interviewed Carrie Cuttler, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

So Dr. Cuttler, I understand that your prior research has examined the effects of cannabis on various mental health conditions. What led you to investigate the use of cannabis in treating OCD?

 Yes. thank you. Before I started studying cannabis, I was actually studying links between memory and OCD, as it's a condition that has always been of interest to me. Also, my PhD student, Dakota Mauzay, who is the first author on this manuscript, he also has strong interests in OCD and spends a lot of time treating OCD as a clinical psychology graduate student.

Also, while many studies have examined cannabis in relation to various mental health conditions like depression, anxiety, PTSD, and psychosis, we found that very little research had actually examined either links between cannabis use and OCD, or the effects of cannabis on OCD. And to us, that represented a significant gap in the research that we thought really needed to be filled. Also, we knew that cannabis has effects on anxiety and, given the role of anxiety in OCD, we figured there would be good reason to suspect that cannabis may have some effects on this condition.

Videos

Contemporary Clinic ® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored on the use of cannabis in treating symptoms of OCD.

The Potential Role of Cannabis in the Treatment of OCD Symptoms

Addiction is 1 of the most costly and tragic diseases in the United States, in both financial and human terms.

Our nation spends around $740 million annually in costs on addiction-related crime, health care, and lost work productivity.

 Tobacco product use alone is linked to an estimated 480,000 deaths a year.

The real tragedy is that addiction disorders and substance use disorders (SUDs) are preventable, and the key is preventing youth initiation of substance use. There is no safe amount of any substance for children and teens. None. Never. No exceptions.

Decades of research across substances has shown that pre-teens and teens become addicted more easily and with less exposure than adults. In fact, 90% of people with drug dependency and addiction issues started using substances prior to age 18, with a significant number initiating use between the ages of 12 to 15 years.

 The earlier that use starts, the higher the risk. Multiple studies have shown many magnitudes higher lifetime risk for SUD with earlier initiation of substance uses.

Why is early substance use so risky? There is an amazing period of brain development and “rewiring” that starts at age 10 years and is not complete until about age 25 years.

 During that period, the brain is particularly vulnerable, and serious and often long-lasting injuries can be caused by substance use.

The limbic region of the brain (behavior, emotion, long-term memory, and motivation) develops faster than the prefrontal cortex (complex cognitive behavior, decision-making, moderating social behavior, and personality expression). This helps explain why pre-teens and teens are very motivated to be easily influenced by peers, take risks, and try novel experiences. At the same the areas of the brain that help them weigh risks are not fully developed. First-time use often occurs in social settings with easily accessible substances, such as alcohol and tobacco products, including high-nicotine-content e-cigarettes.

The young brain’s immature risk and reward system is particularly vulnerable to substance use. All drugs of abuse act directly and quickly on the brain’s reward system, flooding the brain with 2 to 10 times the amount of dopamine (the brain’s “feel good” chemical) as natural rewards from other pleasurable activities.

 The brain creates a memory of this intense satisfaction and quickly forms a conditioned response that causes the individual to repeatedly seek the same pleasure, shortening the path from use to abuse to addiction. Besides the risk of addiction, early drug use can alter the development of brain structures. Brain areas affected by substance use include the basal ganglia, extended amygdala, hippocampus, and pre-frontal cortex. Difficulties with concentration, impulse control, learning, and memory are well documented, with some deficits persisting into adulthood even if use ceases. Early substance use has also been linked to an increased risk for developing mood disorders, such as anxiety and depression.

Families and pediatric health care providers play a vital role in efforts to prevent the onset of substance use. Recognizing and addressing risk factors for substance use and enhancing protective factors are the hallmarks of effective prevention.

Adverse childhood experiences (ACEs), especially living with someone who has an alcohol or drug problem, are strongly linked to an increased risk of and increase risk for ACEs in the subsequent generations. Below are some risk factors.

Academic failure and difficulties concentrating in school

Prenatal exposure to alcohol, marijuana, or tobacco

ACEs, especially living with anyone with a problem with alcohol or drugs

Behavioral health concerns in children or family members, such as anxiety or depression

Lack of attachment to and nurturing by caregivers and parents

Families also provide strong protections that offset risk including:

Accepting and open communication with children

Expressing disapproval of substance use and setting a good example

Forming strong loving and supportive bonds between children and parents

Increasing parental involvement in children’s activities and lives

Setting clear limits and consistently enforcing discipline

Health care providers play a vitally important role in identifying risk factors for substance use and helping families address them. Identifying family history of SUD and more widespread screening for ACEs is needed. The American Academy of Pediatrics recommends that health care providers routinely screen patients for substance use, provide brief interventions, and refer to addiction or behavioral specialists, as needed.

 The National Association of Pediatric Nurse Practitioners also has a position statement on exposure to tobacco products.

 is a widely used substance screening tool that was recently modified to include nicotine.

 Anticipatory guidance should include providing prevention information and supporting effective parenting. It is especially important to address common parental misperceptions of youth substance use that are not supported by data, such as all kids experiment; at least it isn’t heroin; if I let them drink here and collect the keys, they will be safe; and they only listen to their friends. National surveys show that some children are already experiencing difficulties with substance use at age 12 or 13, so prevention and screening activities should start earlier at about age 10.

Substance Abuse and Mental Health Services Administration

 (SAMHSA) are rich in information and resources, including tools to help build parents confidence and skills in discussing substance use with their children. In particular, the SAMHSA’s 

. prevention campaign helps caregivers and parent start talking to their kids early about the dangers of alcohol and other drugs.

The horrible price of addiction in both financial and human terms can be greatly reduced by delaying or stopping youth initiation of substance use. It is important to emphasize that increasing numbers and young people are making healthy choices to abstain from alcohol and drugs. Prevention works. Providers in partnership with families and parents are in a powerful position to identify those at most risk and intervene early.

, is a pediatric nurse practitioner at Marietta Neonatology in Georgia and the program coordinator of the Georgia Tobacco-Free Youth Project, and a member of the National Association of Pediatric Nurse Practitioners.

National Institutes of Health. Costs of substance abuse. National Institute on Drug Abuse. April 6, 2020. Accessed December 8, 2020. 

https://www.drugabuse.gov/drug-topics/trends-statistics/costs-substance-abuse

CDC. Smoking & tobacco use. Updated May 21, 2020. Accessed December 8, 2020. 

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm

Key substance use and mental health indicators in the United States: results from the 2018 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. August 2019. Accessed December 8, 2020. 

https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

Arain M, Hague M, Johal L, et al. Maturation of the adolescent brain. 

National Institutes of Health. Drugs, brains, and behavior. National Institute on Drug Abuse. Updated July 2014. Accessed December 8, 2020. drugabuse.gov/sites/default/files/soa_2014.pdf

Levy SJL, Williams JF, Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138(1):e20161211. doi:https://doi.org/10.1542/peds.2016-1211

National Association of Pediatric Nurse Practitioners, Daley AM, Searcy L, et al. NAPNAP position statement regarding the use and exposure to tobacco products in children, adolescents, and young adults. 

 2020;34;630-634. doi:10.1016/j.pedhc.2020.07.007

Get the CRAFTT. CRAFTT. Accessed December 8, 2020. 

Talk. They Hear You. Substance Abuse and Mental Health Services Administration. Updated June 11, 2020. Accessed December 8, 2020.

Articles

Providers Can Help Identify Young People at Risk for Addiction

During the coronavirus disease 2019 (COVID-19) pandemic, many patients in the United States reduced the number of in-person preventive and elective health care visits and increased the number of telemedicine appointments. However, an analysis of the data from March and April 2020, which were the first 2 months of the COVID-19 pandemic lockdown, found that the switch to telemedicine was not sufficient enough to offset the overall reduction in visits.

The analysis of the data was pulled from the medical records of approximately 5 million Americans with private health insurance and demonstrated that the number of mammograms and colonoscopies decreased by approximately 65%, as these types of elective medical care were not easily transferable to a telemedicine format. Overall, use of preventive and elective health care by patients declined by 23% in March and by 52% in April.

However, in lower-income or predominately non-white zip codes, there was a lower reduction in in-person care in addition to lower rates of telemedicine use. The authors who published these findings in 

 noted that this is another example of how the COVID-19 pandemic intensified existing disparities related to health care.

"This adds detailed evidence to the anecdotal reports that Americans quit going to see the doctor when the pandemic shutdown started," said lead author Christopher Whaley, PhD, a policy researcher at the nonprofit research organization RAND Corporation, in a press release. "If important visits are only delayed for a few months, there will likely be no harm. But if patients do not get important screenings, there could be long-term negative health consequences."

Although other studies have analyzed data from this same period, most have assessed data from a single health system or geographic market in order to observe the impact of COVID-19 on the utilization of medical services. In this study conducted by Whaley and his colleagues, the researchers used insurance claims data from 2018 to 2020 from approximately 200 employers across the country.

The results of the study demonstrated that when compared to the rates in March and April 2019, colonoscopies decreased by approximately 70% during March and April 2020. When conducting the same comparison for mammograms, the researchers observed a 67% decrease among women aged 46 to 64 years.

Additionally, utilization of blood sugar tests decreased by approximately 50%, vaccinations among children under age 2 decreased by 22%, and angioplasty procedures decreased by approximately 17%. Surgeries such as musculoskeletal surgery and cataract surgery, as well as MRIs, all decreased by 45% or more. However, only a small decreased was observed in utilization of chemotherapy treatments.

In April 2020, use of telemedicine appointments increased by over 4000% when compared to April 2019. Yet, this significant increase in telemedicine visits replaced only approximately 40% of the decline in in-person visits during this period.

Notably, the authors observed that patients living in lower-income or predominately non-white zip codes had approximately a third lower increase in telehealth visits than those who lived in the wealthiest neighborhoods.

"The extent to which access barriers to telemedicine contribute to lower rates of in-person care deferral, and thus increases in potential exposure to COVID-19, should be examined in future work," Whaley said in the press release.

Health care use drops during pandemic; switch to telemedicine creates disparities. Rand Corporation; November 5, 2020. 

https://www.eurekalert.org/pub_releases/2020-11/rc-hcu110320.php

During the first 2 months of the COVID-19 pandemic, many Americans reduced their in-person preventive and elective health care visits and increased telemedicine appointments. 

Telemedicine Use During the First 2 Months of the Pandemic Did Not Offset the Drop in In-Person Visits

New research suggests that statins, which are commonly prescribed to lower cholesterol and reduce the risk of heart disease and stroke, may also protect patients from heart damage caused by early breast cancer treatment.

The observational study found that women who were already taking statins and were treated with either anthracyclines or trastuzumab were half as likely to be hospitalized or visit an emergency department for heart failure within 5 years following chemotherapy. The researchers focused on women in Ontario, Canada, and included markers of heart failure severe enough for women to be hospitalized, rather than markers just indicating a weaker heart.

“Our job is to protect the heart and ensure it has the greatest fighting chance to get through chemotherapy,” said lead author of the paper Husam Abdel-Qadir, MD, PhD, FRCPC, DABIM, in a press release.

He added that prior observational studies have reported measures of heart strength in statin-treated women after chemotherapy, but only focused on a single center.

Anthracyclines and trastuzumab are used in many women with breast cancer, although increased risk of toxicity has limited use of these drugs and damage can be severe enough to lead to heart failure. The investigators used several health databases in Ontario to review the occurrence of heart failure in women aged 66 years and older who received trastuzumab or anthracyclines for newly diagnosed early-stage breast cancer between 2007 and 2017.

In the 666 pairs of women treated with anthracyclines, those taking statins were 55% less likely to be treated at the hospital for heart failure, according to a press release. In the 390 pairs of women treated with trastuzumab, those taking statins were 54% less likely, suggesting a protecting trend although it did not meet statistical significance.

One of the ways that the treatments are believed to damage heart muscles is through oxidative stress, defined as the imbalance of free radicals, compounds which can harm the body if levels are too high, and antioxidants, which fight free radicals. In addition to lowering cholesterol, statins may also protect the body against the effects of oxidative stress, which may decrease the likelihood of the heart sustaining damage due to cancer treatment.

“In order to know whether it’s a true cause and effect relationship, we need to do a proper randomized controlled trial,” Abdel-Qadir said. “For the time being, if a woman is supposed to be starting treatment for breast cancer and already has an established indication to be on a statin, there’s now additional motivation to start it or stay on it.”

Common drug may protect hearts from damage caused by breast cancer chemotherapy [news release]. EurekAlert; January 6, 2020. Accessed January 7, 2020. 

https://www.eurekalert.org/pub_releases/2021-01/uhn-cdm010521.php

Anthracyclines and trastuzumab are used in many women with breast cancer, although increased risk of toxicity has limited use of these drugs and damage can be severe enough to lead to heart failure.

Statins May Protect Heart from Adverse Effects of Early Breast Cancer Treatment

New research suggests that shared decision-making interventions can help address asthma disparities among Black adults in urban settings, with study participants showing significantly better asthma control at every checkpoint during the 3-month trial.

Asthma is one of the most common chronic illnesses, affecting approximately 339 million individuals globally with an estimated 15 million disability-adjusted life-years lost due to the disease.1 According to the study authors, asthma affects approximately 19 million adults in the United States, with those living below the poverty level having a higher asthma prevalence than those above it.

Compared to whites and Hispanics, Black Americans have a higher prevalence of asthma and are about 3 times as likely to die of the disease, according to researchers at the Columbia University School of Nursing. To help address these disparities, investigators conducted a group-randomized longitudinal trial designed to assess the effects of a novel shared decision-making intervention.

, evaluated an intervention called BREATHE (Brief Intervention to Evaluate Asthma Therapy) to determine its efficacy, feasibility, and acceptance. Relative to a comparator group of 40 adults, the 40 individuals who participated in BREATHE showed significantly better asthma control and higher perceived shared decision-making immediately after the intervention visit with their health care provider.

The participants were all Black or multiracial, and 83% were female, with a mean age of 45 years. They were followed monthly for 3 months post-intervention and data were collected from December 2017 to May 2019, including surveys, lung function tests, and interviews.

According to the authors, BREATHE is a brief, tailored intervention that can be integrated into office visits using clinicians as the interventionists. The authors said using the patient’s own clinician as the interventionist helps keep the patient appraised of the challenges in asthma management, and the intervention could serve as a template for other patient populations with similar challenges.

“Based on this study, BREATHE has shown to be a promising, brief, and tailored intervention that can be integrated into office visits, with clinicians as interventionists,” said lead author Maureen George, PhD, an associate professor at Columbia University School of Nursing, in a prepared statement. “We believe BREATHE is particularly useful because it’s a pragmatic, shared decision-making approach to improving asthma outcomes in a population that experiences marked health disparities.”

George M, Bruzzese J, Sommers M, Pantalon M, et al. Group-randomized trial of tailored brief shared decision-making to improve asthma control in urban black adults. 

https://pubmed.ncbi.nlm.nih.gov/33249632/

Group-randomized Trial Showed Significant Improvement in Asthma Control Among Urban Black Adults [news release]. Columbia University School of Nursing; December 8, 2020. 

https://www.nursing.columbia.edu/news/group-randomized-trial-showed-significant-improvement-asthma-control-among-urban-black-adults

Intervention with shared decision-making in asthma treatment could serve as a template for other patient populations with similar challenges.


Study: Shared Decision-Making in Asthma Treatment Improves Disease Control in Urban Black Adults

Americans who have not yet done so should make plans to get the flu vaccine during National Influenza Vaccination Week, which is held between December 6-13, 2020, according to the California Immunization Coalition.

The recent spike of coronavirus disease 2019 (COVID-19) cases could make a severe flu season more dangerous, as simultaneous respiratory infections can overrun already burdened clinics and hospitals. Public health officials are concerned that recent stay-at-home orders have discouraged people from getting the flu vaccine, either because they are hesitant to go to a medical clinic or that they believe social distancing has made the flu vaccine unnecessary. However, lack of a flu vaccination may cause a “twindemic,” meaning people can get both COVID-19 and the flu. 

During the 2019-2020 flu season, vaccinations prevented an estimated 7.52 million illnesses, 3.69 million medical visits, 105

000 hospitalization and 6300 deaths. Flu shots are especially important for those at a higher risk of developing serious flu complications, including people 65 and older, pregnant woman, and people with chronic medical conditions such as heart disease, asthma, and diabetes. 

"The flu can be a very serious virus, particularly for the elderly and immune compromised, and even mild cases can result in hospitalizations," said Randy Bergen, MD in a prepared statement. "Because we don't know yet how bad the flu virus will be, and because it peaks at a time when we are seeing COVID-19 cases rise, it is critical for everyone to get a flu vaccination so we do not see a massive and perilous spike of both viruses."

According to Bergen, patients should contact their physicians to see what safety measures are in place to protect patients from COVID-19 during flu vaccination.

Health Officials Stress Importance of Flu Vaccinations Amid the Rise in COVID-19 Cases During National Influenza Vaccination Week (December 6-13) [News Release]. Sacramento, CA; December 9, 2020: California Immunization Coalition.

A flu vaccine is especially important this year, as it can prevent a “twindemic” with COVID-19.

Health Experts Urge Americans to Vaccinate Against Flu During National Influenza Week

Contemporary Clinic spoke with Dana DeShon, special interest group leader at NAPNAP, about National Influenza Vaccination Week, which is observed from December 6-12.

DeShon discusses the importance of continuing to get vaccinated through the holiday season and beyond, the change of perception towards vaccination due to the COVID-19 pandemic, and differentiating flu symptoms versus COVID-19 symptoms. 

What to Know for National Influenza Vaccination Week 2020

Adults with type 2 diabetes (T2D) have a greater risk of developing cardiovascular disease (CVD) compared with the general population, even when risk factors associated with CVD are optimally controlled, according to research published in the American Heart Association's journal 

.

First author Alison Wright, PhD, a research associate at the Centre for Pharmacoepidemiology and Drug Safety at the University of Manchester in the United Kingdom, explained in a press release that previous studies investigating the association between T2D and CVD risk factors had demonstrated that people with T2D had little or no increased risk of CVD events or death when all risk factors are optimally controlled.

"Our team sought to determine how the degree of risk factor control in people with Type 2 diabetes impacted CVD risk and mortality compared to people with type 2 diabetes who had all risk factors optimally controlled and to people who do not have type 2 diabetes," Wright said in the press release.

The researchers analyzed data between 2006 and 2015 from the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset. After collecting the data, the researchers identified more than 101,000 people with T2D and matched them with approximately 379,000 people without diabetes in CPRD and nearly 331,000 with T2D in SCI-Diabetes.

When conducting the analysis, the researchers focused on 5 risk factors for CVD, including blood pressure, smoking, cholesterol, triglycerides, and blood glucose. They then assessed the association between future CVD events and death with these risk factors when the risk factors are optimally controlled. They also investigated whether the presence of cardiorenal (heart and kidney) disease had any impact on these connections as well.

The results demonstrated that only 6% of participants included in the analysis with T2D had all 5 risk factors within target range. Among patients with these 5 risk factors who had them optimally controlled, those patients with T2D were demonstrated to still have a 21% higher risk for CVD and 31% higher risk for hospitalization from heart failure than people without diabetes.

Additionally, the association between the number of increased risk factors and CVD event risk was greater in people with T2D who did not also have cardiorenal disease.

"People with type 2 diabetes should be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not," Wright said in the press release. "There is real potential here to reduce the overall impact of type 2 diabetes on future cardiovascular events, especially for patients with type 2 diabetes who have not yet been diagnosed with CVD."

The researchers noted that although this research showed the importance of controlling all risk factors in patients, future research will investigate the individual risk factors that may have a greater impact on CVD risk and require targeted interventions.




Preventing heart disease should be a priority for people with Type 2 diabetes. Dallas, TX: American Heart Association; November 16, 2020. eurekalert.org/pub_releases/2020-11/aha-phd111620.php. Accessed November 17, 2020.

Adults with type 2 diabetes have a greater risk of developing cardiovascular disease (CVD) compared with the general population, even when risk factors associated with CVD are optimally controlled.

People With Type 2 Diabetes Have a Greater Risk of Cardiovascular Disease Even With Risk Factors Optimally Controlled

Randall A. Oyer, MD, president of the Association of Community Cancer Centers, and medical director at Penn Medicine’s Ann B. Barshinger Cancer Institute in Lancaster, Pennsylvania talks to 

® on the necessity of cancer screenings in the effort to reduce cancer mortality. The coronavirus disease 2019 (COVID-19) pandemic is projected to cause a spike in cancer deaths, which, according to Oyer, is due to the decline in screening since the pandemic began.

Cancer deaths are expected to spike due to COVID-19. 

Cancer Screenings Crucial for Mortality Reduction

Contemporary Clinic spoke with Daniel R. Wilson, MD, PhD, President of Western University of Health Sciences, about what to recommend to those who are struggling cognitively through the COVID-19 pandemic.

Wilson reminded those who may be stressed since the start of the pandemic to continue to take care of both your body and mind, such as eating well, sleeping well, and socializing when possible.

Wilson also shared his thoughts on what he hopes to see for the future of COVID-19 and the focus of future studies on it. 

The Future of Neurological Studies During COVID-19

According to 2 editorials in the journal 

, research in the nursing field has been critically influential to understanding evidence-based health care practice, care delivery, and policy during the coronavirus disease 2019 (COVID-19) pandemic. In order to investigate this influence further, researchers at the University of Pennsylvania School of Nursing assessed what the role of nursing research has been in supporting patients during the pandemic.

According to the authors of the guest editorial “Nursing Research Is Coronavirus Research

,” nursing practice has not only saved lives throughout the pandemic, but it has also played a critical role in understanding the nature of care for patients with COVID-19. The research conducted to understand this role further has helped to progress knowledge regarding the necessary elements of more supportive work environments that save patient lives and promote recovery in both hospitals and nursing homes.

Additionally, research in the field of nursing has helped to advance knowledge regarding how individuals sheltering at home with in-home nursing care are managing diets to support their health in light of chronic conditions, as well as how in-home nursing care has been able to stabilize chronic conditions during the pandemic.

The research in the field has also been able to bring to light lessons from the past around areas of concern for patients in order to positively impact policy around patient care during the pandemic.

"We know that nursing practice is saving lives in this pandemic. Nursing research also plays a critical role," write the authors of the guest editorial. “We support the move in universities to concentrate research on innovations directly related to the coronavirus crisis. But so much of nursing's research is coronavirus research. We applaud the search for reliable epidemiological data, effective treatments, and vaccines. We, though, must articulate nursing research's fundamental frame. We focus on the lived experiences of clinicians, patients, families, and communities.”

The author of the second editorial “How Effective Response to COVID-19 Relies on Nursing Research

,” Eileen T. Lake, PhD, the associate director of the Center for Health Outcomes and Policy Research and editor in chief of 

, explained further that throughout the pandemic, several clear challenges to an effective response to the public health crisis became evident. These challenges included the country’s restricted access to health care, the present surging demand for health care personnel, and the moral distress that many health care providers face during the pandemic.

Lake also noted that in order to better help institutions meet the demands that the COVID-19 pandemic posed to the health care system, nursing research was critical to effectively inform crucial elements of policy response and institutional preparedness.

"Nursing research provides answers during crises," writes Lake in the editorial. “In a time of profound upheaval, risk, and strain, it is reassuring to have evidence-based solutions to the challenges confronting our health care system and its clinicians.”

Nursing research informs response to COVID-19 pandemic. Philadelphia, PA: University of Pennsylvania School of Nursing; April 27, 2020. eurekalert.org/pub_releases/2020-04/uops-nri042720.php. November 30, 2020.

D’Antonio P, Naylor M, Aiken L. Nursing research is coronavirus research. 

Lake ET. How effective response to COVID‐19 relies on nursing research. 

2020;43(3):213-214. doi: 10.1002/nur.22025.

According to 2 editorials, research in the nursing field has been critically influential to understanding evidence-based health care practice, care delivery, and policy during the COVID-19 pandemic.

Nursing Research Has Been Critical to Improving the COVID-19 Pandemic Response

Favipiravir may be a beneficial treatment for mild-to-moderate coronavirus disease 2019 (COVID-19), according to a study published in the 

International Journal of Infectious Diseases

The COVID-19 pandemic has caused over 1.39 million deaths and there have been more than 59.2 million confirmed cases worldwide, according to the World Health Organization.

 Favipiravir is an RNA-dependent RNA polymerase (RdRp) inhibitor that is approved in Japan and China for the treatment of novel influenza virus.

Currently, 2 other trials have demonstrated that favipiravir has an advantage over other antivirals in treating COVID-19. Additionally, it is estimated that over 80% of patients with COVID-19 experience mild-to-moderate illness. However, very little antiviral research has investigated therapeutic interventions in this patient group.

The randomized, open-label phase 3 study took place across 7 sites in India. Study participation had a maximum treatment period of 28 days. Care was provided past the 14-day mark based on investigator judgement. The control arm received standard of care alone while the study group received standard of care plus favipiravir. Drugs with suspected antiviral activity against SARS CoV-2, including hydroxychloroquine, were prohibited.

Patients treated with favipiravir met the primary end point of median time to RT-PCR negativity 28.7% sooner than those treated with standard of care alone. However, according to the study, the median time to viral clearance was shorter in the control group (7 days) than in the study group (11 days). The statistically significant endpoint was not achieved.

“Faster viral clearance would be expected to reduce the duration of infectivity during the early course of disease, which would yield critical reductions in the secondary attack rate, duration of quarantine, and burden on health care providers and facilities,” study authors write.

Favipiravir was found to be well tolerated, and no adverse events led to drug discontinuation. One patient in the control group died of acute respiratory distress syndrome.

1. Udwadia, Zarir, et al. Efficacy and Safety of Favipiravir, an Oral RNA-Dependent RNA Polymerase Inhibitor, in Mild-to-Moderate COVID-19: A Randomized, Comparative, Open-Label, Multicenter, Phase 3 Clinical Trial. November 8, 2020. 

https://doi.org/10.1016/j.ijid.2020.11.142

2. WHO Coronavirus Disease (COVID-19) Dashboard

. The World Health Organization. Accessed November 25, 2020. 

The drug, which is approved for use in Japan and China, may help those with mild-to-moderate COVID-19. 

Favipiravir May be an Effective COVID-19 Treatment

A new study from researchers at the University of California (UC) Davis found that eating Ataulfo mangoes, also known as honey or champagne mangoes, may reduce facial wrinkles in older women with fairer skin.

Postmenopausal women who ate a half cup of Ataulfo mangoes 4 times a week saw a 23% decrease in deep wrinkles after 2 months and a 20% decrease after 4 months, according to the study authors.

“That’s a significant improvement in wrinkles,” said lead study author Vivien Fam, RDN, LDN, a doctoral student in the UC Davis Department of Nutrition, in a press release. “Women who ate a cup and a half of mangoes for the same periods of time saw an increase in wrinkles. This shows that while some mango may be good for skin health, too much of it may not be.”

The pilot study involved 28 postmenopausal women with Fitzpatrick skin types 2 or 3, or skin that burns more easily than it tans. The women were divided into 2 groups, with 1 group consuming a half cup of mangoes 4 times a week for 4 months, and the other group consuming a cup and a half of mangoes for the same period of time. Facial wrinkles were evaluated using a high-resolution camera system, according to the study authors.

“The system we used to analyze wrinkles allowed us to not just visualize wrinkles, but to quantify and measure wrinkles,” said study author Robert Hackman, PhD, professor in the Department of Nutrition, in a press release. “This is extremely accurate and allowed us to capture more than just the appearance of wrinkles or what the eye might see.”

Additionally, the study looked at the severity, length, and width of fine, deep, and emerging wrinkles. The study authors noted that the group that consumed a half cup of mangoes saw improvements in all categories.

Further research is needed to learn the mechanisms behind the reduction in wrinkles, considering the beneficial effects of carotenoids and other phytonutrients that could help build collagen, according to the study authors.




Can eating mangoes reduce women’s facial wrinkles? UC Davis. 

https://www.ucdavis.edu/news/can-eating-mangoes-reduce-womens-facial-wrinkles/

. Published November 19, 2020. Accessed November 23, 2020.


Although women who hate half a cup of mangoes 4 times a week saw a reduction in wrinkles, women who ate more mangoes saw an increase, suggesting that too much may have the opposite intended effect. 

Study: Eating Mangoes Can Reduce Women’s Facial Wrinkles

Officials with the FDA expanded the approved indication for baloxavir marboxil (Xofluza; Genentech) to include post-exposure prevention of influenza for patients aged 12 years and older, after contact with an individual who has the flu. The therapy previously available only in tablet form, is also now available as granules for mixing in water.

Baloxavir marboxil was originally 

 for treating uncomplicated flu in patients aged 12 years and older who have been symptomatic for no more than 48 hours. Its’ indication was first 

 for patients aged 12 years and older who are at high risk for developing influenza-associated complications.

Baloxavir marboxil’s safety and efficacy for post-flu exposure prevention is supported by a randomized, double-blind, controlled trial in which 607 subjects, aged 12 years and older who were exposed to a person with influenza in their household, received either a single dose of baloxavir marboxil or a single dose of a placebo. Of these 607 subjects, 303 received baloxavir marboxil and 304 received the placebo.

According to the FDA, the trial’s primary endpoint was the proportion of subjects who were infected with influenza virus and presented with fever and at least 1 respiratory symptom from day 1 to day 10. Of those who received baloxavir marboxil, 1% of subjects met these criteria, compared to 13% of subjects who received a placebo for the clinical trial.
The most common adverse effects of baloxavir marboxil include diarrhea, bronchitis, nausea, sinusitis and headache. Additionally, hypersensitivity, including anaphylaxis, can occur in patients taking baloxavir marboxil.

Patients should be advised not be co-administer baloxavir marboxil with dairy products, calcium-fortified beverages, or laxatives, antacids, or oral supplements containing calcium, iron, magnesium, selenium, aluminum or zinc.

Flu is a contagious respiratory illness caused by influenza viruses. According to the FDA, treating flu patients with antiviral drugs within 48 hours of their becoming sick can reduce symptoms and duration of the illness. An annual seasonal flu vaccine is the best way to protect against the flu.






FDA Expands Approval of Influenza Treatment to Post-Exposure Prevention [news release]. Silver Spring, MD; November 23, 2020: FDA. Accessed November 23, 2020. 

https://www.fda.gov/news-events/press-announcements/fda-expands-approval-influenza-treatment-post-exposure-prevention

Officials with the FDA expanded the approved indication for baloxavir marboxil (Xofluza; Genentech) to include post-exposure prevention of influenza for patients aged 12 years and older, after contact with an individual who has the flu.

FDA Expands Indication of Antiviral Therapy to Include Post-Exposure Influenza Prevention

Contemporary Clinic spoke with Daniel R. Wilson, MD, PhD, President of Western University of Health Sciences, about the impact that COVID-19 is having on the brain.

Wilson explained how certain people with COVID-19 are experiencing post-COVID-19 symptoms of cognitive changes, such as clarity in thinking and memory. 

In addition, Wilson also discusses the importance of focusing on the cognitive long-term effects of the virus and specific trials regarding this topic. 

News

All Content