Wednesday 29 April 2020

Lemon, honey, and alcohol: Which is best for sore throat?

As sore throats are making the rounds through the Medical News Today editorial office, the debate is rife: what is the best drink to soothe the pain? More importantly, whether it’s alcohol, spices, or lemon and honey, what is the scientific basis for our home remedy of choice?
A few weeks ago, we found out that both hot and cold drinks or ice pops can help alleviate the pain of a sore throat that most of us will be familiar with during the annual cold and flu season.
Now, the debate has taken another turn: where do alcohol, spices — such as cinnamon and ginger — and lemon and honey fit into the mix?
To find out, I first conducted a scientific survey among the office staff to highlight our drinks-of-choice, followed by a deep dive into the scientific evidence underpinning our beliefs.
Among the MNT editorial office staff, a home-made hot drink with fresh lemon juice and honey was the most popular choice, with a staggering 62 percent citing it as one of their ‘go-to’ drinks, while hot lemon on its own took second place with 31 percent.
Our faith in lemon and honey stems from knowledge passed from generation to generation and reports in the media.
“Hot water with lemon and honey – I’m sure I’ve read it somewhere,” and “This is mostly based on family and friends recommending it, although reinforced by studies and things based on getting vitamin C from lemon, and the antibacterial/antimicrobial elements of honey,” are just two of the examples that my colleagues cited.
Lemon is popular in drinks because of its high levels of vitamin C. Interest in the use of vitamin C to treat the common cold goes all the way back to the 1940s, but results from the various clinical trials conducted since then varies.
While earlier studies reported that taking vitamin C reduced how long a cold would stick around, the current consensus is that for the general population, it is ineffective.
However, there are certain groups of individuals who may benefit from vitamin C when a cold is looming. These include people who undertake severe physical exercise, those exposed to cold environments, and those with vitamin C levels below the recommended levels.
But there is no evidence that it soothes a sore throat.
Honey is known for its antimicrobial properties. One study found that Manuka honey is effective in reducing how quickly the influenza virus — the cause of the flu — reproduces.
When it comes to pain, honey has been studied mostly in the context of tonsillectomy, and research has shown that honey is effective. Bingo.
Other studies have looked into the effectiveness of honey to reduce cough, associated with the common cold and flu. Here, several clinical trials have shown a small improvement in nighttime cough and sleep quality in children over the age of 1 year.
So, honey probably helps with the pain and the lemon may or may not help speed up recovery from our symptoms.

While lemon and honey was the clear winner in our race to beat a sore throat, alcoholic drinks took joint second place, with 31 percent of MNT editorial folk saying hot or cold alcoholic drinks soothe their sore throat.
The reasons for this ranged from “alcohol to ‘disinfect’ my throat,” to “alcohol is [an] anesthetic after all.”
While there is evidence that alcohol can kill the viruses responsible for the common cold and flu, this is really only the case for alcoholic hand gels and sanitizers or for lozenges that contain alcohol.
Alcohol does have anesthetic effects, but there is no scientific evidence of the benefits that we attribute to various alcoholic concoctions in calming our sore throat. It is purely speculation.
However, alcohol is a vasodilator. So, if you are feeling cold and achy due to a viral cold or flu infection, an alcoholic drink can bring a rosy tint to your cheeks and help you feel warm and fuzzy at the same time.
The final category in the office survey was spiced or mulled drinks.
Ginger was cited by 23 percent of my colleagues as an effective method to soothe a sore throat. Indeed, ginger has been shown to reduce pain.
In one study, researchers used computer modeling to find out if ginger could prevent influenza infection — particularly the H1N1 strain that causes swine flu. The team found that the active ingredient in ginger prevents the virus from infecting human cells.
The final throat-soother on our list is cinnamon, which was preferred by 8 percent of the office.
“This is based on trying it out and reading about the properties of cinnamon,” was one of the reasons for choosing this popular spice.
According to one study, a component found in the essential oil contained in cinnamon inhibited the growth of the influenza A virus in vitro and in vivo. But there are no specific studies looking at cinnamon and sore throat.
The MNT office is, of course, too small to give us a real snapshot of the general population. But we are not far off some of the findings of a large study published in 2016.
According to the research, 99 percent of people use some form of home remedy when they experience the trials and tribulations that come with the common cold.
Similar to the results of our office survey, honey was a clear favorite on the list, which 42 percent of participants looked to for relief.
While it’s important to remember that the scientific basis for all of the home remedies preferred by the MNT office staff is fairly slim, hot drinks of any kind of description have been shown to have the best effect on sore throats.
As Prof. Ron Eccles — previously the director of the Common Cold Centre in the School of Biosciences at the University of Cardiff in the United Kingdom — explained to me, hot drinks — especially hot, sweet drinks — help to lubricate a sore throat and soothe the pain.
Source: MedicalNews Today

Monday 27 April 2020

What to know about cancer

Cancer causes cells to divide uncontrollably. This can result in tumors, damage to the immune system, and other impairment that can be fatal.
In the United States, an estimated 15.5 million people with a history of cancer were living as of January 1, 2016, according to a 2018 report from the American Cancer Society.
In this article, we examine types of cancer, how the disease develops, and the many treatments that help improve the quality of life and survival rates.
What is cancer?
Cancer is a broad term. It describes the disease that results when cellular changes cause the uncontrolled growth and division of cells.
Some types of cancer cause rapid cell growth, while others cause cells to grow and divide at a slower rate.
Certain forms of cancer result in visible growths called tumors, while others, such as leukemia, do not.
Most of the body’s cells have specific functions and fixed lifespans. While it may sound like a bad thing, cell death is part of a natural and beneficial phenomenon called apoptosis.
A cell receives instructions to die so that the body can replace it with a newer cell that functions better. Cancerous cells lack the components that instruct them to stop dividing and to die.
As a result, they build up in the body, using oxygen and nutrients that would usually nourish other cells. Cancerous cells can form tumors, impair the immune system and cause other changes that prevent the body from functioning regularly.
Cancerous cells may appear in one area, then spread via the lymph nodes. These are clusters of immune cells located throughout the body.
There are many causes of cancer, and some are preventable.
For example, over 480,000 people die in the U.S. each year from smoking cigarettes, according to data reported in 2014.
In addition to smoking, risk factors for cancer include:
Other causes of cancer are not preventable. Currently, the most significant unpreventable risk factor is age. According to the American Cancer Society, doctors in the U.S. diagnose 87 percent of cancer cases in people ages 50 years or older.
Is cancer genetic?
Genetic factors can contribute to the development of cancer.
A person’s genetic code tells their cells when to divide and expire. Changes in the genes can lead to faulty instructions, and cancer can result.
Genes also influence the cells’ production of proteins, and proteins carry many of the instructions for cellular growth and division.
Some genes change proteins that would usually repair damaged cells. This can lead to cancer. If a parent has these genes, they may pass on the altered instructions to their offspring.
Some genetic changes occur after birth, and factors such as smoking and sun exposure can increase the risk.
Other changes that can result in cancer take place in the chemical signals that determine how the body deploys, or “expresses” specific genes.
Finally, a person can inherit a predisposition for a type of cancer. A doctor may refer to this as having a hereditary cancer syndrome. Inherited genetic mutations significantly contribute to the development of 5–10 percent of cancer cases.
Innovative research has fueled the development of new medications and treatment technologies.
Doctors usually prescribe treatments based on the type of cancer, its stage at diagnosis, and the person’s overall health.
Below are examples of approaches to cancer treatment:
  • Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing cells. The drugs can also help shrink tumors, but the side effects can be severe.
  • Hormone therapy involves taking medications that change how certain hormones work or interfere with the body’s ability to produce them. When hormones play a significant role, as with prostate and breast cancers, this is a common approach.
  • Immunotherapy uses medications and other treatments to boost the immune system and encourage it to fight cancerous cells. Two examples of these treatments are checkpoint inhibitors and adoptive cell transfer.
  • Precision medicine, or personalized medicine, is a newer, developing approach. It involves using genetic testing to determine the best treatments for a person’s particular presentation of cancer. Researchers have yet to show that it can effectively treat all types of cancer, however.
  • Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a doctor may recommend using radiation to shrink a tumor before surgery or reduce tumor-related symptoms.
  • Stem cell transplant can be especially beneficial for people with blood-related cancers, such as leukemia or lymphoma. It involves removing cells, such as red or white blood cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen the cells and put them back into the body.
  • Surgery is often a part of a treatment plan when a person has a cancerous tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the disease’s spread.
  • Targeted therapies perform functions within cancerous cells to prevent them from multiplying.      They can also boost the immune system. Two examples of these therapies are small-molecule drugs and monoclonal antibodies.
Doctors will often employ more than one type of treatment to maximize effectiveness.
The most common type of cancer in the U.S. is breast cancer, followed by lung and prostate cancers, according to the National Cancer Institute, which excluded nonmelanoma skin cancers from these findings.
Each year, more than 40,000 people in the country receive a diagnosis of one of the following types of cancer:
  • bladder
  • colon and rectal
  • endometrial
  • kidney
  • leukemia
  • liver
  • melanoma
  • non-Hodgkin’s lymphoma
  • pancreatic
  • thyroid
Other forms are less common. According to the National Cancer Institute, there are over 100 types of cancer.
Cancer development and cell division
Doctors classify cancer by:
  • its location in the body
  • the tissues that it forms in
For example, sarcomas develop in bones or soft tissues, while carcinomas form in cells that cover internal or external surfaces in the body. Basal cell carcinomas develop in the skin, while adenocarcinomas can form in the breast.
When cancerous cells spread to other parts of the body, the medical term for this is metastasis.
A person can also have more than one type of cancer at a time.
Improvements in cancer detection, increased awareness of the risks of smoking, and a drop in tobacco use have all contributed to a year-on-year decrease in the number of cancer diagnoses and deaths.
According to the American Cancer Society, the overall cancer death rate declined by 26 percent between 1991 and 2015.
When a person has cancer, the outlook will depend on whether the disease has spread and on its type, severity, and location.
Cancer causes cells to divide uncontrollably. It also prevents them from dying at the natural point in their life cycle.
Genetic factors and lifestyle choices, such as smoking, can contribute to the development of the disease. Several elements affect the ways that DNA communicates with cells and directs their division and death.
After nonmelanoma skin cancer, breast cancer is the most common type in the U.S. However, lung cancer is the leading cause of cancer-related death.
Treatments are constantly improving. Examples of current methods include chemotherapy, radiation therapy, and surgery. Some people benefit from newer options, such as stem cell transplantation and precision medicine.
The diagnosis and death rates of cancer are dropping yearly.
Q:           How do I recognize cancer before it starts to cause serious health problems?
A:            Some cancers cause early symptoms, but others do not exhibit symptoms until they are more advanced. Many of these symptoms are often from causes unrelated to cancer.
The best way to identify cancer early is to report any unusual, persistent symptoms to your doctor so they can advise you on any further testing that may be needed.

Yamini Ranchod, PhD, MS

Source: MedicalNews Today

Novel coronavirus: Your questions, answered

SARS-CoV-2 is a coronavirus that causes coronavirus disease 2019 (COVID-19). Coronaviruses are a family of viruses that target and affect mammals’ respiratory systems. According to their specific characteristics, there are four main ranks, or genera, of coronavirus: alpha, beta, delta, and gamma.
Most of these only affect animals, but a few can also pass to humans. Those that are transmissible to humans belong to only two of these genera: alpha and beta.
Only two coronaviruses have previously caused global outbreaks. The first of these was the SARS coronavirus — responsible for severe acute respiratory syndrome (SARS) — which first started spreading back in 2002, also in China. The SARS virus epidemic primarily affected the populations of mainland China and Hong Kong, and it died off in 2003.
The other one was the MERS coronavirus — responsible for Middle East respiratory syndrome (MERS) — which emerged in Saudi Arabia in 2012. This virus has affected at least 2,494 people since then.

When humans do contract a coronavirus, it typically happens due to contact with an infected animal.
Some of the most common carriers are bats, though they do not typically transmit coronaviruses directly to humans. Instead, the transmission might occur via an intermediary animal, which will usually — though not always — be a domestic one.
The SARS coronavirus spread to humans via civet cats, while the MERS virus spread via dromedaries. However, it can be difficult to determine the animal from which a coronavirus infection first starts spreading.
In the case of the new coronavirus, initial reports from China tied the outbreak to a seafood market in central Wuhan. As a result, local authorities closed down the market on January 1, 2020.
However, later assessments have suggested that this market was unlikely to be the single source of the coronavirus outbreak, as some of the people with the virus had not been frequenting it.
Specialists have not yet been able to determine the true source of the virus or even confirm if there was a single original reservoir.

Although it likely originated in animals, the virus does transmit from person to person. However, some questions about its transmission remain unanswered.
According to WHO spokespeople, “Researchers are still studying the exact parameters of human-to-human transmission.”
“In Wuhan at the beginning of the outbreak, some people became ill from exposure to a source, most likely an animal, carrying the disease. This has been followed by transmission between people,” they explained.
In a press briefing from February 6, 2020, WHO consultant Dr. Maria Van Kerkhove said that, for now, “[w]e do know that mild individuals shed virus, we know that severe individuals shed virus. […] We know that the more symptoms you have, the more likely you are to transmit.”
The WHO also state that “[t]he risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. […] It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill.”
In an interview for the JAMA Network broadcast on February 6, 2020, Dr. Anthony Fauci — the director of the National Institute of Allergy and Infectious Diseases — said that based on data they have received from Chinese specialists, the new coronavirus’s “incubation period is probably between 5 and 6 — maybe closer to 5 — days.
That is, the virus likely takes about 5–6 days to cause symptoms once it has infected a person.
Although the WHO say that experts estimate that the new virus’s incubation period may last anywhere between 1 and 14 days, they suggest that the most likely duration is about 5 days.
The CDC recommend that all people wear cloth face masks in public places where it is difficult to maintain a 6-foot (2-meter) distance from others. This will help slow the spread of the virus from asymptomatic people and people who do not know that they have contracted it. People should wear cloth face masks while continuing to practice physical distancing. Instructions for making masks at home are available here. Note: It is critical that surgical masks and N95 respirators are reserved for healthcare workers.

Researchers from Chinese institutions were able to use state-of-the-art genome sequencing tools to identify the DNA structure of the novel coronavirus.
It has emerged that SARS-CoV-2 is most similar to two bat coronaviruses: bat-SL-CoVZC45 and bat-SL-CoVZXC21. Its genomic sequence is 88% the same as theirs.
The same study shows that the new virus’s DNA is about 79% the same as that of the SARS coronavirus and approximately 50% like that of the MERS virus.
Recently, a study by researchers in China suggested that pangolins may have been the initial propagators of SARS-CoV-2, as its genomic sequence appears to be 99% like that of a coronavirus specific to these animals.
Since then, however, other specialists have cast doubts over this idea, citing inconclusive evidence.

Like other coronaviruses, the novel coronavirus causes respiratory disease, and the symptoms affect a person’s respiratory health.
According to the Centers for Disease Control and Prevention (CDC), the main symptoms of COVID-19 are a fever, a cough, and shortness of breath.
“Current information suggests that the virus can cause mild, flu-like symptoms, as well as more severe disease. Most [people] seem to have mild disease, and about 20% appear to progress to more severe disease, including pneumonia, respiratory failure, and, in some cases, death,” WHO spokespeople told MNT.
In their press briefing from February 27, 2020, WHO officials also pointed out that a runny nose is not usually a symptom of COVID-19.

The WHO officially changed their classification of COVID-19 from a public health emergency of international concern to a pandemic on March 11, 2020.
In a declaration, WHO’s director general, Dr. Tedros Adhanom Ghebreyesus, stated that:
“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.
We have therefore made the assessment that COVID-19 can be characterized as a pandemic.
Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.
Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
The global implications have been severe. Many countries have closed schools and are recommending that people work from home when they can. Some countries have completely locked down their international borders and are discouraging travel unless it is deemed essential.
In the U.S., the White House is advising that people avoid social gatherings of more than 10 people, while individual states have introduced their own measures to try to deal with the situation.
Many questions also remain about how SARS-CoV-2 compares with other viruses in terms of its rates of infection and mortality.
In response to questions about this, WHO spokespeople told MNT that “[t]his is a new disease, and our understanding is changing rapidly. We will continue to analyze information on both current and any new cases.”
“We don’t yet know many details about the mortality rate from SARS-CoV-2, and studies are ongoing now. With MERS, we know that approximately 35% of reported patients with [MERS coronavirus] infection have died. For SARS, WHO estimated that the case fatality ratio of SARS ranges from 0% to 50% depending on the age group affected, with an overall estimate of case fatality of 14% to 15%.”
According to recent assessments, SARS-CoV-2 seems to be more infectious than other coronaviruses — such as those that cause SARS and MERS — but less likely to lead to death.
Some estimates suggest that the death rate of the new coronavirus is in the range of 2–3%, but there are no official numbers in this regard, as it is hard to tell how the outbreak will develop.
The WHO report that the two groups most at risk of experiencing severe illness due to a SARS-CoV-2 infection are older adults and individuals who have other health conditions that compromise their immune system.
The report also notes that “[t]he risk of severe disease gradually increases with age starting from around 40 years.”
Other reports note that very few children have contracted the new coronavirus. However, a recent preliminary study — not yet peer reviewed or published in a journal — claims that children face the same risk of infection as adults, and the CDC reinforce this.
Among adults, some reports suggest that males might be more at risk than females, though neither the WHO nor the CDC include being male as a risk factor.
Although there are currently no published scientific reports about the susceptibility of pregnant women, the CDC note that:
“Pregnant [women] have had a higher risk of severe illness when infected with viruses from the same family as COVID-19 and other viral respiratory infections.”
The CDC also recommend that infants born to mothers with suspected or confirmed COVID-19 go into isolation.
Mother-to-child transmission is unlikely during pregnancy. A very small number of babies have tested positive for the virus, but it is not clear whether they contracted the virus before or after birth.
The WHO report that pregnant women with COVID-19 symptoms should receive priority access to diagnostic tests.

Official WHO prevention guidelines suggest that in order to avoid contracting coronavirus, people should apply the same best practices for personal hygiene that they would to keep any other virus at bay.
The CDC recommend maintaining a distance of 6 feet (2 meters) from other people.
According to WHO spokespeople:
“Standard recommendations to prevent infection spread include regular hand-washing, covering [the] mouth and nose when coughing and sneezing, [and] thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness, such as coughing and sneezing.”
As for wearing protective masks, the CDC recommend that everyone wear a cloth face covering when out in public, such as when going to the grocery store. This is to slow the spread of the virus and prevent people who do not know that they have the virus from transmitting it.
Face coverings should cover the nose and mouth and be very secure. They should include multiple layers of fabric and allow unrestricted breathing. When removing the covering, be careful not to touch the eyes, nose, or mouth. Wash the hands immediately after removing it.
When using a cloth face covering, people should wash them regularly in the washing machine.
People can find out how to make face coverings at home here.

There are currently no targeted, specialized treatments for COVID-19. When doctors detect a SARS-CoV-2 infection, they aim to treat the symptoms as they arise.
As Dr. Van Kerkhove explained: “Because this is a new virus, we don’t have specific treatments for that virus. But because this virus causes respiratory disease, those symptoms are treated.
“Antibiotics won’t work against a virus,” she added.

Dr. Van Kerkhove also noted that “there are treatments that are in development” for the new coronavirus. Over the years, she said, “many treatments [have been] looked at to treat other coronaviruses, like the MERS coronavirus.”
“And hopefully, those treatments can [also] be useful for the novel coronavirus,” she continued.
Clinical trials are under way to find a treatment and a vaccine against the MERS coronavirus, which, if successful, could lay the groundwork for a SARS-CoV-2 vaccine and COVID-19 treatment.
Scientists are currently investigating the drug remdesivir against SARS-CoV-2. This is an intravenous drug with broad antiviral abilities. Research has shown some potential against SARS-CoV-2 and other coronaviruses.
They are also investigating hydroxychloroquine and chloroquine, which are prescription drugs for treating malaria and some inflammatory conditions. Researchers are looking at their ability to both prevent and treat COVID-19.
Other drugs, including antiretroviral drugs for treating HIV, are also under investigation.
Another potentially promising avenue is using baricitinib, an arthritis drug, against the new coronavirus. The researchers who came up with this idea explain that it is likely that SARS-CoV-2 can infect the lungs by interacting with specific receptors present on the surface of some lung cells.
However, such receptors are also present on some cells in the kidneys, blood vessels, and heart. Baricitinib, the researchers say, may be able to disrupt the interaction between the virus and these key receptors. However, whether or not it will really be effective remains to be seen.
In a press briefing from February 5, 2020, WHO officials explained investigators’ preference for experimenting with existing drugs.
Such drugs, they said, have already gained official approval for use against other specifications, meaning that they are largely safe. As a result, they need not go through the extensive series of preclinical and clinical trials that new drugs require, which can take a very long time.