Why are smelling salts so popular on NHL benches?
Ammonia inhalants, or smelling salts, aren't a new product in the professional sports world. But they've also become increasingly popular for amateur athletes and, in some cases, minor hockey leagues. Dr. Shazma Mithani, an emergency physician at the Royal Alexandra and Stollery Children's hospitals in Edmonton, weighs in.
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Medscape
2 hours ago
- Medscape
Use of Oral Steroids to Treat MS Relapse Is Growing
OTTAWA — The use of oral rather than intravenous (IV) steroids to respond to relapses in patients with relapsing-remitting multiple sclerosis (RRMS) is growing, a study suggested. The data, which were presented in a moderated poster session at the annual meeting of the Canadian Neurological Sciences Federation (CNSF) Congress 2025, indicate a decreasing reliance on steroids over time to manage relapses. Researchers retrospectively examined data from 2010 to 2022 from the MS database MuSicaL. Investigators identified 2413 eligible patients for their analysis, and 1086 had at least one attack or relapse. Of these 1086 patients, half (543) had used high-dose steroids for 818 attacks. Information on the route of high-dose steroids was known in 348 attacks. IV steroids were administered for 148 attacks (42.5%), and oral steroids for 208 (59.8%) attacks. Oral and IV steroids are considered to have equal efficacy, study author Jihad Al Kharbooshi, MD, a fourth-year adult neurology resident at London Health Sciences Centre in London, Ontario, told Medscape Medical News. 'There have been studies involving patients with RRMS who received IV and oral steroids. Both groups of patients were compared, and they found the same effect' in terms of efficacy, he added. A review paper published in 2013 cited several investigations that compared IV steroid management with oral steroid management. These investigations concluded that the routes managed relapses in patients with RRMS with comparable efficacy. 'The second objective [of the present study] was to see whether the patient's type of relapse had anything to do with oral versus IV steroids being used,' said Al Kharbooshi. The researchers found that patients who experienced a multifocal relapse, which is a more severe type of relapse, were more likely to receive IV steroids than oral steroids (39.3% vs 25.5%). 'If the physician perceived that the relapse was very serious, such that it may be a life-endangering situation, they may have chosen IV steroids,' said Al Kharbooshi. Clinicians may believe that IV steroids can better manage more severe relapses, he added. The researchers also analyzed the route of administration according to prescriber specialty. 'The specialty of the prescriber, whether a neurologist or another prescriber, didn't significantly influence the choice of route of high-dose steroids,' said Al Kharbooshi. Taking steroids orally offers the benefit of convenience for patients with MS who, if they live in remote areas, may not be able to access IV steroids easily, pointed out Al Kharbooshi. Maryam Nouri, MD, an associate professor of pediatric neurology at Western University in London, Ontario, who moderated the poster session, noted that the growing decline in the use of steroids to manage MS relapses likely results from the greater efficacy of emerging medical therapies for RRMS. 'There was a downward trend toward using steroids to begin with, which could indicate that patients with MS are not experiencing as many relapses,' said Nouri. 'This confirms that the treatment landscape of MS has changed, as there are a lot of patients who are starting with high-affinity therapies right from the get-go. It is probably that the number of relapses is declining to begin with, so patients are not requiring as many steroid therapies.' One limitation of the analysis is that investigators did not have information about the route of steroid use for a substantial proportion of relapses, said Nouri. The investigators acknowledged this shortcoming in their presentation. Still, the fact that oral steroid use has grown over time suggests that clinicians are giving more consideration to this route of administration, according to Nouri. 'It is positive news that people are feeling more comfortable about using oral steroids,' she said. But in her clinical experience and that of her colleagues, the IV route is still the route of choice for managing MS flares in the pediatric setting, given that the evidence supporting comparable efficacy of IV and oral routes comes from adult studies.
Medscape
2 hours ago
- Medscape
Pediatric HS Linked to Gut Microbiome Changes
Emerging evidence suggests the gut microbiome may play a contributing role in the development of inflammatory skin diseases — including hidradenitis suppurativa (HS). The evidence incudes a small prospective study recently published in JAMA Dermatology , which found significant differences in gut microbial composition in pediatric patients with HS compared with matched healthy control participants, offering new insights into possible disease mechanisms that may extend beyond the skin. This follow-up to prior microbiome studies included pediatric participants for the first time. 'Overall, we found significant differences in gut microbiome composition of pediatric patients with HS compared with pediatric control participants and adult patients with HS, suggesting that gut microbiome dysregulation may extend to pediatric patients with HS and should be investigated further,' wrote the authors, from the Department of Dermatology at Boston University School of Medicine, Boston. Gut Dysbiosis and Reduced Microbial Diversity in HS The study included 16 participants — eight participants with HS and eight matched control participants — half of whom were younger than 18 years. Although beta diversity (variation between individuals) was similar across groups, a decrease in alpha diversity (diversity within an individual's gut microbiome) was observed in participants with HS, as measured using Pielou evenness. 'This may indicate gut dysbiosis,' the authors noted. In pediatric patients with HS, there were notable shifts in microbial composition. Bifidobacterium adolescentis was present in all pediatric patients with HS but absent in all adults with HS. 'As B adolescentis abundance typically increases with age, its absence in adults with HS may indicate dysregulation in gut microbiome maturation,' the authors explained. Other notable findings in the pediatric patients with HS included increases in Ruminococcus , Clostridium , and Bilophila . An increase in the beneficial bacterium Faecalibacterium prausnitzii was also noted compared with pediatric control participants. Clinical Implications and Future Directions Asked to comment on this emerging research, Tamia Harris-Tryon, MD, PhD, associate professor of dermatology and immunology at UT Southwestern Medical Center in Dallas, said the results highlight a nutritional component to HS that warrants greater attention. 'HS patients often have diets that are deficient in fiber and other nutrients,' she explained. 'The gut microbiome is directly linked to diet. A diet low in fiber will be deficient in microbes that ferment fiber. Fiber fermentation influences the immune system.' Harris-Tryon added that the new findings, particularly in children, emphasize the need for diet-based interventions. 'HS patients, especially pediatric patients, need to be meeting with a nutritionist,' she said. 'The emphasis should be on increasing fiber and nutrient-dense foods in the diet, while dropping high-glycemic index foods such as candy, soda, fruit juice, sweet teas, and cutting packaged and ultraprocessed foods.' While microbiome-targeted treatments such as probiotics are often discussed in chronic inflammatory skin conditions, Harris-Tryon advised caution. 'There is no data for microbiome-directed therapies in HS yet,' she said. 'But there is significant data on the benefits of a nutrient-dense, fiber-rich diet in pediatric patients and the influence of diet on the gut microbiome. Diets from all over the world with components similar to the Mediterranean diet have been shown to be the most beneficial for human health, including skin health. Fermented foods are an excellent time-tested source of beneficial microbes — including low sugar yogurt, kimchi, and kefir.' In a recent episode of the Medscape InDiscussion podcast series on HS and the microbiome, Harris-Tryon emphasized that 'understanding how the gut, skin, and immune system talk to each other is going to be key to developing future treatments for HS' and noted that this area of research 'is really just beginning to open up.' The study authors also encouraged future studies to examine potential interactions between the gut and the brain. ' B adolescentis produces gamma-aminobutyric acid [GABA], a mediator of the gut-brain axis that has been associated with anxiety and depression disorders through direct modulation of neural signals from the gut,' they wrote. 'As HS can affect mental health, particularly in vulnerable pediatric populations, it may be worthwhile to incorporate mental health screenings in future studies and assess correlations with GABA-producing microbes.' Noting that the study had limitations, such as a small sample size and the lack of matching by BMI or disease duration, the authors concluded that there were significant differences in the gut microbiome of pediatric patients with HS compared with pediatric control participants and adults with HS. The authors also referred to their previous study, which observed an increase in Bilophila and a decrease in Pielou evenness alpha diversity in both pediatric and adult patients with HS compared to control participants, pointing to potential gut dysbiosis. Collectively, the authors noted these findings suggest that 'gut microbiome dysregulation may extend to pediatric patients with HS and should be investigated further.' The study was independently supported by institutional grants from Boston University. The authors reported having no conflicts of interest. Harris-Tryon disclosed serving or having served as a director, officer, partner, employee, advisor, consultant, or trustee for Mirofend and Johnson & Johnson; serving as a speaker or a member of a speaker bureau for Tamia; and receiving research grants from LEO Pharmaceuticals.
Yahoo
2 hours ago
- Yahoo
The cheap fat jabs sending big pharma into a frenzy
For many Americans who tuned in to watch the Super Bowl earlier this year, it was a surprise to find themselves fat-shamed during the ad break. 'Obesity is America's deadliest epidemic,' a voiceover said, as images of wobbling bellies, greasy burgers and giant apple pies flashed across TV screens. The Super Bowl's 127m-strong audience, who were tucking into an estimated 1.5bn chicken wings during the event, were warned that 'obesity leads to half a million deaths each year'. But Hims and Hers, the US online medicines company behind the ad, said people should not blame themselves. Instead, its advert claimed that 'the system' was keeping them 'sick and stuck', adding that 'there are medications that work, but they're priced for profits, not patients'. To the relief of viewers, Hims and Hers offered a 'life-changing' solution. Rather than paying hundreds of dollars each month for well-known, branded weight-loss jabs such as Wegovy, households could instead try Hims and Hers' cheaper, replica versions. 'This is the future of healthcare,' it argued. 'Join us in the fight for a healthier America.' However, for the likes of Danish obesity drug maker Novo Nordisk and US pharma rival Eli Lilly, which have claimed the rise of copycat jabs poses potential health risks, such claims have become a serious headache. Over the past few decades, both businesses have poured billions of dollars into obesity drug research – recently yielding blockbuster drugs Wegovy and Mounjaro. The rapid uptake of such drugs has prompted a surge in revenues for big pharma. But bosses are now increasingly worried that demand among American patients has been dented by a cluster of smaller, copycat companies. According to industry estimates from November, around a quarter of the 8m Americans on weight-loss drugs were taking knock-off replica versions. These medicines, known as 'compound' drugs, were priced at around $200 ($148) a month, compared to over $1,300 for some branded versions. Barclays analyst Emily Field says the boom in copycat weight-loss drugs has been a 'unique phenomenon' in the US, sparking an inevitable surge in legal claims that has drawn the attention of regulators. So-called compound drugs are essentially custom-made medicines created by pharmacies using the same active ingredients of patented drugs. Historically, compounding pharmacies create custom versions of medicines if they need to personalise them for patients. For example, if someone is unable to take a standard oral medicine in pill form, or is allergic to an ingredient in an existing medicine. Compounding pharmacies are also typically blocked from mass-producing their drugs. For weight-loss drugs, though, it has been a different story. After the US Food and Drug Administration (FDA) put semaglutide – marketed as the blockbuster obesity drug Wegovy – and tirzepatide – the same for Eli Lilly's Mounjaro – on the shortage list in 2022, compounders were allowed to ramp up production. 'It was almost like these companies found a loophole where they were allowed to do this on a mass scale,' says Field. The impact has been significant. At the start of this year, Novo Nordisk estimated that the copycat drugs accounted for around a third of the entire weight-loss market. That is despite warnings from the FDA about the health risks posed by compounded medicines, which do not have to be approved by the regulator. Beth, from Washington, says she was tempted by online ads for the compound medicines, having struggled with her weight since the pandemic. For her, the drugs helped her at a time when it seemed impossible to lose weight or stick to a diet. She dropped 30lbs over a few months of taking a compound weight-loss medicine. Others say they had little choice but to opt for compound versions, given that the branded medicines were too expensive and not covered by their health insurance. However, the situation is rapidly changing. Last month, the FDA banned mass production of copycat weight-loss treatments that use semaglutide, the ingredient in Novo Nordisk's Wegovy. It also removed tirzepatide from its shortage list last October. Novo Nordisk said the law has now made things clearer. 'Moving forward, any compounder that mass produces or sells knock-off drugs is breaking the law and compromising patient safety,' a spokesman said. Eli Lilly says the products 'pose potentially life-threatening health risks', adding: 'Patients shouldn't be exposed to risky, unapproved products when regulator-approved medicines are available.' Online medicines firms, also known as telehealth businesses, are now racing to find a way to continue getting cheaper, personalised replica drugs out to patients. Noom, a rival to Hims and Hers, has suggested it will still be able to sell compounded weight-loss drugs to patients under an exception set aside for 'personalised' medicines. Hims and Hers, meanwhile, has already struck a new deal with Novo to offer its branded obesity drug to patients. The US firm also said this month it was exploring expansion in the UK, after acquiring European rival Zava. Andrew Dudum, the Hims and Hers chief, suggested there could be 'expansive options in obesity that include that type of personalisation, or similar types', telling the Financial Times that it could sell replica obesity medicines in the UK and Europe. David Meinertz, the boss of Zava, agrees that there are opportunities for the business to grow outside of America. 'There's clearly the experience and expertise that Hims and Hers have built up in the US,' he says. 'But then we have things like the regulatory knowledge here in Zava, and this is where we combine our experiences and spearhead this effort.' Still, the situation in the UK is very different to the US. Here, the compounding pharmacy market is much smaller, with pharmacies able to prepare personalised medicines for patients if it is prescribed by a doctor. Elizabeth Philp, the co-founder of compounding pharmacy Roseway Labs, says there could be a role for more personalisation of medicines. 'The NHS will say wasted medication is one of their top issues – people who try medication, put it in their bathroom cupboard and never use it again because it didn't suit them,' she says. 'We can really help with that.' However, drug insiders argue it would be a 'very bad idea' if the UK started to think about bringing in cheaper compound medicines for weight loss. 'The real drugs are getting very cheap at volumes,' says one senior drug leader. 'Supply is not an issue.' It will be a message that Novo and Eli Lilly will seek to drum home as they seek to prevent smaller rivals from selling cheaper weight-loss medicines to patients. Still, the effects of this debate are already being felt by many in the US battling to lose weight. 'I cannot afford the full price at this time,' says Beth. 'I think it's awful that people are losing access to this medication due to finances or compounded meds going away. 'These drugs are literally life-changing.'
