e-456381994a6a"></span></p> <p dir="ltr">Given the widespread use of medical steroids, they add that it’s important for doctors and patients to know about the possible effects they can have on the brain and that more research should be done into alternative options for treatment.</p> <p dir="ltr"><em>Image: Getty Images</em></p>

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Man accidentally inhales drill bit at the dentist

<p>A run-of-the-mill trip to the dentist for a 60-year-old man from Illinois in the US turned into anything but a normal occasion with the unthinkable happened.</p> <p>Right at a crucial moment during his dental procedure, the man inhaled sharply right before an innocent cough – and accidentally breathed in the dentist’s drill bit, resulting in an emergency trip to the hospital.</p> <p>In recounting the terrifying incident, Tom Jozsi said that he was at the dentist getting a tooth filed when he was told he had "swallowed" the tool. However, doctors later determined that he had "inhaled" it right before he coughed, sending the 2.5cm drill bit deep into the lung.</p> <p>“I didn’t really even feel it going down. All I felt was a cough. When they did the CT scan they realised, ‘You didn’t swallow it. You inhaled it,’” he said.</p> <p><img src="https://oversixtydev.blob.core.windows.net/media/2022/04/Drill-bit.jpg" alt="" width="572" height="370" /></p> <p>Dr Abdul Alraiyes, at Aurora Medical Center-Kenosha in Wisconsin, said the bit was so deep that normal scopes couldn’t reach it. Jozsi said he was told that if it couldn’t be taken out, part of his lung would have to be removed.</p> <p>Alraiyes and his medical team decided to try a newer device to remove the object – one that’s designed for early detection of cancer. They were able to pull out the drill piece without harm.</p> <p>“I was never so happy as when I opened my eyes, and I saw him with a smile under that mask shaking a little plastic container with the tool in it,” Jozsi said.</p> <p>Joszki said he now keeps the drill bit on a shelf at home.</p> <p><em>Image: Getty & NBC</em></p>

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Scientists creating inhalable Covid vaccine

<p dir="ltr">Scientists are a step closer to creating an inhalable “aerogel” vaccine that successfully induces an immune response against Covid.</p> <p dir="ltr">Researchers at Penn State University developed and patented a gel-like material, called an "aerogel," to deliver antimicrobials to the lungs to treat bacterial respiratory infections, particularly tuberculosis.</p> <p dir="ltr">Graduate student in biomedical engineering and a lead author of the <a href="https://www.psu.edu/news/story/inhalable-aerogel-triggers-immunity-covid-19-mice-may-block-transmission/" target="_blank" rel="noopener">study</a> Atip Lawanprasert said there was an advantage to the inhalable formulation for those who don’t like needles.</p> <p dir="ltr">“One is avoidance of needles. Inhalable vaccines might be able to help increase the rate of vaccination because so many people are afraid of injections,” he said.</p> <p dir="ltr">“No matter how high the efficacy of a vaccine, if people don’t get it, then it’s not useful.”</p> <p dir="ltr">Scott Medina, an assistant professor of biomedical engineering at the university, said the team started working on the inhalable vaccine when the pandemic began.</p> <p dir="ltr">“When the pandemic started, we decided to develop an inhalable formulation for COVID-19 by combining our aerogel with a nucleic acid-encoded antigen — specifically, DNA that encodes the SARS-CoV-2 proteins,” he said.</p> <p dir="ltr">Their Covid formula, also known as CoMiP (coronavirus mimetic particle), was created to target alveolar macrophages, a type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells.</p> <p dir="ltr">“Alveolar macrophages represent attractive targets for inhalable vaccines because they are abundant within the lungs, and previous evidence has suggested that they may be important in early COVID-19 pathogenesis,” Medina explained.</p> <p dir="ltr">“Alveolar macrophages are one of our key defenders against viral infection because they serve to present antigens to the rest of the immune system.”</p> <p dir="ltr">The CoMips were tested on mice which were then given a booster dose two weeks later.</p> <p dir="ltr">The samples from the animals were collected 14 days after the vaccine, and day 28, after the booster, which found no significant change in the systemic antibody levels between mice who received CoMiP and those that didn't.</p> <p dir="ltr">The researchers also collected samples from immunised mice to assess differences in the total and spike-protein specific lung mucosal IgA antibodies - the predominant antibody isotype in the mucosal immune system</p> <p dir="ltr">They found a significant increase in the total IgA for mice vaccinated with CoMiPs, but IgA specifically targeting the SARS-CoV-2 spike protein was lower than expected for the vaccinated animals.</p> <p dir="ltr">Medina said data was “encouraging” but more will need to be done.</p> <p dir="ltr"><em>Image: Shutterstock</em></p>

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New inhalable device could be lifesaving for new mums

<p><span style="font-weight: 400;">A new inhalable product more than a decade in the making could save the lives of tens of thousands of new mothers.</span></p> <p><span style="font-weight: 400;">The device, developed by Melbourne researchers, looks like a small whistle and allows oxytocin to be inhaled rather than injected, to prevent postpartum haemorrhages.</span></p> <p><span style="font-weight: 400;">Postpartum haemorrhages happen when a new mother experiences excessive blood loss after giving birth.</span></p> <p><span style="font-weight: 400;">As the leading cause of maternal mortality globally, these haemorrhages occur in up to 18 percent of births and result in an estimated 60,000 deaths each year across the world.</span></p> <p><span style="font-weight: 400;">Oxytocin is the </span><a rel="noopener" href="https://www.aafp.org/afp/2007/0315/p875.html" target="_blank"><span style="font-weight: 400;">recommended first choice</span></a><span style="font-weight: 400;"> for preventing postpartum haemorrhage due to its greater effectiveness in comparison to other drugs and has fewer side effects, and is currently administered via an injection.</span></p> <p><span style="font-weight: 400;">Researchers from the Institute of Pharmaceutical Sciences at Monash University partnered with Johnson &amp; Johnson have developed a new inhalable form of oxytocin that, unlike the injectable form, doesn’t need to be refrigerated, making it a less invasive and easier to distribute option for developing countries.</span></p> <p><span style="font-weight: 400;">“Many women in Australia will receive an oxytocin injection after every childbirth to prevent or lower risk of postpartum haemorrhages,” project leader Michelle McIntosh said.</span></p> <p><span style="font-weight: 400;">“We needed something that was really low cost and simple to use, but just as effective.”</span></p> <p><span style="font-weight: 400;">The World Health Organisation recommends every woman in the world to be given an injection of oxytocin after they give birth, but Professor McIntosh said this isn’t always possible.</span></p> <p><span style="font-weight: 400;">“Unfortunately, in a lot of low-resource settings, having access to someone present when you give birth, someone who is trained to give an injection and a product that has been maintained in cold storage, is very challenging.”</span></p> <p><span style="font-weight: 400;">Even in Australia, Professor McIntosh said the rate of postpartum haemorrhages has been increasing significantly.</span></p> <p><span style="font-weight: 400;">“While our focus has always been on low-resource settings, obstetricians in Australia and other developed countries [are] also quite keen to look at inhaled oxytocin,” she said.</span></p> <p><span style="font-weight: 400;">“That’s because it would take away the risk of needlestick injuries, it’s less invasive than a painful intramuscular injection and there are cohorts of patients we think would benefit from inhaled administration.”</span></p> <p><span style="font-weight: 400;">Clinical trials of the device, which could still be several years away from commercial use, have been funded by the Victorian government’s Medical Research Acceleration Fund, which allows researchers to develop new healthcare solutions in partnership with experts from Johnson &amp; Johnson.</span></p> <blockquote class="twitter-tweet"> <p dir="ltr">Research and innovation to address the leading cause of maternal mortality 💕<br /><br />Excited about our ongoing partnership <a href="https://twitter.com/JNJInnovation?ref_src=twsrc%5Etfw">@JNJInnovation</a><br />Wonderful to visit <a href="https://twitter.com/MIPS_Australia?ref_src=twsrc%5Etfw">@MIPS_Australia</a> <br />Thanks to Delia for sharing her story with <a href="https://twitter.com/bridgerollo?ref_src=twsrc%5Etfw">@bridgerollo</a> <a href="https://t.co/4lPRvIC8h7">https://t.co/4lPRvIC8h7</a></p> — Jaala Pulford MP (@JaalaPulford) <a href="https://twitter.com/JaalaPulford/status/1415507837925531651?ref_src=twsrc%5Etfw">July 15, 2021</a></blockquote> <p><span style="font-weight: 400;">“When medtech, biotech, and pharmaceutical businesses innovate, they change lives,” said Victoria’s Minister for Innovation, Medical Research and the Digital Economy, Jaala Pulford.</span></p> <p><span style="font-weight: 400;">“This new powder is going to be an extraordinary additional tool for women and their doctors and midwives and nurses [to deal] with something that comes on very suddenly and would be extremely terrifying.”</span></p> <p><em><span style="font-weight: 400;">Image: Monash Institute of Pharmaceutical Sciences / Twitter</span></em></p>

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