One of the deadliest street drugs, illicit fentanyl, has transitioned from a hidden killer that people often hope to avoid to one that many drug users now seek out on its own.

The shift to intentional use of fentanyl underscores a worrying trend in the country’s ongoing opioid epidemic, experts say: That a growing number of people have become so tolerant to opioids like heroin, that they’re turning to the synthetic compound, which is up to 50 times stronger.

Until recently, intentional use of fentanyl was mostly limited to the West Coast, but in the past few years, addiction specialists have seen an uptick in use of the drug across the country. 

“Two years ago, I would have thought this was crazy,” said Dr. Akhil Anand, a psychiatrist at the Cleveland Clinic who specializes in addiction. Now, Anand said, he’s seeing a lot more people in Ohio seeking out illicit fentanyl as their drug of choice. 

In medical settings, fentanyl is used to treat patients in severe pain, such as people just out of surgery. Fentanyl skin patches are sometimes prescribed for severe pain for use at home.

But fentanyl first made its way into the illicit drug supply about 10 years ago, particularly in areas east of the Mississippi River. The white powder looked just like heroin, but was much cheaper. Drug dealers started mixing the two drugs as a way to stretch their heroin supply. Fentanyl also started showing up in non-opioid drugs, such as cocaine and fake versions of prescription pills. 

The shadowy addition of fentanyl to the illegal drug supply sent deadly overdoses skyrocketing among users who were unaware they were using such a strong drug. By 2021, fentanyl was involved in the vast majority of overdose deaths, according to the National Center for Health Statistics.

Mary Ward, president of the McLeod Addiction Center in Charlotte, North Carolina, has noticed the shift toward a preference for fentanyl in her home state. “Some people thought they were buying heroin on the street, and it turned out to be fentanyl,” Ward said. “They ended up liking it better.”

Alex Kral, a Berkeley, California-based epidemiologist who studies illicit drugs at the nonprofit research institute RTI International, said he’s heard from users that once they start using fentanyl, it’s very tough to go back to using heroin, because they don’t get the same high.

What’s more, experts said, people are increasingly moving from injecting fentanyl to smoking it. 

“My prediction would be that smoking fentanyl will be the norm within a year” among those who use the drug on its own, said Dr. Daniel Ciccarone, a professor of family community medicine at the University of California, San Francisco.

Ciccarone said that the shift from injecting to smoking could be seen as a form of harm reduction, in that it eliminates the risk of infections spread through shared needles, including HIV, hepatitis C and bacteria that can cause heart infections.

“It’s nice to not have to use your veins or not inject, and so a lot of people would prefer not to be doing that,” Kral said. “I think we’re going to see more and more people smoking fentanyl than injecting it.”

Others were concerned that because smoking fentanyl is easier and often more appealing than injecting it, it could result in more widespread use. And there’s no data to suggest that smoking fentanyl reduces the risk for fatal overdoses. 

“I don’t know that we’re at a place where we can say, ‘Hey, maybe you should smoke it instead,'” said Dr. Kris Kast, clinical director of the Addiction Consult Service at Vanderbilt University Medical Center in Nashville. “It would be hard for me to feel confident in recommending that to somebody.”

While fentanyl overdoses can be reversed with naloxone, the high potency of the drug means more naloxone is needed to counteract it, both Anand and Ward said. 

The drug also causes a shorter-lived high than other opioids, meaning users must take the drug more frequently to avoid withdrawal.

“Usually by the time somebody is transitioning to fentanyl, they’re already needing to use pretty consistently throughout the day to feel normal, to not be in withdrawal,” Kast said. “As they’re progressing to fentanyl, they’re gonna have to use it more often in order to manage that withdrawal.”

And for fentanyl users receiving treatment for their addiction, doctors must prescribe higher doses of medications like suboxone and methadone to control their withdrawals.

“Because fentanyl is so powerful, patients are having greater physical withdrawals,” Ward said. “We’ve seen an uptick in the amount of medication we’ve had to prescribe for some patients just to keep them stable.”

Follow NBC HEALTH on Twitter & Facebook.

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here

SUNDAY, Aug. 7, 2022 (HealthDay News) — As a new school year begins, many students return to their favorite sports or try something new.

Encouraging kids to make physical activity part of their lives has lifelong benefits, said Dr. Theodore Shybut, assistant professor of orthopedic surgery and sports medicine at Baylor College of Medicine in Houston.

Shybut offered some tips for getting children ready to start fall sports or any physical activities at any age. His advice comes at a time when many youngsters may be losing interest in organized sports.

Shybut recommends giving the youngest kids opportunities to explore many activities to see what they like best. Create an environment in which a child feels encouraged to be active with routine free play at home, family walks or trying out the latest exercise trend.

“Keep it fun and interesting. The goal is to cement the idea of exercise as an enjoyable and healthy habit,” Shybut said in a college news release. “Once your child latches onto something they like, then you can then work together to begin mastering the fundamentals of the activity they choose to pursue in the long term.”

Kids and teens who have already participated in organized sports at school or in community leagues should be given opportunities to stay active during their off-seasons. Appropriate drills or training camps can get them ready for a new season and help prevent injury.

In hot regions, the need to beat the heat is key.

“It’s important for athletes to adjust to heat and sun exposure,” Shybut said. “Even a week of regular exercise before group training sessions begin can be beneficial. Additionally, ensuring young athletes are properly hydrated is vital to preventing serious heat-related illnesses.”

Make sure kids get the chance to recover from workouts with proper diet and sleep. Keys are a healthy sleep schedule and diet rich in unprocessed foods, such as fruits, whole grains, beans, nuts and vegetables, plus complex carbohydrates and proteins.

Young athletes’ diets should be tailored to the sport they do. Those who have heavy training loads, such as competitive swimmers, for instance, may need to eat throughout the day to get all the calories they need.

“Above all, their activity should be healthy and enjoyable,” Shybut said.

Always take a child’s complaint of pain seriously, he stressed. Children do not tend to exaggerate symptoms of injury, Shybut said. A young athlete having trouble running, throwing or performing in the way that’s normal for the child should see a sports medicine professional.

“Some of the most common injuries young athletes experience are a result of pushing too much too fast too quickly,” Shybut noted.

“Junior high and high school athletes may have access to their team’s athletic trainers [ATs], who can often identify the problem and the correct course to address the problem,” he said. “ATs are also knowledgeable about preventing injury. If there is not a training staff available, many resources developed by reputable athletic organizations, like STOP Sports Injuries, can be used to help ensure young athletes stay safe.”

More information

The American Academy of Child and Adolescent Psychology has more on sports and children.

SOURCE: Baylor College of Medicine, news release, Aug. 3, 2022

Was this page helpful?

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here

SATURDAY, Aug. 6, 2022 (HealthDay News) — Pickleball has become a wildly popular sport for older Americans, but seniors who enjoy playing it should know about potential injuries and how to avoid them.

The most common problem is with the rotator cuff tendon in the shoulder, which can cause pain. Issues can included tendonitis, bursitis and even a tear in the tendon. Bigger tears are harder to fix and can make your arm weak.

“The unfortunate reality of the rotator cuff is that everyday use can cause tearing and damage,” said Dr. Bruce Moseley, a surgeon in the Joseph Barnhart Department of Orthopedic Surgery at Baylor College of Medicine in Houston.

“You don’t necessarily have to do anything wrong or abnormal to get a rotator cuff tear — in many instances it just happens as a consequence of living,” he said in a college news release.

For a lot of people, it’s not an accident or injury that causes rotator cuff damage, but use over time. Pickleball requires people to reach overhead while using a lot of force, which can risk damaging or tearing the rotator cuff.

Tears aren’t always preventable, but stretching and light or moderate strength training may keep it healthier and more flexible.

“If you warm up and stretch before your activity and ice down afterwards, your shoulder will be better prepared for the activity and will recover quicker,” Moseley said.

If you are experiencing shoulder pain, don’t wait to see a doctor.

“The success rate of surgery to permanently fix the problem goes down as the size of the tear goes up, so if you’re having lingering shoulder pain that isn’t getting better over time and the pain is getting worse as the activity continues, I recommended seeing a specialist,” Moseley said. “If we can get to the tear and fix it while it is small, the success rate is much higher.”

The only way to repair a torn rotator cuff is through surgery. Living with it can be painful and limit movement, and it would be difficult to remain active.

Other potential racquet sports injuries are meniscus tears, tendon ruptures and aggravation of arthritic knees.

“Considering seeing a physician if you have pain that gets progressively worse in the shoulder or pain that persists for a long time after your activity. These may be warning signs of a torn rotator cuff tendon, so make sure to get it checked,” Moseley said.

More information

The U.S. National Library of Medicine has more on rotator cuff injuries.

SOURCE: Baylor College of Medicine, news release, Aug. 2, 2022

Was this page helpful?

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here

Arizona [US]: Worldwide, cardiovascular diseases continue to be one of the leading causes of death. High blood pressure, or hypertension, is a major factor in these conditions.

In a new study, published in the current issue of the journal Scientific Reports, researchers from Arizona State University’s Biodesign Center for Applied Structural Discovery and their colleagues, in collaboration with Mayo Clinic, Rochester, make critical progress toward unveiling the structure of pGC-A.

While treatments exist for the condition, which affects tens of millions of Americans, these remedies are not without side effects, and some variants of the disorder are treatment-resistant. The need for more effective therapies to address hypertension-related disease is therefore acute. The illustration shows a portion of the receptor pGC-A, known as the extracellular domain, which protrudes from cell surfaces in the cardiovascular system. Small molecules bind with the receptor and exert subtle control over blood pressure. The new research offers the first sneak peek at the full-length receptor, a vital step in the development of new drugs to treat hypertension and other afflictions.

To accomplish this however, biologists need more detailed maps of the mechanisms underlying cardiovascular regulation. One such regulator is a protein receptor that sits atop cardiovascular cells, acting as a conduit for messages that are transmitted when specific hormone molecules bind with them.

Known as pGC-A, this membrane receptor acts a bit like a thermostat, sensitively adjusting the body’s blood pressure to maintain a homeostatic balance essential for health. The receptor acts not only as a vital cellular component for vascular and cardiac homeostasis, but also plays an important role in lipid metabolism and is implicated in cancer development.

The study provides the first purification, characterization and preliminary structural analysis of the full-length protein receptor. The research advances include crystallizing the protein and showing that these crystals diffract X-rays — two critical steps essential to solving the structure.

A clearer understanding of this complex receptor and its signaling mechanisms paves the way for a new suite of anti-hypertensive drugs, which could help stave off heart attacks and strokes and improve recovery from these incidents.

“This accomplishment is the first described X-ray diffraction for a new class of membrane protein receptors, and represents an extraordinary effort by our graduate student, Shangji Zhang,” says co-author and Biodesign researcher Debbie Hansen. “Structures of unique classes of membrane proteins often require years of effort and are built on similar critical advances.”

Co-author John C. Burnett Jr., from the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, has been working to develop candidate molecules for new anti-hypertensive drugs, based on the structure of the pGC-A receptor.

Heart-stopping threat

According to the World Health Organization, over a third of all deaths worldwide may be attributed to cardiovascular disease. Hypertension is among the leading factors contributing to the progression of cardiovascular disease.

The burden of hypertension has been steadily growing, resulting in a recent recommendation by the Report of the National Heart, Lung and Blood Institute Working Group on Hypertension to “develop new drugs and treatments to target diverse hypertensive patient populations, such as patients with resistant hypertension.”

Treatment-resistant forms of hypertension, which are more likely to occur in patients with obesity, diabetes or renal dysfunction, account for 12-15% of hypertensive patients. Such individuals show limited or poor response to existing therapeutics. The condition can develop when the blood vessels become calcified and inelastic, losing their ability to fully contract and relax. Clinical studies show that treating high blood pressure reduces the risk of stroke by 35-40%, and the risk of heart failure by 50%.

Cardiovascular diseases include rheumatic and congenital heart disease; coronary, cerebral and peripheral arterial disease; deep vein thrombosis; and pulmonary embolism. Coronary artery disease, a leading killer, occurs when blood flow to heart muscle cells is reduced or obstructed, which can lead to heart failure. In the United States alone, the condition is projected to increase to $70 billion by the year 2030.

New insights begin to crystalize

The pGC-A membrane receptor exists in three primary forms. This class of receptors are so important, they comprise the majority of pharmaceutical drug targets. For most organisms, whether prokaryotes like bacteria or eukaryotes like mammals, a full 20-30% of the genome is devoted to the expression of membrane proteins. Such receptors protrude from the outer cell membrane and penetrate deep into the cell’s interior, often acting as conduits for external signals that modify the cell’s behavior.

Designing drugs to target membrane proteins however, requires a highly detailed blueprint of the receptor structure, usually with atomic-scale resolution. Using this information, drug designers can engineer a drug that will bind in a selective and precise manner with the cell receptor, to produce a given outcome.

In the case of pGC-A, the binding molecules are peptide hormones produced by cells of the cardiovascular system. Known as natriuretic peptide hormones, they occur in natural variations and can also be synthetically designed, using genetic mutation. Part of the receptor’s activity involves the conversion of GTP to cGMP, a molecule essential for the normal function of vital organs.

“The heart is not only a pump but an endocrine gland which produces a highly beneficial hormone called atrial natriuretic peptide (ANP),” Burnett says. “This hormone plays an important role in blood pressure, kidney and over all metabolic balance.”

Digging deeper

To date, only the extracellular component of the pGC-A receptor has been characterized. The current work is a major step toward characterizing the full-length structure, particularly the transmembrane domain and functional intracellular domain regions, about which little is currently known.

To achieve this, the researchers use a method known as baculovirus protein expression. The process involves turning insect cells into tiny protein production factories. Insect cells resemble human cells in terms of their protein-processing machinery yet are easier and cheaper to grow than mammalian cells. Baculoviral vectors allow researchers to turn an insect virus into a vehicle for delivering the genetic recipe for a protein.

The process involves inserting a gene for making the receptor into a special type of DNA vector or carrier known as a bacmid. The recombinant bacmid carrying the receptor gene is then used to infect insect cells, which begin manufacturing recombinant baculoviruses.

The pGC-A receptor protein can then be extracted, purified and subjected to X-ray crystallography, to determine its structure. The process is tricky, labor-intensive and prone to failure for a variety of reasons. Only a small number of the many existing membrane proteins have been fully characterized, making the preliminary characterization of pGC-A an impressive achievement.

The insect cell expression system offers several advantages for protein expression, particularly in the case of membrane proteins like pGC-A. The technique makes it easier for researchers to extract properly folded membrane proteins directly from the cell membrane, compared with the bacterial expression of misfolded and non-functional proteins common with traditional expression in Escherichia coli (E. coli) bacteria.

Horizon line

“This was a massive accomplishment,” Hansen says. “Membrane proteins are not trivial to purify, and she was also able to get crystallization of the protein and X-ray diffraction.”

Further purification and better diffraction data will ultimately enable atomic-level structural characterization.

The research opens the door to the detailed characterization of other membrane proteins, which may ultimately find their way into effective drugs to control hypertension and a broad range of other medical conditions.

“A major goal is to develop breakthrough drugs based on ANP and its target receptor in humans to treat high blood pressure, heart failure as well as obesity,” Burnett says. “The work done by the ASU and Mayo teams and reported in Scientific Reports helps unlock the secret of the receptor target and will accelerate the development of new drugs and truly help patients worldwide.”

Petra Fromme, director of the Center for Applied Structural Discovery, who is the senior author of this study and served as the PhD supervisor of Zhang, is excited about the high impact of this work.

“Metabolic diseases are one of the most important health threats of the 21st century, with diabetes, high blood pressure and heart diseases taking the lives of millions each year — and the numbers are rising. The work on the pGC-A receptor has the potential to develop an effective drug that reduces the symptoms without serious side effects,” she said.

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here

It’s estimated that millions of Americans are living with hepatitis. But while the inflammatory liver condition can affect anyone, Black people are more likely to die from it — and structural inequities have a lot to do with this. 

PQ

“Even if you don’t know what the risk factors are, that everyone should be tested at least once in their lifetime for hepatitis C virus,” said Adrienne Simmons, director of programs at the National Viral Hepatitis Roundtable (NVHR).

Adrienne Simmons, director of programs at the National Viral Hepatitis Roundtable (NVHR), says awareness of the virus begins with education, but many people don’t know what factors put them at risk for infection.

People become at greater risk for hepatitis C when they share drug injection needles, have sex with infected people, and receive tattoos or piercings in unlicensed facilities. This long-term type of hepatitis can lead to liver damage, cancer, and death.

Black folks were nearly twice as likely to die from hepatitis C than white people in 2018, according to the U.S. Department of Health and Human Services Office of Minority Health. 

Just two years earlier, Black people were 2.6 times more likely to die from hepatitis B than white people. 

“People need to understand what the risk factors are, and understand that even if you don’t know what the risk factors are, that everyone should be tested at least once in their lifetime for hepatitis C virus,” Simmons told Word In Black in a phone interview. 

Though the Black community as a whole is affected by the hepatitis C virus, Simmons says it’s important for us to think about “which communities within the Black community might be disproportionately impacted.”

Despite making up only 12.4% of the U.S. population, Black people account for 38.3% of prisoners, according to the Federal Bureau of Prisons. People who are incarcerated and living with hepatitis C face serious barriers to accessing treatment. 

“For a number of years,  jails and prisons have not provided access to hepatitis C treatment while incarcerated,” Simmons says. “And again, due to advocacy and litigation, we have seen more correctional facilities providing access to treatment now than we did 10 years ago, but we still have a long way to go.”

Simmons says the Black unhoused community is particularly at risk for hepatitis A, which is a short-term liver infection often contracted through contaminated food or water. 

According to a 2020 report of national homelessess, an estimated 40% of people experiencing homelessness were Black. About a quarter of the unsheltered homeless community — people sleeping out in the open on sidewalks or on bus or park benches — was Black, the annual assessment conducted by the U.S. Department of Housing and Urban Development also noted. 

“We’ve seen a number of outbreaks of hepatitis A among people experiencing homelessness. So again, thinking about health disparities and the fact that homelessness often disproportionately impacts the Black community, the Black community tends to be at risk for hepatitis A infections,” Simmons says. 

As a coalition of patients, providers, community-based organizations, and public health partners, the National Viral Hepatitis Roundtable (NVHR) is working to bring an end to global hepatitis.

NVHR recently launched a collaboration with the National Alliance of State and Territorial Aids Directors and the National Association of County and City Health Officials that’s focused on people who use drugs.

“We’re approaching it with a health equity lens. And so there’s a focus on racial and ethnic communities who are disproportionately impacted by hepatitis B and hepatitis C…We’re going to be providing technical assistance and training to those network members to help address any unmet need as it relates to viral hepatitis and substance disorder care in that community. And so the Black community is very much a focus of that new collaboration,” Simmons says. 

In 2014, when a curative form of therapy called direct acting antivirals came to the market, Simmons said “insurance companies immediately put barriers into place…due to the high costs of those medications.”

While we’ve seen a number of the barriers come down, there are a lot that still remain in place…some examples of the barriers that we saw were that insurance companies would require that you have severe liver disease before they would treat your hepatitis C infection, which is something that’s a requirement that is very much unique to hepatitis C treatment. If you think about cancer, we don’t tell people, ‘oh, you’ve got to wait until you have stage four cancer before we’re treated,’” Simmons says.

“We also saw an insurance company just require that patients be abstinent from drugs and alcohol. And so this continues to be probably the most widespread barrier that we’re seeing,” she continued. 

Considering the barriers people living with hepatitis face, NVHR has made it its mission to fight to increase access to hepatitis C treatment in state Medicaid programs. 

“We have data that shows that a large number of people who are living with hepatitis C receive Medicaid. And so that has been our focus over the last five years,” Simmons says.

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here

FRIDAY, Aug. 5, 2022 (HealthDay News) — Globally, chronic obstructive pulmonary disease (COPD) remains a major public health concern, according to a study published online July 26 in The BMJ.

Saeid Safiri, Ph.D., from Tabriz University of Medical Sciences in Iran, and colleagues conducted a systematic analysis of data from the Global Burden of Disease Study 2019 to report the global, regional, and national burden of COPD and its attributable risk factors between 1990 and 2019.

The researchers found 212.3 million prevalent cases of COPD were reported globally in 2019; COPD accounted for 3.3 million deaths and 74.4 million disability-adjusted life-years (DALYs). For COPD, the global age standardized point prevalence, death, and DALY rates were 2,638.2, 42.5, and 926.1 per 100,000 population, representing decreases of 8.7, 41.7, and 39.8 percent, respectively, versus 1990. The global DALY rate of COPD increased to age 85 to 89 years in men, then decreased with advancing age, while the rate increased up to the oldest age group (95 years and older) among women. There was an overall reverse V-shaped association between sociodemographic index and the age-standardized rate of COPD. Smoking, pollution from ambient particulate matter, and occupational exposure to particulate matter, gases, and fumes were factors that contributed most to the DALY rates for COPD (46.0, 20.7, and 15.6 percent, respectively).

“Although the point prevalence, death, and DALY rates declined during the study period, the corresponding counts are increasing,” the authors write. “With an ageing population, COPD will continue to become an even greater problem in the future.”

Abstract/Full Text

>>> ad: Don't Miss Today's BEST Amazon Deals!
Originally Appeared Here