Latest news with #DukeUniversitySchoolofMedicine
New York Post
3 days ago
- Business
- New York Post
‘Exciting' new non-opioid painkiller shows promising results — and doesn't build up tolerance
A real ache-ievement! Duke University researchers have devised a promising, potent pain reliever — seemingly without the harmful side effects and addictive highs of opioids. While opioids interact with numerous cellular pathways, the experimental drug is more selective. SBI-810 targets a receptor in the brain and spinal cord, activating a single pain-relief signal while steering clear of other signals that could trigger troublesome consequences. Advertisement 3 Ru-Rong Ji, an anesthesiology and neurobiology researcher who directs the Duke Anesthesiology Center for Translational Pain Medicine, led the team in developing the painkiller SBI-810. Duke University School of Medicine 'What makes this compound exciting is that it is both analgesic and non-opioid,' said senior study author Ru-Rong Ji, an anesthesiology and neurobiology researcher who directs the Duke Anesthesiology Center for Translational Pain Medicine. '[The receptor] is a promising target for treating acute and chronic pain,' Ji added. Advertisement Chronic pain is a persistent problem in the US. Nearly a quarter of adults, about 62 million, experienced it in 2023. Chronic pain has helped fuel the opioid crisis. About 8.6 million Americans 12 years and older reported misusing prescription opioids in 2023. And almost 70% of the 107,000-plus US drug overdose deaths that year were attributed to opioids such as fentanyl. 3 Chronic pain is a persistent problem in the US, with about 62 million adults experiencing it in 2023. AS/ – Advertisement The good news is that there has been recent progress on this front, with more treatment options and fewer opioid-related deaths. It's too early to tell if SBI-810 can help the cause. The drug has not been thoroughly tested in humans, but the results in mice have been encouraging. Opioids like morphine often lead to tolerance with repeated use, requiring higher or more frequent doses to maintain the same level of pain control. Advertisement SBI-810 relieved pain from surgical incisions, bone fractures and nerve injuries without a buildup of tolerance or constipation, another common opioid side effect. 3 The experimental drug SBI-810 targets a receptor in the brain and spinal cord, activating a single pain-relief signal. mybox – When coupled with small doses of opioids, SBI-810 made them more effective at lower doses. And it's said to work better than the painkillers oliceridine and gabapentin in certain situations. The findings were published recently in the journal Cell. Ji's team has secured several patents for SBI-810 and hopes to start human trials soon.
Medscape
21-05-2025
- Health
- Medscape
Mobility Over Metrics: A New Take on Senior Obesity
For older adults living with obesity, the goal of treatment should not just be shedding pounds — it should be improving physical function, preserving independence, and enhancing quality of life. That was the central message from a group of experts who presented on patient-centered approaches to obesity care at the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting in Chicago. Rather than defaulting to weight loss as the primary measure of success, clinicians should focus on what matters most to each patient, said Julianna Marwell, MD, geriatrician and assistant professor of medicine at the Duke University School of Medicine in Durham, North Carolina. 'We can't afford to be weight-centric,' she said. Marwell framed obesity management using the 5Ms of geriatrics, which include mind, mobility, medication, multicomplexity, and what matters most. Through the case of a 73-year-old woman with a body mass index of 38 who had multiple chronic conditions, Marwell explained how functional goals like fall prevention, sleep improvement, and managing depression should drive treatment decisions. Research shows intentional weight loss in older adults can lead to better mobility, reduced medical complications, and improved quality of life. Marwell said clinicians have to integrate nutrition, physical activity, behavioral support, and medication review to achieve these benefits. Many medications commonly prescribed to older adults like antidepressants and pain medications can contribute to weight gain or hinder weight loss efforts, underscoring the need for routine medication reassessment, she said. Structural inequities such as not having access to healthy food options, limited access to exercise spaces, and lack of transportation can make weight loss guidance unrealistic for many patients without broader systems-level support, said Anna Pendrey, MD, primary care physician at Indiana University Health in Indianapolis. 'We can't recommend diet and exercise without acknowledging the social and economic realities our patients face,' Pendrey said. Pendrey and her colleagues at the Indiana University Student Outreach Clinic are addressing these barriers through community partnerships, free clinic services, transportation support, and embedding pharmacists, dieticians and physical therapists to support underserved older adults. Pendrey said obesity treatment requires 'tackling structural obstacles to care, not individual willpower.' That same level of intentionality is important when considering newer pharmacologic treatments, she added. While incretin mimetics drugs, including glucagon-like peptide 1 receptor agonists like semaglutide, offer promising results for both obesity and diabetes management, they must be used cautiously in older adults, given side effects, high costs, and limited long-term data in this age group, panelists said. The expert panel members did not report any relevant disclosures.
Medscape
13-05-2025
- Health
- Medscape
Self-Administered Etripamil Cuts ED Visits for PSVT
Self-administered intranasal etripamil was nearly twice as likely as placebo to terminate a paroxysmal supraventricular tachycardia (PSVT) episode within 30 minutes and reduced emergency department (ED) visits by 39%. METHODOLOGY: Researchers conducted two randomized placebo-controlled studies (NODE-301 part 1 and RAPID) that involved 340 patients (mean age, 54.7 years) who experienced PSVT at home. Participants were randomly assigned to receive 70 mg of intranasal etripamil (n = 206) or placebo (n = 134). In the RAPID study, a second dose of etripamil was permitted 10 minutes after the first if symptoms persisted. Electrocardiogram recordings were used to confirm the occurrence of PSVT episodes and their termination following study drug administration. The study outcome was an emergency care visit within 24 hours of treatment. TAKEAWAY: Vagal maneuvers were attempted by 370 patients, but these maneuvers terminated PSVT in only 4.6% of cases without clinician assistance. PSVT was terminated within 30 minutes in 57.8% of patients who received etripamil vs 32.1% of those who received placebo ( P < .001). < .001). ED visits occurred in 13.6% of the etripamil group vs 22.4% of the placebo group, reflecting an 8.8% absolute risk reduction and a 39% relative risk reduction (relative risk, 0.61; P = .04). = .04). Fewer etripamil recipients required additional medical intervention than placebo recipients (14.6% vs 25.4%; P = .01). No serious adverse events were noted with etripamil; the most common events were localized to the nasal administration site. IN PRACTICE: "Self-administered, outpatient-based treatment for PSVT could contribute to reduced ED visits and cost and complexity of care," the study authors wrote. SOURCE: The study was led by Sean Pokorney, MD, MBA, Duke University School of Medicine, Durham, North Carolina. It was published online on April 9, 2025, in JAMA Cardiology . LIMITATIONS: The trials were not individually powered to assess differences in ED visit rates, and data were pooled to achieve statistical power. DISCLOSURES: This study was funded by Milestone Pharmaceuticals. Several authors reported receiving personal fees from Milestone Pharmaceuticals or having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. Medscape Medical News © 2025 WebMD, LLC Cite this: Edited by Gargi Mukherjee. Self-Administered Etripamil Cuts Emergency Department Visits for Paroxysma Supraventricular Tachycardia - Medscape - May 13, 2025.
Yahoo
11-03-2025
- Health
- Yahoo
What we still don't know about COVID 5 years after the WHO declared a pandemic
Five years ago, the World Health Organization declared the COVID-19 outbreak to be a pandemic, leading to stay at-home orders and shutdowns across the U.S. and world. The nation looks much different since then, and scientists and researchers have learned a lot about the virus, including how it infects people, the best forms of treatment and what puts someone at risk for long COVID. MORE: 5 years since COVID declared public health emergency in US, still killing thousands There are still many questions, however. Health care professionals are working to find answers, such as how many people have truly died, how long the virus spread undetected in the U.S. and its origins. "We know this emerged in China, around the city Wuhan. That's very clear," Dr. Cameron Wolfe, an infectious diseases specialist and a professor of medicine at Duke University School of Medicine, told ABC News. "We know when [the] medical community identified it, but we don't know quite how long it was circulating before then. I think it's caused some of the consternation." As of March 6, at least 1,222,603 Americans have died of COVID-19, according to data from the Centers for Disease Control and Prevention. The U.S. currently has the highest number of deaths of any country in the world, according to the WHO. Experts, however, believe the true death toll is higher. "More than a million people is a tragedy into itself, let's start with that obvious fact," Wolfe said. "I think the numbers are really hard to pin down for one key reason." Determining the exact cause of death can be complicated, Wolfe explained. Someone could die of COVID pneumonia -- a lung infection caused by the virus -- or die from a heart attack after contracting COVID. Another example is an older adult who contracts COVID-19. They may become dehydrated, break a bone -- because dehydration negatively impacts bone health -- and suffer fatal complications, Wolfe said. "How you count those outcomes is really important because, to me, that person wouldn't have had their heart attack or that person wouldn't have become dehydrated and fallen over and landed in the hospital if not for COVID triggering that event in the first place," he said. "So, I actually think it's really important to count those as COVID-associated mortalities, but they're hard to count. They're hard to track." Globally, more than 7 million people have died due to COVID-19, WHO data shows, although the agency says the pandemic caused an estimated 14.83 million excess deaths around the world in 2020 and 2021. Scientists are not sure what causes long COVID but have identified certain risk factors such as an underlying health condition. Long-COVID symptoms can last for weeks, months or even years and can include -- but are not limited to -- fever, fatigue, coughing, chest pain, headaches, difficulty concentrating, sleep problems, stomach pain and joint or muscle pain, according to the CDC. MORE: What to know about 'quad-demic' of COVID, flu, RSV and norovirus in US Research has found that patients with long COVID tend to have lower cortisol levels and lower testosterone levels. "There are several questions that we still do not have answers for. What is the mechanism of the disease? Why do some people get more sick than others?" Dr. Fernando Carnavali, an internal medicine physician and a member of the team at Mount Sinai's Center for Post-COVID Care, told ABC News. Carnavali said scientists are using machine learning to study groups of long COVID patients in an attempt to determine the mechanisms that cause the condition. "Do we have a single answer? Not as of yet, and most likely, perhaps we'll have more than one answer," he said. Carnavali said the mechanism may not be the same for every long COVID patient. Additionally, people may have different symptoms due to different genetic predispositions. "Some of the deficits that we have five years ago still remain, but I think that we should all understand and be hopeful that ... researchers using machine learning will [provide] us some of the answers that we need as clinicians," he said. It's still not exactly clear when the virus first entered the U.S. The first confirmed case in the country was Jan. 20, 2020, in a man in his 30s in Washington state, who developed symptoms after a trip to Wuhan. However, studies have suggested the virus may have been circulating undetected for months beforehand. Although the WHO was first notified on Dec. 31, 2019, about the mysterious pneumonia-like illness that originated in Wuhan, experts say it is likely that in an age of global travel, the virus was in the U.S. before then. "It's more likely circulated before Jan. 1 [2020]. It doesn't seem unreasonable, November, December," Dr. Lisa Olson-Gugerty, an associate teaching professor for Syracuse University and practicing family nurse practitioner in emergency medicine, told ABC News. "COVID masquerades itself as a flu-like illness, upper respiratory-like illness, like many other viral illnesses. It's not easy to say, 'Hey, I think this must be a new thing, and I'm going to tell everyone.'" She went on, "I think it takes a bit of collective time to recognize a new viral strain, and it doesn't seem unreasonable [there were] cases that could have been recognized as COVID before the date of release of information." MORE: COVID-19 timeline: How the deadly virus and the world's response have evolved over 4 years There are two theories about where the virus, known as SARS-CoV-2, originated. At least four U.S. agencies believe the virus was a result of natural transmission and that the virus jumped from animals to humans at a wet market. The FBI, the CIA and the Department of Energy – the latter with "low confidence" -- believe the COVID-19 pandemic "most likely" was the result of a laboratory leak in China. Additionally, an April 2023 report from Senate Republicans conceded that "both hypotheses are plausible" but that the evidence points to the virus emerging from an accidental lab leak in Wuhan -- and there may even have been multiple leaks. If the virus did come from an animal, there are questions about which species may have spilled the virus over from animals to humans. "I've seen a lot of conflicting information," Olson-Gugerty said. "Did it come from a bat? Did it get into raccoon dogs or civet cats? Or was it a lab-created virus in Wuhan, China? There does seem to be a jury that's out." Wolfe said we may never know the true origins of SARS-CoV-2, but trying to answer the question helps scientists and public health professionals learn how to mitigate the spread so a pandemic -- or even widespread illness -- doesn't happen again. "This was the same question that happened during the Ebola pandemic, when we had to say, 'Where did this come from? How can we educate people to minimize this future risk?'" he said. "It was important to examine where COVID-19 came from to try and put things in place that would stop that happening." He added, "We certainly, I would say, have better safety mechanisms now in place ... so there are some good things that have come out of this." What we still don't know about COVID 5 years after the WHO declared a pandemic originally appeared on
New York Times
28-02-2025
- Health
- New York Times
In Texas Measles Outbreak, Signs of a Riskier Future for Children
Every day, as Dr. Wendell Parkey enters his clinic in Seminole, a small city on the rural western edge of Texas, he announces his arrival to the staff with an anthem pumping loudly through speakers. As the song reaches a climax, he throws up an arm and strikes a pose in cowboy boots. 'Y'all ready to stomp out disease?' he asks. Recently, the question has taken on a dark urgency. Seminole Memorial Hospital, where Dr. Parkey has practiced for nearly three decades, has found itself at the center of the largest measles outbreak in the United States since 2019. Since last month, more than 140 Texas residents, most of whom live in the surrounding Gaines County, have been diagnosed and 20 have been hospitalized. Nine people in a bordering county in New Mexico have also fallen ill. On Wednesday, local health officials announced that one child had died, the first measles death in the United States in a decade. It may not be the last. Large swaths of the Mennonite community, an insular Christian group that settled in the area in the 1970s, are unvaccinated and vulnerable to the virus. The outbreak has struck at a remarkable juncture. Vaccine hesitancy has been rising in the United States for years and accelerated during the coronavirus pandemic. Now the nation's most prominent vaccine skeptic, Robert F. Kennedy Jr., has been named its top health official, the secretary of health and human services. Mr. Kennedy has been particularly doubtful of measles as a public health problem, once writing that outbreaks were mostly 'fabricated' to send health officials into a panic and fatten the profits of vaccine makers. At a cabinet meeting on Wednesday, Mr. Kennedy minimized the crisis in West Texas, saying that there had been four outbreaks so far this year (there have been three, according to federal health officials) and 16 last year. Vaccine fears have run deep in these parts for years, and some public health experts worry that the current outbreak is a glimpse at where much of America is headed. Researchers think of measles as the proverbial canary in a coal mine. It is among the most contagious infectious diseases, and often the first sign that other pathogens may be close behind. 'I'm concerned this is a harbinger of something bigger,' said Dr. Tony Moody, a pediatric infectious disease expert at the Duke University School of Medicine. 'Is this simply going to be the first of many stories of vaccine-preventable disease making a resurgence in the United States?' On the front lines of the outbreak, simple answers aren't easy to come by. Measles was officially declared eliminated in the United States in 2000. Not long ago, it had become so rare that many American doctors never saw a case. But as the outbreak spread, Dr. Parkey learned to spot the signs of infection in the examination room even before he saw the telltale rashes. School-age children often zipped around the room or pestered their mothers or asked him for lollipops. The children stricken with measles sat still, vacant looks in their eyes. On Monday, Dr. Parkey walked into a hospital room where an unvaccinated 8-year-old boy sat with that distant stare. His mother had scheduled an appointment after she noticed his barking cough the night before. By the time they arrived at the clinic, the boy's eyes were red and crusted. He had a low-grade fever and a blotchy pink rash covering his chest and back. Dr. Parkey tried the usual banter: 'Do you have a girlfriend?' The boy looked past him, glassy eyes trained on the wall. 'Which of your uncles is your favorite?' Dr. Parkey asked. The boy let out a dry cough and slumped further into his seat. He spoke only once, to request a cup of water. Over the next 24 hours, if the boy's illness followed the typical progression, he was likely to get sicker. His fever would spike, and the rash would fan out over his torso and thighs. If he was lucky, the worst would pass within a few days. If he was not, the virus might find its way into his lungs and cause pneumonia, potentially making it difficult breathe without an oxygen mask. Measles might even invade his brain, causing swelling and possible convulsions, blindness or deafness. Doctors have few options to alter its course once the virus infects someone. There is no treatment that will stop it, only medicines to make the patient more comfortable. Dr. Parkey wrote prescriptions for cough syrup and antibiotics for the boy. A nurse swabbed the back of his throat for a sample to be shipped to the state health department in a box of dry ice, adding to the county's growing case count. Scary Stories Online For decades, the doctors at Seminole Memorial Hospital had been having conversations with patients about the importance of childhood vaccines. Even on busy days with back-to-back appointments, staff members sat down with parents to discuss fears about side effects and to recount the horrors of many preventable diseases. Go to an old cemetery, Dr. Parkey often told his patients — look at how many children died before vaccines arrived. In many families, though, minds were made up, and the conversations rarely broke through. The largest school district in Gaines County reported that just 82 percent of kindergartners received the measles, mumps and rubella (M.M.R.) vaccine in 2023. One of the smaller school districts reported that less than half of the students had received the shot. For a virus as contagious as measles — which spreads through microscopic droplets that can linger in the air for two hours — experts say that at least 95 percent of a community must be vaccinated in order to stave off an outbreak. Gaines County, a dusty expanse the size of Rhode Island dotted with cotton fields and whirring pump jacks, had not hit that mark in many years. Although there is no religious doctrine that bans vaccination, the county's tightknit Mennonites often avoid interacting with the medical system and hold to a long tradition of natural remedies, said Tina Siemens, a Seminole historian who has written several books about the community in West Texas. In recent years, concerns about childhood vaccines appeared to rise even in the broader Seminole community, especially after Covid-19, several doctors said. An outbreak began to feel inevitable. 'I'd never seen measles, but I knew it was coming,' Dr. Parkey said. In this respect, Gaines County is not so different from much the country. Before the pandemic, 95 percent of kindergartners in the United States had received the M.M.R. vaccine, according to federal tallies. The figure sunk below 93 percent last year. Immunization rates against polio, whooping cough and chickenpox fell in similar proportions. When the cases in Texas first surfaced, local doctors and health officials hoped that the outbreak would make the M.M.R. vaccines an easier sell. If parents saw what measles did to children, the thinking went, they would understand what the vaccine was designed to protect them from. But there has been no stampede to vaccination. In Seminole, a city of about 7,200 people, almost 200 residents have received shots at pop-up clinics. 'Hopefully, at least the next generation will change their minds about vaccines,' Dr. Parkey said. 'Just maybe not this one.' One mother told Dr. Leila Myrick, a family medicine physician at Seminole Memorial, that the measles outbreak had helped solidify her decision not to vaccinate her children. She'd heard from a friend that the virus was similar to a bad flu. Even some parents who recognized the dangers that measles posed to their children still felt that vaccines were riskier. Ansley Klassen, 25, lives in Seminole with her husband and four young children, three of whom are fully unvaccinated. She considered bringing her children to a vaccine clinic when measles cases first started popping up. Mrs. Klassen, who is about five months pregnant, knew she didn't want to risk getting measles. She had been scrubbing counters with Lysol wipes and keeping her children away from others as much as possible. But on social media, she had seen a deluge of frightening posts about the side effects of vaccines: stories of children developing autism after a shot or dying from metal toxicity. (Both claims have been debunked by scientists.) 'There are stories that you can read about people multiple hours after they got the vaccine having effects, and that's scary to me,' she said. 'So I'm like, is it worth the risk? And right now I can't figure that out.' These anecdotes — regardless of whether they are factual — are part of what has made vaccine hesitancy such an intractable problem in the age of social media, said Mary Politi, a professor at the Washington University School of Medicine who studies health decision-making. Stories about children who don't have serious side effects from vaccines and never contract vaccine-preventible illnesses don't go viral on TikTok, she noted. 'It's not that they're trying to make a bad choice or do something against evidence,' she said. 'People are trying to do the best thing they can for their families, and they don't know who to trust.' Mrs. Klassen didn't consider herself staunchly anti-vaccine. Her oldest daughter, now 6, had received all of her vaccines up to a year. But she didn't trust everything doctors were telling her, either. She thought the Covid-19 vaccine had been developed too quickly and pushed too forcefully, making her skeptical that the authorities were telling the truth about the measles shot. She prayed about it and ultimately decided to forgo the vaccine. 'The trust I have in the medical system is not there,' she said. It's not just unvaccinated people who are at risk during the current outbreak. Measles increases the likelihood of stillbirths and serious complications in pregnant women, yet they cannot receive the vaccine or booster. Andrea Ochoa, a nurse's assistant at Seminole Memorial who is six months into her first pregnancy, said she thought about taking time off from her job but ultimately decided to stay so she could keep her health insurance. She wore an N95 mask during her entire shift, which sometimes made her so lightheaded that she sat in her car for a break. She showered as soon as she was home. 'I hope it doesn't get worse,' Ms. Ochoa said of the outbreak. 'I don't know what choice I would make.' Five vaccinated residents also have contracted measles, state health officials said. At the clinic, Dr. Parkey recently cared for a teacher who was vaccinated but immunocompromised. A serious measles infection kept the teacher curled in a fetal position on the couch for a week, her eyes so swollen that she opened them only for brief runs to the bathroom, she recalled in an interview. She asked not be named to protect her privacy. The West Texas measles outbreak is far from the largest in the United States in recent years. In 2019, outbreaks in at least two dozen states sickened more than 1,250 people. A vast majority of those infections occurred in 'underimmunized, close-knit communities,' the C.D.C. noted. More than 930 patients were infected in Orthodox Jewish communities in New York. Federal, state and local officials swung into action with vaccination campaigns that led to more than 60,000 M.M.R. immunizations in the affected communities. They reached out to religious leaders, local doctors and advocacy groups. And in areas like Williamsburg, Brooklyn, officials went further, issuing mandates requiring vaccination. The campaign in West Texas has been less forceful. Management of outbreaks like this one falls to state health officials, and they ask for help from the C.D.C. and other federal resources as necessary. The C.D.C. is providing some technical assistance, but Texas health officials said they did not need more help from the agency. They have not declared a public health emergency, as officials did in parts of New York State, nor have they moved to mandate vaccination. 'We can't force anybody to take a drug — that's assault,' said Dr. Ron Cook, a health official in nearby Lubbock, at a news conference on Friday. Zachary Holbrooks, the local public health official for four Texas counties, including Gaines, said that type of mandate would be deeply unpopular in the state, where individual freedom is a strongly held value. Texas public schools require children to have received certain vaccines, including the M.M.R. shot. But in this state, as in many others, parents can apply for an exemption for 'reasons of conscience,' including religious beliefs. In January, as the first cases of measles began spreading in Gaines County, state legislators introduced several bills designed to weaken school vaccination requirements. 'I don't want to see a baby's lips turn blue because they can't breathe,' Mr. Holbrooks said. 'I don't want anybody to suffer from long-lasting disability because they got measles.' 'But if you choose to live in Texas,' he added, 'you can exercise that option.'
