Friday, 16 August 2019

On Natural Anti-Emetics

Last July I posted on audiovestibular symptoms, not exclusively but also related to Sjogren's syndrome, and anti-emetics/balance therapy as an aid for fixing balance and nausea issues. The post was very insightful and deserves a revisiting HERE. In any case I had promised to look a bit deeper on natural anti-emetics since anti-emetic drugs trigger secondary effects more frequently than natural products. These can be used as a good approach to correct developed symptoms arising from audiovestibular complications. Before we proceed, a very important disclaimer: If you or anyone you know is going through any medical event that can relate to the information hereby shared, please do not take such information as medical advice. The current post, as any other post in The Toxicologist Today blog is purely for scientific information; exclusively to the use of the reader in growing a better knowledge of the science surrounding the different debated topics. This information does not intend to support any clinical or medical decision, but to enhance your capacity to discuss scientific topics based on real scientific publications/references.

What are anti-emetics?

Anti-emetics are substances that can prevent or arrest nausea and emesis (vomiting). They can be classified into different pharmaceutical types. Drugs falling within this category should only be prescribed when the underlying reasons for nausea and vomiting are known, otherwise their action could be masking more serious conditions that can develop in the background with no adequate diagnosis conducted. The range of secondary effects that are known to occur when taking anti-emetics are non-extensively listed in a very good post by Medical News Today (Access HERE). [1].

Different pharmaceuticals (e.g., antihistamines, phenothiazines, Bismuth-subsalicylate, cannabinoids, corticosteroids, dopamine receptor blockers, NK1 receptor blockers, serotonin receptor blockers, etc) are specifically indicated according to the causation (aetiology) of the condition, but its use can be followed by different secondary effects. For a lengthier look into the different treatment possibilities you can visit NICE's page on the matter that contains excellent content (access HERE) [2]. 

Some of these products are used for controlling post-surgery symptoms. Others address 'simpler' cases like gastroenteritis, or for counteracting sickness in pregnancy due to, for example, certain endocrine levels in the female body. Some other products are intended to counteract iatrogenic nausea and vomiting urges that are related to the use of immunomodulatory drugs (as it is the case in chemotherapy treatments).

How do anti-emetics work?

Very simply put they basically block certain neurotransmitters (like serotonin receptor blockers and dopamine receptor blockers, for example) found in the body and that are related to the triggering of nausea and vomiting impulses.

What natural anti-emetics are available?

Ginger (Zingiber officinale) is a root known for holding very potent anti-emetic properties and does not lack scientific support of its capacity to reduce nausea in different scenarios, such as in pregnancy [3],  prophylaxis in day case surgery [4], in the reduction of nausea and mild emesis induced by chemotherapy [5].

Peppermint (Mentha piperita, spicata) inhalation/aromatherapy is believed to possess anti-emetic properties when tested against postoperative nausea or chemotherapy-induced nausea, however some authors think it might be more related to the assumed breathing patterns rather than the inhaled substance itself [6] or that the herb should be used as an adjunct prophylactic rather than the principal therapy [7] [8].

Cinnamon (Cinnamomum zeylanicum) has also been pointed as showing anti-emetic properties when compared to known synthetic drugs [9], and especially on systemic symptoms associated to menstrual bleeding, that do account for the possibility of nausea and vomiting [10].

[1] What are the best ways to get rid of nausea, Medical News Today, [], Last visited on the 16-Aug-2019, last updated on the 10th of February 2018.

[2] Nausea and Labyrinth Disorders, NICE National Institute for Health and Care Excellence, [], last visited on the 16th of August 2019, last update unknown.

[3] Viljoen, E., Visser, J., Koen, N. et al (2014). "A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting". Nutrition Journal, 13 (20), pp. 2-14.

[4] Phillips, S., Ruggier, R., Hutchinson, S. E. (1993). "Zingiber officinale (Ginger)–an antiemetic for day case surgery". Anaesthesia, 48, pp. 715-717.

[5] Sontakke, S., Thawani, V., Naik, M. S. (2003). "Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study". Indian Journal of Pharmacology, 35, pp. 32-36.  

[6] Lynn, A., Anderson, R. N., Gross, J. B. et al (2003). "Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea". Journal of PeriAnesthesia Nursing, 19 (1), pp. 29-35.

[7] Lane, B., Cannella, K., Bowen, C.  (2011). "Examination of the Effectiveness of Peppermint Aromatherapy on Nausea in Women Post C-Section ". Journal of Holistic Nursing, 30(2), pp. 90-104.

[8] Tayarani-Najaran,Z., Talasaz-Firoozi, E., Nasiri, R., et al (2013). "Antiemetic activity of volatile oil from Mentha spicata and Mentha × piperita in chemotherapy-induced nausea and vomiting". Ecancermedicalscience. 7 (290).

[9] Khan, I. A., Aziz, A., Sarwar, H. S. (2014). "Evaluation of antiemetic potential of aqueous bark extract of cinnamon". Canadian journal of applied sciences, 4(1), pp. 26-32.

[10] Jaafarpour, M., Hatefi, M., Najafi, F. et al (2015). "The Effect of Cinnamon on Menstrual Bleeding and Systemic Symptoms With Primary Dysmenorrhea". Iran Red Crescent Med J., 17(4).

1st image Caglar Araz on Unsplash

2nd image by Dominik Martin on Unsplash

Friday, 26 July 2019

Why is there a “delayed onset” of antipsychotic action?

As a medical information specialist I am confronted with a variety of questions related to the trending therapeutic areas out there: immunoncology, cardiovascular, central nervous system, virology, orphan diseases, immunology, and so on and so forth. Every day I learn something new, from medical nomenclature to the mode of action of a certain drug, a wide range of topics pass through my eyes and I savour the opportunity to be well informed. Often, I myself, try to understand certain disease area aspects that are not so well explicit to the public or still remain a huge question mark for most of the healthcare professionals, clinicians and researchers out there. 

Recently, I have asked myself 'Why is there a “delayed onset” of antipsychotic action when changing between products?' as this is a recurrent situation to which I was never offered a clear response. Why is it so typical of treatments with antipsychotics that the patients deriving from product A to product B will quite often experience an adaptation phase? I can immediately relate to, for example, some research work I did back in the days when I graduated and my final year research project covered Cushing's syndrome. The case study I prepared did partially look through the desensitisation experienced by the patient's organism after a certain period of exposure to the very same drug. Different active substances would perform differently in terms of the body responses to the drug (pharmacokinetics) and the effects of such drugs in the different human sub-systems (pharmacodynamics). But when you consider the same basic active agents however in different products, it's very unlikely (if not almost impossible) that the aggregating/stabilising salt where these molecules 'sit' would impact that much on the efficacy of the product.

I decided to investigate a bit further, and here's what I found on the delayed onset of antipsychotic action, especially when changing between products?

Effect timings

Apparently, when considering the findings of the review article by Agid et al (2006) [1] there isn't a delayed onset, and actually the antipsychotic effect is within the first day, however the strongest more 'visible' antipsychotic effects are produced in the first two weeks after administration. Still according to this review, the most improvement is obtained in the very first month of treatment against any other period of treatment or follow up.

Even though it does not immediately respond to the question, as there is no switch between products in the previous paragraph, it already offers some nice pointers to understanding this issue. Could all this be a myth? Let's continue investigating.

A myth or a theory?

Psychotherapy is full of acquired myths as it is the norm for any therapeutic area with considerable difficulty in scientifically measuring improvement. But according to [1] it was in the 70s when this idea appeared stating that the onset of antipsychotic action is delayed in about 2 to 3 weeks. This led to investigations on what would be the underlying causes prompting such delay; and some authors arrived to a possible theory known as 'The Depolarisation Block Theory'. As per the authors two studies suggest that the explanation for a delayed onset of action is based on preclinical studies (on paralysed anaesthetised mice) involving recordings of dopamine neuron firing proposing that the effect on dopaminergic neurons in the brain after repeated administration of an antidopaminergic drug (commonly known as antipsychotic) is the inactivation of firing that usually occurs only after ~3 weeks of continuous treatment with said drug - ergo, a delay onset. Consequently, clinicians and investigators thought that this reported delay explained the delay in the therapeutic effect of the administered drugs [2] [3] [4].

The fact is that this theory was so strongly believed as factual that researchers started looking for biomarkers to actually support it. If found, no one would dare question its prevalence and thus the theory would be validated into something more clinically and scientifically accepted. The idea of its consubstantiation was to basically grow the theory into a postulate, to then grow it into an axiom.

After many different attempts this theory was 'officially' refuted as so well discussed by Agid et al (2003) [5]. The authors quite well mention that for understanding the mechanism of action of antipsychotics it is crucial to have a clear understanding of the time course over which effects take place. [5] put to test the delayed-onset hypothesis by subjecting it to a meta-analytic study, meaning by subjecting 'a large amount of data from a multitude of studies' to a statistical combinatorial arrangement that in the end informs on whether effects in different studies are equal or vary to the next one. And sometimes, it is even possible to obtain from a meta-analysis study, the underlying reason why effects were different/same. Clever, isn't it? One got to love this STATS geniuses!

So by scrutinising 42 published studies, 7450 patients 119 independent treatment response and time curves, the investigators recognised that actually an 'early onset effect' was present even beating the timeline of the estimated effect of the placebo treatment!!! In conclusion, the analysis fully rejects the 'delayed onset' theory, reinforces the idea that effects initiates at first week and grows in strength over the proceeding weeks, and that the most 'readable/visible' signs of effect are observed two weeks after treatment has initiated [5].

Big names of the neuroscience field throughout the middle of the 20th century helped propagate this idea of 'delayed onset' of antipsychotics. This helped propagate yet another theory that resulted as the possible physiological explanation, the aforementioned 'depolarisation block hypothesis'. But because the precise time course of improvement observed after administration of antipsychotics in a patient-treatment has never been solidly scientifically established, this hypothesis cannot be assumed as having enough scientific backing to support its reliability.

As extremely well presented and discussed in [5], the crucial detail in this debate is to accept and differentiate 'delayed onset' from 'delayed realisation of full improvement' as suggested by the authors. OK, many people can say - 'Well, but the idea is to know when you feel better; it doesn't really matter if it's working or not in the body if in fact one can't feel the physical effects and improve'.

I give' em that. Makes perfect sense!!! ... But then, that is what happens in all medical areas, with specific differences concerning the class of pharmaceuticals used> Nonetheless, all pharmaceuticals will take their time to act upon the subject. What really makes an incredible difference in all of this debate is, in my opinion, four very important things:

1) The level of affliction - a patient who is feeling quite poorly will urge the healthcare professionals for an immediate effect of the administered treatment (drug or drugs) on the physical system; if compliance, quality of drug or prescribed treatment as a whole is not adequate, it is possible that the patient will turn on the drugs' supposed 'delayed onset' as the one factor undermining improvement to his/her health. Add to that a multitude of disease experts making noise about the same and there you go, you have built your much wanted axiom. But one can never forget that wrongly or incompletely postulated ideas are not scientific validations, and ... a headache is a headache, a psychosis is a psychosis.

2) The seriousness of the disease - The more complex a disease the harder it is for a single pharmaceutical to respond to improvement expectancy, especially when there is concomitant medication involved. That and to an extent, considering their different biochemical natures, will affect the perceiving of efficacy of the drug under scrutiny.

3) The drug's mode of action - drugs are not all acting the same way or via the same pathways. Physiological resistances are present as they would normally be in a hyper-dynamic responsive organism as the human body is.  Where the effects might take different times to be 'concretely felt' by the patient, some drugs will operate differently or through different mechanisms even when the overall goal is the same. This will immediately impact on how rapidly their effects are observed, not only concerning its pharmacodynamics, but actual also in the sense of improvement felt by the patient.

[1] Agid, O., Seaman, P., Kapur, S. (2006). "The “delayed onset” of antipsychotic action — an idea whose time has come and gone". J Psychiatry Neurosci, 31(2), pp. 93–100.

[2] Bunney, B S., Grace, A. A. (1978). "Acute and chronic haloperidol treatment: comparison of effects on nigral dopaminergic cell activity". Life Sci., 23(16), pp. 1715-27.

[3] Grace, A. A., Bunney, B. S. (1986). "Induction of depolarization block in midbrain dopamine neurons by repeated administration of haloperidol: analysis using in vivo intracellular recording". J Pharmacol Exp Ther, 38(3), pp. 1092-100.

[4] Bunney, B. S.,  (1984). "Antipsychotic drug effects on the electrical activity of dopaminergic neurons". Trends in Neurosciences, 7(6), pp. 212-215.

[5] Agid, O, Shitij, K., Tamara, A. et al (2003). "Delayed-Onset Hypothesis of Antipsychotic Action: A Hypothesis Tested and Rejected". Arch Gen Psychiatry. 60(12), pp.1228-1235. 

Post image by Laurynas Mereckas on Unsplash.

Wednesday, 17 July 2019

Audiovestibular symptoms, Balance Therapy and Sjogren's Syndrome

The impact of Primary Sjogren's syndrome (PSS) on a patient's health and quality of life can be tremendous. Some people end up changing not only their life styles, read Venus Williams' example [1], as well as their professional careers or the way their perform professionally, again and to a certain extent, Venus Williams. Some symptoms associated with autoimmune diseases are quite devastating and can drive the body immune responses to lengths that are known to be quite compromising to the physiological system itself. Other issues are mild, moderate, temporary, infrequent or just somewhat annoying. But one known affliction related to autoimmune diseases and that is also quite present in roughly 22 to 46% [2] of Sjogren's syndrome patients is the involvement of audiovestibular symptoms. These can derive in severity and result in compromising lack of balance, vertigo, nausea, dizziness or even, in some more grave cases, chronic audiovestibular neuronitis.

There are many factors that do participate in the sense of lacking balance, prevalence of vertigo, occurrence of nausea and dizziness. And well before your healthcare professional can assume there is something affecting your inner ear fluid, a battery of blood and urine tests might be requested to rule out certain deficiencies or health issues that indeed also, directly or indirectly, promote/generate the aforementioned symptoms. Multiple components can participate in triggering audiovestibular symptoms; take for example lack of vitamin B12 [3] that indirectly promote audiovestibular imbalance due to possibility of pernicious anaemia, paraesthesia, the umbrella 'ataxia' set of conditions that is comprised by lack of balance, coordination and speech. Also the calcium-vitamin D bridge for vitamin D is involved in the regulation of calcium and phosphorus in the human body for maintaining adequate bone structure, but ultimately is also recognised as a risk factor in idiopathic benign paroxysmal positional vertigo [4] [5]. Also and for example, peaks of hypertension (increased blood pressure) might eventually reveal the presence of underlying audiovestibular symptoms [6], even though high blood pressure (recognised as a silent killer) is known to be generally asymptomatic. And even endocrine factors can contribute to these audiovestibular aspects.

Before all PSS patients deliver themselves to tears of commiseration with the possibility of yet another serious health affliction, it is important to understand that these tend to have a higher prevalence of sensorineural hearing loss (SNHL) in comparison to the general population [2], HOWEVER there aren't presently reports of damage to the central auditory pathways that I know. In the past, bilateral progressive SNHL in PSS would be treated with steroids and cytotoxic treatments [7], but I suspect nowadays clinicians are ever more aware of the possible presence of macroglia/macrophages in the inner ear of these patients, and treatments are likely to be progressing towards addressing the presence of such resident cochlear inflammatory macrophages.

When audiovestibular symptoms blossom, due to a chronic condition, it is very well possible that the inner ear will be compromised and permit entry to viral and bacterial agents. On its own a chronic condition can sensitise the spaces/vesicles/glands where bodily fluids sit, but it can also wear out the tissues that viral and bacterial infections may use to proliferate at. In that instance chronic vestibular neunorinits or infection of the vestibular nerve in the inner ear can potentiate more serious vertigo, severe lack of balance and grave dizziness symptoms as a result of chronic inflammation. 

In all cases, be it mild or severe, visiting a healthcare professional is important for a good assessment on the causes that originate such afflictions. Where in more serious cases the clinical approach may consider prescribed medication with anti-emetics, anti-inflammatories and other products to control deriving situations, simpler cases can be resolved with two basic yet crucial measures, i.e., 1) the use of natural anti-emetics alongside natural anti-inflammatories, that for a viral infection and in time, will improve the patient's condition; 2) balance therapy (a specialised form of physiotherapy to alleviate primary and secondary problems that derive from vestibular disorders).

Natural anti-emetics and Balance Therapy:

Synthetic anti-emetics are known to potentiate, in some cases, a range of secondary effects that put people off using these products. Hence, natural plants with anti-emetic properties gain more relevance. For the sake of conciseness I won't be adding hereby any information on the several natural anti-emetics available in the market, leaving it for a subsequent post with depth on their method of action and on their nature. However, if you'd like to learn more about balance therapy for vestibular rehabilitation, there are so many different good sources of exercises that it was difficult for me to summarise in a simple paragraph how these can potentiate your recovery. I leave you with a few options for judgement according to your school of thought. Just visit the links and ask your doctor which he/she would consider the best alternative treatment for your specific case. In any case, rest assured that a future post will review how effective balance therapy can be, and also the promised post on the available natural anti-emetics. 

Vestibular Rehabilitation Exercises by the Brain And Spine Foundation ACCESS HERE.

Vestibular Rehabilitation Exercises by the Northern Lincolnshire and Goole NHS Foundation Trust ACCESS HERE.

Basic Vestibular Rehabilitation Exercises by Salisbury NHS Foundation Trust ACCESS HERE.

Disclaimer: All links were functional as of 17th of July 2019. However, these are pages maintained by third-parties so I have no responsibility whatsoever on their content and functionality.

Before I go and if you want to know more about vestibular neuronitis there is a very good NHS page where relevant patient information is tremendously well summarised [8].

[1] This Drastic Diet Change Helped Venus Williams Fight Her Autoimmune Condition, Health, [], last visited on the 17th of July 2019, last update on the 18th of March 2019.

[2] Ralli, M., D’Aguanno, V., Di Stadio, A. et al (2018). "Review Article: Audiovestibular Symptoms in Systemic Autoimmune Diseases". Journal of Immunology Research, 18(1), pp. 1-14.

[3] Healton, E. B., Savage, D. G., Brust, J. C. (1991). "Neurologic aspects of cobalamin deficiency". Europe PMC, 70(4), pp. 229-245.

[4] Jeong, S-H., Kim, J-S., Shin, J-W. et al (2013). "Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo". Journal of Neurology, 260(3), pp. 832–838.

[5] Talaat, H.S., Kabel, A-M. H., Khaliel, L. H. et al (2015). "Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency". Auris Nasus Larynx, 43(3), pp. 237-241.

[6] Esparza, C. M., K. Jáuregui‐Renaud, K., Morelos, C. M. C. et al (2007). "Systemic high blood pressure and inner ear dysfunction: a preliminary study". Clinical Otolaryngology, 32(3), pp. 173-178.

[7] McCabe, B. F. (1979). “Autoimmune sensorineural hearing loss”. The Annals of Otology, Rhinology, and Laryngology, 88 (5), pp. 585–589.

[8] Vestibular neuronitis, NHS, [], last visited on the 17th of July 2019, last update on the 23rd of June 2016.

Post image by Guilherme Stecanella from Unsplash.

Tuesday, 11 June 2019

A Dry Market With Plenty of Fertile Opportunities

In this modern day and time, where pharmaceutical innovation is in/extensively driven towards patient-centric approaches and broad range product promoting, it is almost impossible to find an overlooked yet fertile niche market. Nevertheless, there is still one out there that presents a wide array of opportunities for integrated research teams working synergistically with clinicians - Dry Eye Disease (DED) is still an area where patients are treated with conventional therapies delivering quite limited practical results. If we consider that 1 of 3 people over the age of 65 is diagnosed with dry eye disease [1], and that the population in the UK amounts to about 66 million people where 18% are over the age of 65, we can consider that approximately 11,880,000 patients in the UK alone are still waiting for the newest dry eye panacea. In addition, in the United States of America, dry eye disease currently affects 17% of the total population with 15 to 33% being over the age of 65 [2].

The numbers are out there to be savoured and analysed, and that is what the members of the TFOS DEWS Management Therapy Subcommittee have been doing with the publication of their Management and Therapy Report. This is a much focused insightful disease state publication emerging after their interactive workshops on DED and their expert conferences on Tear Film and Ocular Surface (TFOS). Their latest publication [3] inform us of how unaddressed, despite so many peculiar innovations and niche approaches, this medical issue is. Nevertheless, countless solutions are being developed, although overshadowed by a major limitation, i.e., no product has yet fully responded to the multiplicity of comorbidities DED revels on.

Products developed to tackle DED are usually linked to treatments for tear insufficiency, for lid abnormalities, anti-inflammatory therapies, surgical approaches and even dietary/environmental considerations. It still remains impossible to find one single product that is effectively producing the desired ‘holistic’ results. Over-the-counter tear replacement products with ocular lubricants are purely palliative, hence populating pharmacies out there without resolving the primary pathophysiology of DED. Use of punctal occlusion therapies developed to temporarily or permanently retain tears on the ocular surface by stalling their drainage, is controversial, as it is linked to promotion of inflammation by prolonging the retention of pro-inflammatory cytokines [4] [5]. Several tear stimulation pharmacologic agents are commercially available or still under pipeline development, but these only usually address stimulation of aqueous, mucin and/or lipid secretion whilst ignoring the underlying issues related to meibomian and lacrimal gland disorders.  Treatments for lid abnormalities have long existed and actually a simple lid hygiene routine can help avoid the occurrence of a variety of lid conditions that trigger DED (e.g., blepharitis – inflammation of the edges of the eyelids). In this case, no pharmaceutical product is as effective as lid scrubs soaked in a mild dilution of baby shampoo applied with  a cotton bud/swab to inhibit upsurge of associated lipolytic bacteria [6] [7] [8] [9]. And finally, anti-inflammatory products like topical glucocorticoids, known to be highly effective in halting immune response cycles, also live up to their infamous reputation of hypertension/cataracts/opportunistic infection developers, if used for a long time [10].

The miracle agent may unexpectedly reside in a coadjuvant biological matrix that has been recently applied to ocular surface disease. This matrix has been used as a contact lens-based device emerging from a birth discarded bioproduct, i.e., amniotic membrane. In fact, two specific products ‘threaten’ to become big names in the Ocular Surface industry (one from the USA and one from the UK) that for the sake of privacy will not be disclosed hereby. These products are delivering revolutionary results even in moderate cases of ocular surface chemical/thermal burns. The revolution is happening, and it is just a matter of time until the industry delivers the one product successfully responding to the multiple comorbidities associated to DED.

Post Photo by Andrew Santellan on Unsplash.

[1] Dry eye syndrome, National Institute for Health and Care Excellence, [!topicSummary], last visited on the 11th of June 2019, last update on August 2017.

[2] Dry Eye Syndrome PPP 2018, American Academy of Ophtalmology, [], last visited on the 11th of June 2019, last update on November 2018.

[3] Jones, L., Downie, L. E., Korb, D. et al. (2017). "TFOS DEWS II Management and Therapy Report". The Ocular Surface, 15(3), pp. 575-628.

[4] Wang, Y., Dogru, M., Matsumoto, Y., 2007). "The Impact of Nasal Conjunctivochalasis on Tear Functions and Ocular Surface Findings". American Journal of Ophthalmology, 144(6), pp. 930-937.

[5] Erdogan-Poyraz, C., Mocan, M. C., Bozkurt, B. et al (2009). "Elevated Tear Interleukin-6 and Interleukin-8 Levels in Patients With Conjunctivochalasis". Cornea, 28(2), pp. 189-193.

[6] McCulley, J., Dougherty, J. M., Deneau, D. G. (1982). "Classification of Chronic Blepharitis". Ophthalmology, 89(10), pp. 1173-1180.

[7] Geerling, G., Tauber, J., Baudoun, C. et al (2011). "The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction". IOVS, 52, pp. 2050-2064.

[8] Romero, J., Biser, S., Perry, H. et al (2004). "Conservative Treatment of Meibomian Gland Dysfunction". Eye & Contact Lens: Science & Clinical Practice, 30(1), pp. 14-19.

[9] Alghamdi, Y. A., Camp, A., Feuer, W., Karp, C. L. et al (2018). "Compliance and subjective patient responses to eyelid hygiene". Eye Contact Lens, 43(4), pp. 213217.

[10] Marsh, P. and Pflugfelder, C. (1999), "Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren syndrome". Ophthalmology, 106(4), pp. 811-816.

Thursday, 6 June 2019

Inflammation, Good or Bad?

By working in medical communications you are presented several different questions on a daily
basis. Some are accessible and straightforward, and some others are very high profile and demand further research. Nevertheless, even after these are answered, based on the many sources of information available in-house and spread out there through official sources, now and then remaining question marks still surface. I suspect that one universal question that always pester people's minds, be them the general public or highly proficient medical professionals is the importance and relevance of inflammation.  

If you think about it we were always told that it is important to tackle inflammation to avoid it progressing and end up in febrile events and other tricky associated scenarios. However, inflammation in its pure sense and in a non-chronic autoimmune patient is a natural and necessary immune response our bodies trigger to refrain an external agent from affecting us. And this is a good thing, right? So why do we jump on to taking antiphlogistics at the very first sign of inflammation? 

My personal take on inflammation in generally healthy people has always been the same as for fever, i.e., let your body control it until you conscientiously recognise your body is either not controlling it adequately or has triggered hyper-reactive control measures. I rarely take any antipiretics if I'm not around 38 Celsius. I always let the body challenge itself. Then when I recognise it's not going to go there on its own, the pharmaceutical is at hands' reach. This is me, please do not use it as clinical guidance. I am not a healthcare professional, I am a professional in medical communications/information and this is solely my personal view as an avid science researcher. For the sake of what is your health and safety follow the advice given to you by your healthcare professionals.

Obligatory disclaimer shared, the remaining question here is actually of a double nature:

1) Is inflammation good or bad?


2) When do we know we must tackle the inflammatory process?

I did some literature search on this topic and was able to find some interesting information that is hereby compiled for you.

What is Inflammation?

On its own inflammation is a protocol developed by higher organisms to tackle any foreign agent of developing an invasive strategy that can undermine the stability of the system. In that sense, we humans have developed internal and external barriers that account participation of many agents, from anti-inflammatory foods, to structures like skin, nasal hair, or even mucus.

Being part of the human organism's natural defensive pathways and protective paraphernalia, inflammation is a gradual response process to infection and tissue damage as one of the primary steps of the healing process. When we consider that for producing muscle mass at the gym we need to break the muscle tissue, thus allowing it to grow and then refill it with the new generated cells, the process that encompasses it is inflammation!  But on the other hand, and so well simplified by the website Science-Based Medicine [1], when aging brings about chronic inflammation, the result, among other detrimental losses and consequences, is the cellular damage that can chronically lead to several ailments like the well known atherosclerosis (where plaque composed of fat, cholesterol, calcium ad other molecules build up in the arteries narrowing them overtime) [2] leading to very serious issues like stroke, heart attack, eventually death. There is also the almost universal example of the autoimmune condition rheumatoid arthritis, where the immune system mostly attacks synovial joints, heart and lungs and that results in swelling, stiffness and pain with devastating consequences for the quality of life of the affected patients [3]. 

In what consists the Inflammatory process?

Is Inflammation Good or Bad?

To answer this questions we must visualise an aid motion picture where one is continuously exercising and breaking muscle, not allowing the same any time to heal. Or for example, imagining the immune system sending patrol cells to destroy invaders but prolonging the destruction to such lengths that it wouldn't be even possible to discern anymore who is evil from who is good. Another figurative example can be the use of the water in a swimming pool to put down a lighting match. Unnecessary, is it not?). Water all over the place when you could have done the same with a bit of a glass of water!

Constantly hitting one's cells with a protective army of patrol soldiers can become irritating for one's organism. That is exactly what happens with people when they eat particular foods they are sensitive too, be it lactose, honey, peanuts, you name it. If your body sends out those patrol cells in a normal approach you'd have a mild inflammation and allergic reaction (let's say). If your body is as nervous as Venezuela's Maduro or Turkey's Erdogan, your body would want to send five armies to seek for two little peanut buds and then end up beating up everything they found in the vicinity and further on. And that would progress to a senseless chronic beating up if you don't eventually tackle such unnecessary and unregulated defensive mechanisms with the common sense of an antiphlogistic tablet to refrain the body's immune system's rage.

Overall, inflammation plays a vital role when as a balanced natural response to a disruptive physical imbalance in one's injured organism. However, if one lets it overwork in its functions,  one'll suffer the consequences. And these can be devastating in chronic autoimmune or immunosuppressed patients.

For a list of anti-inflammatory natural products that you can use in your normal diet, please ACCESS HERE, HERE and HERE.

1. Inflammation: Both friend and foe, Science -Based Medicine, [], last visited on the 6th of June 2019, last update on the 27th of December 2011.

[2]. Atherosclerosis, National Heart, Blood and Lung Institute, [], last visited on the 6th of June 2019, last update unknown.

[3]. Diet and rheumatoid arthritis, The Association of UK Dietitians, [], last visited on the 6th of June 2019, last update on September 2018.

Post picture by Cristian Newman on Unsplash.

Wednesday, 1 May 2019

Interesting apps for the purpose of medical or scientific education

These past months have been extraordinarily complicated, work is pilling up, so are responsibilities, and my personal projects/hobbies have ALL had to be postponed to make ends meet. Nevertheless, I take this blog as an educational tool that actively works for myself and the readers who send me questions on different matters. My self-education is a matter that I take too seriously as this helps me on my personal evolution and my professional progression. Regardless of how employers see it, I will always thrive and take pride as being constantly seeking knowledge to support my professional awareness and for my own intellectual feeding up. I am sure this is what will always keep me up-to-date with new technologies, new approaches and new visions, as this world is in constant mutation and one MUST keep in tune with the new languages. 

Because online courses are often very expensive and lengthy, I recently took a different route. My approach is now quite straightforward and dynamic. To keep myself not only adequately informed , but also conscientious that I am using modern sources of information, I am nowadays resorting a lot to Android apps. I have found quite a few that are a disgrace, deserve no respect whatsoever and reflect how greedy the educational market has turned into. But some are quite impressive in terms of content, in terms of interfaces, in terms of language, in terms of simplicity and finally in terms of its educational acumen.

I'll try, now and then, to look into some of the applications that are out there from a user's perspective, and criticise it with keen eyes and day-to-day criticism. Today, I'll start this 'review exercise' with 3 apps that I recently came across with.

App: Medical Quiz (by Flaticon)
Content: Nine in-depth clinical topics, from general pathology to organ pathology, radiology lab diagnostics, biology anatomy, hygiene infectiology, neurology, nutritional science, pharmacology and ophthalmology.
Interface: Simple, sometimes resembling Visual Basic of the 90's, but its simplicity does not compromise the experience.
Language: You need to be experienced in medical science to understand most of the questions. Definitely not for the average aspiring curious, hence I Love It. Don't use it if you think 'Polysynaptic Reflexes' is a song by Muse!
Accessibility: Free of charge with little ads that can be easily ignored. But please, if someone went through the trouble of preparing this tool for your enjoyment, at least acknowledge them with a decent review or watch the ads now and then.
Educational value: Great for aspiring medical professionals, but could be extremely uninspiring and difficult for those who are looking for educational entertainment.
Play store ratings: 4.6, 39 reviews, 10K+ downloads.

App: Science Quiz (by Smart Quiz Apps)
Content: I am basically addicted to this game to the point where I must play it daily and try to beat my previous scores. Two types of game possible: Endless Mode and Time Mode with slightly different nervousness levels associated to the fact that for the former you have limited lives, but all the time in the world to answer the different questions, and for the latter you can make as many mistakes as you want but you have a defined time to deliver as many correct answers as you can. 
Interface: Colourful without being too infantile, simple but attractive. I like the fact that there's a blueish pallet square pattern that sets the background to an harmonious visual experience.
Language: General science knowledge that can sometimes be hard but never put you off! It is genuinely a great experience for learning as the questions are direct, meaning either you know it or not. The leader board is of easy understanding and the game rules couldn't be easier.
Accessibility: Free of charge but the number of ads that are attached to this gaming experience can drive you nuts. Now and then another and another and another add in between games and from the main panel will be a bit too much for those who are trying to genuinely enjoy the learning experience.
Educational value: Great for parties, great for when you are on your own, tremendously interesting information as science trivia, but nothing too fancy for professional development or the like.
Play store ratings: 4.3, 635 reviews, 50K+ downloads.

App: Nursing Exam Quiz Pharmacology Terms (by Speed Draw)
Content: I am by no means prepared to confidently state that the content of this course is in agreement with what nursing students do in fact learn at uni, so I'll blindly trust the developers in this case. However, I tried this app a number of times and I learned some stuff about they're degree (not so much on what I already knew about Pharmacology), nevertheless some of the answers provided as correct in the quiz I don't immediately agree with, so I'd take it with a pinch of salt.
Interface: Could it be more boring? Only if you could find a sloth singing the original lyrics of the Hallelujah poem by Leonard Cohen. Maroon, Brownish colors that can make your eyes tired very quickly are the immediate reason, but the lack of interactivity is also to blame.
Language: It is what it is... a quiz. A limited one where if you learn anything it's already fulfilling its educational value, but this app is not challenging nor promising.
Accessibility: Free of charge, a tiny rectangular add area on the bottom of the screen ? Not that bad, I'd say.
Educational value: Even for those who are to take a Pharmacology exam as part of their nursing degree, going through the same 25 or so questions over and over again will dismay any student. Nice first attempt but this app needs immediate developing if it is to survive a growing competition in the educational games/serious games industry. I don't think they had that initiative as it appears to me the developers were just trying to have a go at a alpha- beta- version for their own amusement.
Play store ratings: No reviews yet.

And that's it, next time I'll post a few more I am currently trying and if you have any requests or ideas for review on educational and serious digital games, please let me know!

Post Image - Photo by Rob Hampson on Unsplash

Wednesday, 10 April 2019

Did you know that...

March is over, April is almost half-way done, Mother's Day is long gone now, and maybe over Easter time we can skip some Netflix or Amazon Prime easy entertainment to get our eyes on some very interesting reads. It's never easy to find enough time, I totally understand, but if you love science you always take some minutes to educate yourself. I myself am afflicted by very limited time to check all the science news that emerge daily like a Spring-scented garden. But if from a list of say, 14 interesting links, you pick a single one to really lay your eyes on, you will be automatically more informed than the moment that preceded it.

One single article may provide you with the information that you've been craving concerning that health issue you are affected by, that trick to get rid of fat stains from your new carpet, that medical advance that might be relevant for someone you know, or even that charity that is doing some philanthropic work in an African country that you've always wanted to visit... Who knows?, let the flow of an interesting article entice and seduce you into knowing a bit more science. A learned information cannot be unlearned, it will stay with you forever and one day might be useful.

Find below a list of topics I personally believe are extremely interesting with potential to draw a smile on your face today, for knowledge is not only power, knowledge is also very sexy!


The 2018 Employee Engagement Report for the Life Sciences Industry is live. Access it to read the 18 pages distilling the relevant information on key motivations and differential, company type, Management and Non-Management, Demographics, Type of contracts and the interesting findings observed. A very interesting reading for anyone on the industry, be it employee, and especially employers.


The Pacific plastic vortex is being cleaned up by System 001, a gigantic net created by the startup Ocean Cleanup to collect floating plastic from oceanic waters (Portuguese Language only). 

If you would like to know more on the plastic island floating through the pacific vortex read the post published by The Toxicologist Today in 2011.


And if you're into diets, learn from specialists on how detrimental to one's health can it be the currently famous ketogenic diet (Portuguese language only).

And for those like myself, concerned with animal rights and the lack of options to wear, a great online shop I found for satiating your clothing desires.


A Universal flu vaccine is entering Phase 3 trial and intends to counteract known limitations of other vaccines against seasonal flu. BiondVax Pharmaceuticals apparently is leading the way towards a great prevention against the 8th leading cause of death that is costing America $87bn.

A new anti-malaria drug in the making; one that might actually be targeting the mosquito parasite at an early stage of life rather than focusing on the reduction of symptomatic impact. A good read with very promising results.


Lego! Your children love eating those colourful plastic bricks at all times. But now a group of paediatricians decided to determine typical transit times for a swallowed Lego figurine head, as a matter of example.

The role of MicroRNA in autoimmunity, with special focus on Sjogren's syndrome, is discussed in this interesting article.

An investigation on whether TNF-like weak inducer of apoptosis (TWEAK) plays a role in cerebral involvement in human systemic lupus erythematosus and primary Sjögren's syndrome with neuropsychiatric implications. 

Discover who is talking about your research by accessing this web page by Altmetric. They track a range of sources to capture and collate activity concerning your publications.

Some researchers are studying the role of the vagus nerve (one of the cranial nerves that has gastric, respiratory and cardiovascular implications in the human body) in fatigue and tiredness in Sjogren's syndrome patients. True or not, the judge is still out there.

If you would like to know more on how I overcame tiredness and fatigue related to my Sjogren's by applying the Wim Hof method, please access this post.

Researchers published pertinent cardiovascular/oncology information in the British Medical Journal concerning the increased risk of lung cancer for those patients taking blood pressure medication, namely ARB and ACEI products (Portuguese language only).

Post image kindly obtained from Motor24, [].