Giving patients who have septic shock a combo of two steroids could potentially be a lifesaver, according to a new study. Researchers found that patients receiving a combination of hydrocortisone and fludrocortisone had lower death rates and discharge to hospice compared to those who received hydrocortisone alone. “Our results provide robust evidence that one steroid regimen is superior to the other regimen and, in absence of further clinical trials, directly inform the choice of steroids in patients with septic shock,” said study co-author Dr. Nicholas Bosch, an assistant professor at Boston University’s Chobanian & Avedisian School of Medicine. For the study, published March 27 in JAMA Internal Medicine, researchers compared treatment options using a multicenter database that included about 25% of U.S. hospitalizations. The study was designed to mimic a randomized clinical trial. The team compared the outcome of death or discharge to hospice between patients who received the regimen of hydrocortisone and fludrocortisone to those who received hydrocortisone alone. On average, patients who received the combined regimen died or were discharged to hospice about 4% less of the time than patients who received hydrocortisone alone. More than a third of the estimated 1.7 million U.S. hospitalizations involving sepsis — an extreme response to infection — each year end in death. These findings may change clinical practice, the authors said. “It is possible that guideline…  read on >  read on >

If you’re one of the millions of people with allergic asthma or eczema, you may be more likely to develop the wear-and-tear form of arthritis as you age. This is the main finding from a new study that examined the risk of developing osteoarthritis among people with the two allergic conditions. The study wasn’t designed to say how, or even if, these allergic diseases increase osteoarthritis risk, but the researchers do have a theory. “Our group has done work showing that mast cells [a type of allergic cell] are increased in numbers in the joints of people with osteoarthritis, and their activity contributes to the development of osteoarthritis,” said study author Dr. Matthew Baker, clinical chief in the division of immunology and rheumatology at Stanford University in Stanford, Calif. And asthma and eczema may be the tip of the iceberg, he said. “It is possible that other atopic conditions such as seasonal allergies, food allergies and/or allergic rhinitis [hay fever] may provide a similar risk,” Baker noted. These researchers did not look at these conditions in the new study. For the study, they reviewed insurance claims from two databases. The first set included more than 117,000 people with asthma or eczema and 1.2 million people without these conditions. After eight years of follow-up, the risk of developing osteoarthritis was 58% higher among folks with allergic…  read on >  read on >

Researchers have discovered that two drugs might be better than one for women who have advanced endometrial cancer. Combining chemotherapy and immunotherapy or a monoclonal antibody at the same time helped these patients live longer without their cancer progressing, especially those who had a specific type of endometrial cancer known as a mismatch repair-deficient tumor. “We found a profound improvement,” Dr. Carol Aghajanian, a medical oncologist specializing in gynecologic cancers at Memorial Sloan Kettering Cancer Center in New York City, who was senior study author on one of the reports, told NBC News. The findings from the two studies were published March 27 in the New England Journal of Medicine and simultaneously presented at the annual meeting of the Society of Gynecologic Oncology in Tampa, Fla. “This is going to drastically change the conversation” with patients — “probably as of tomorrow,” Dr. David O’Malley, a gynecologic oncologist with The Ohio State University Comprehensive Cancer Center, told NBC News. Chemotherapy is typically used to treat women with this cancer, and immunotherapy is only approved as a second-line treatment. But in one study, researchers led by Aghajanian found that adding the immunotherapy drug pembrolizumab (Keytruda) to a standard chemotherapy regimen of carboplatin and paclitaxel cut the risk of disease progression or death in patients by up to 70%. The improvement was an average of 13.1 months before…  read on >  read on >

Children with mental health problems are flooding America’s hospitals. A new study of 4.8 million pediatric hospitalizations between 2009 and 2019 found that the number of acute care hospitalizations for kids with mental health problems increased significantly. In 2019, most were due to attempted suicides, suicidal thoughts or self-injury, researchers said. “What we’re seeing are more and more hospital stays by children and adolescents due to mental health concerns in terms of absolute numbers, and a substantially larger fraction of these stays are related to suicide or self-injury,” said study leader Mary Arakelyan, research project manager at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. “With hospitalizations for mental health concerns representing a larger proportion of all pediatric hospitalizations in 2019 than in 2009, it’s imperative to consider how inpatient settings will meet the mental health needs of a growing population of young people,” she added. The study found that pediatric mental health hospitalizations rose 26% between 2009 and 2019. And, over that same period, those owing to attempted suicide, suicidal thought or self-injury increased from 31% to 64%. Senior researcher Dr. JoAnna Leyenaar, vice chair of research in the pediatric department at Dartmouth-Hitchcock, said kids with mental health issues go to hospitals because they have nowhere else to turn. “Acute care hospitals provide access to care for youth and families when they’re experiencing a mental health…  read on >  read on >

Could inhaling a deep whiff of another person’s sweat help ease crippling social anxiety? Quite possibly, new Swedish research suggests. The notion stems from a trial that involved just 48 women. All struggled with what’s known as social anxiety disorder — an often intense and relentless fear of being watched or judged by others when participating in common social situations. The standard course of treatment centers on talk therapy involving meditation practices that are designed to ease some of the anxiety that arises. But Swedish researchers discovered that when such “mindfulness therapy” is combined with the inhaling of sweat of others, the result appears to be a far steeper drop in anxiety levels. “Social anxiety is a common disorder which entails an intense and persistent fear of social situations,” explained study author Elisa Vigna, a research assistant with the Swedish National Centre for Suicide Research and Prevention at the Karolinska Institute. “This can lead to anxiety and fear of common situations like speaking in front of an audience, meeting new people, even talking to a cashier in a store. So, it can be very debilitating, affecting many areas of everyday life.” This is the first study that uses body odor as a treatment enhancer, Vigna noted. The results “were very interesting and promising,” she said. While a single session of mindfulness therapy alone triggered a…  read on >  read on >

In yet another sign of the stress that can haunt gay, lesbian and bisexual youth, a new study finds that compared with their straight peers, they are twice as likely to report trouble falling asleep or staying asleep. Depression and family conflict may be contributing to sleep issues in young LGBTQ people, the researchers noted. “Young people who identify as lesbian, gay or bisexual may face discrimination and negative attitudes because of their sexual orientation. These experiences can make it harder for them to get a good night’s sleep,” said lead author Dr. Jason Nagata, an assistant professor of pediatrics at the University of California, San Francisco. “Difficulties getting along with family, feeling sad and hopeless, and being under a lot of pressure could all make it hard for lesbian, gay and bisexual youth to sleep well,” he explained. For the study, Nagata’s team used data from 2018 to 2020 on more than 8,500 chlidren aged 10 to 14 who were part of the Adolescent Brain Cognitive Development Study, a large, long-term study of brain development and child health in the United States. The children and their parents answered questions about their sleep habits. The kids were also asked about their sexual orientation. Those who were only starting to question their sexuality also had greater risk for sleep problems compared to their straight peers, the…  read on >  read on >

For depressed or anxious children, taking melatonin may afford a good night’s sleep and, as a result, lower the odds they will harm themselves, new research suggests. The risk of self-harm increased before melatonin was prescribed and decreased by about half after kids started taking the supplement, the study found. Teen girls suffering from depression or anxiety were the most likely to benefit. “This suggests that melatonin might be responsible for the reduced self-harm rates, but we cannot rule out that the use of other psychiatric medications or psychotherapy may have influenced the findings,” said senior researcher Sarah Bergen, from the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm, Sweden. “Melatonin is a naturally occurring hormone, and we believe the findings are due to improved sleep,” she said. The study can’t prove that melatonin caused the drop off in self-harm, only that there appears to be a link. Of the more than 25,000 young people in the study, 87% had psychiatric disorders in addition to sleep problems. “Melatonin was probably only one part of their treatment package,” Bergen said. “We found that controlling for antidepressant use did not appreciably alter the results, but it’s possible that other medications or psychotherapy are contributing to the observed findings.” For the study, her team identified nearly 25,600 Swedish youngsters between 6 and 18 years…  read on >

While all Americans could benefit from proposed new limits on what’s called PM2.5 air pollution, new research indicates the change has the potential to benefit Black and low-income Americans the most. The limits being considered by the U.S. Environmental Protection Agency (EPA) could cut death rates in those more vulnerable groups by up to 7%, according to researchers from Harvard T.H. Chan School of Public Health, in Boston. “The EPA is currently considering stronger rules for PM2.5 air pollution and the decision will have profound effects on ensuring all Americans have an equal opportunity to breathe clean air,” said co-lead author Scott Delaney, a research associate in the department of environmental health at Harvard. “Our research shows that, while stronger rules will protect all aging Americans from air pollution, those harmed the most by air pollution will benefit the most — and that these benefits may be larger than prior research suggests,” Delaney said in a Harvard news release. These stronger air quality policies could also drive innovative ways to reduce the emission of heat-trapping gases, the study authors said. This might save even more lives through its impact on climate change. To study this, the researchers used Medicare data from more than 73 million Americans aged 65 and older between 2000 and 2016 according to race, income level and annual average PM2.5 exposure by…  read on >  read on >