Botox injections may reduce depression, study finds

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People who received Botox (botulinum toxin) injections for certain conditions reported less depression less often compared to patients who did not receive the injections for similar diagnoses, according to a study published Thursday in the journal Scientific Reports.

“For years, clinicians have observed that Botox injected for cosmetic reasons seems to ease depression for their patients,” said Ruben Abagyan, Ph.D., professor of pharmacy and one of the lead researchers of the study, in a statement.

“It’s been thought that easing severe frown lines in the forehead region disrupts a feedback loop that reinforces negative emotions. But we’ve found here that the mechanism may be more complex because it doesn’t really matter where the Botox is injected," the author stated in a news release.

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The research team at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego combed through the U.S. Food and Drug Administration (FDA)’s Adverse Effect Reporting System (FAERS) database to see the side effects reported by nearly 40,000 people who received Botox injections for various reasons, according to a news release by the university.

The treatments were not just in the forehead but included several different sites, including the neck, limbs and forehead. The release stated the researchers used an algorithm to find significant statistical differences between patients who used Botox and those who did not for the same issue.

The treatments were not just in the forehead but included several different sites, including the neck, limbs, and forehead. (iStock)

The researchers found depression was reported 40 to 88 percent less often by Botox users for six of the eight conditions and injection sites, according to the release.

“This finding is exciting because it supports a new treatment to affect mood and fight depression, one of the common and dangerous mental illnesses — and it’s based on a very large body of statistical data, rather than limited-scale observations,” Tigran Makunts, PharmD, one of the researchers in the study, stated in the release.

More research is needed to determine how Botox potentially acts as an antidepressant, according to the study. The researchers have a few theories that need further investigation. For instance, Botox being absorbed systemically to the central nervous system, which is involved in mood or emotions, they hypothesized, or possibly Botox indirectly affecting a person’s depression because the Botox helped relieve an underlying chronic condition that may have been a contributing factor to the patient’s depression.

Health experts say Botox is commonly used not only for cosmetic reasons, such as combatting wrinkles but also for muscle spasms, tight muscles, migraines, temporomandibular joint dysfunction, as well as other conditions including excessive sweating and bladder conditions.

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The FAERS data used in this study was not exclusively gathered for the purpose of investigating the link between Botox and depression, according to the news release.  The data represents only a subgroup of Botox users who reported experiencing negative side effects. The authors note they excluded data from patients who were taking antidepressants; however, in some of the cases, the use of medications could have been underreported.

The release stated there is a clinical trial underway that is directly investigating Botox treatment for people with depression, but it is only testing forehead injection sites,. The authors said additional clinical trials are necessary to investigate which site is best to specifically inject to treat depression.

According to the World Health Organization, an estimated more than 264 million people worldwide experience depression.

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Sperm don’t swim anything like we thought they did, new study finds

Under a microscope, human sperm seem to swim like wiggling eels, tails gyrating to and fro as they seek an egg to fertilize. 

But now, new 3D microscopy and high-speed video reveal that sperm don’t swim in this simple, symmetrical motion at all. Instead, they move with a rollicking spin that compensates for the fact that their tails actually beat only to one side. 

“It’s almost like if you’re a swimmer, but you could only wiggle your leg to one side,” said study author Hermes Gadêlha, a mathematician at the University of Bristol in the U.K. “If you did this in a swimming pool and you only did this to one side, you would always swim in circles. … Nature in its wisdom came [up] with a very complex, ingenious way to go forward.” 

Strange swimmers

The first person to observe human sperm close up was Antonie van Leeuwenhoek, a Dutch scientist known as the father of microbiology. In 1677, van Leeuwenhoek turned his newly developed microscope toward his own semen, seeing for the first time that the fluid was filled with tiny, wiggling cells. 

Under a 2D microscope, it was clear that the sperm were propelled by tails, which seemed to wiggle side-to-side as the sperm head rotated. For the next 343 years, this was the understanding of how human sperm moved. 

“[M]any scientists have postulated that there is likely to be a very important 3D element to how the sperm tail moves, but to date we have not had the technology to reliably make such measurements,” said Allan Pacey, a professor of andrology at the University of Sheffield in England, who was not involved in the research. 

The new research is thus a “significant step forward,” Pacey wrote in an email to Live Science. 

Gadêlha and his colleagues at the Universidad Nacional Autónoma de México started the research out of “blue-sky exploration,” Gadêlha said. Using microscopy techniques that allow for imaging in three dimensions and a high-speed camera that can capture 55,000 frames per second, they recorded human sperm swimming on a microscope slide. 

“What we found was something utterly surprising, because it completely broke with our belief system,” Gadêlha told Live Science. 

The sperm tails weren’t wiggling, whip-like, side-to-side. Instead, they could only beat in one direction. In order to wring forward motion out of this asymmetrical tail movement, the sperm head rotated with a jittery motion at the same time that the tail rotated.The head rotation and the tail are actually two separate movements controlled by two different cellular mechanisms, Gadêlha said. But when they combine, the result is something like a spinning otter or a rotating drill bit. Over the course of a 360-degree rotation, the one-side tail movement evens out, adding up to forward propulsion.

“The sperm is not even swimming, the sperm is drilling into the fluid,” Gadêlha said. 

The researchers published their findings today (July 31) in the journal Science Advances.

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Asymmetry and fertility

In technical terms, how the sperm moves is called precession, meaning it rotates around an axis, but that axis of rotation is changing. The planets do this in their rotational journeys around the sun, but a more familiar example might be a spinning top, which wobbles and dances about the floor as it rotates on its tip. 

“It’s important to note that on their journey to the egg that sperm will swim through a much more complex environment than the drop of fluid in which they were observed for this study,” Pacey said. “In the woman’s body, they will have to swim in narrow channels of very sticky fluid in the cervix, walls of undulating cells in the fallopian tubes, as well have to cope with muscular contractions and fluid being pushed along (by the wafting tops of cells called cilia) in the opposite direction to where they want to go. However, if they are indeed able to drill their way forward, I can now see in much better clarity how sperm might cope with this assault course in order to reach the egg and be able to get inside it,” Pacey said

Sperm motility, or ability to move, is one of the key metrics fertility doctors look at when assessing male fertility, Gadêlha said. The rolling of the sperm’s head isn’t currently considered in any of these metrics, but it’s possible that further study could reveal certain defects that disrupt this rotation, and thus stymy the sperm’s movement. 

Fertility clinics use 2D microscopy, and more work is needed to find out if 3D microscopy could benefit their analysis, Pacey said. 

“Certainly, any 3D approach would have to be quick, cheap and automated to have any clinical value,” he said. “But regardless of this, this paper is certainly a step in the right direction.”

Originally published in Live Science.

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UK modelling study finds case isolation and contact tracing vital to COVID-19 epidemic control

In the absence of a vaccine or highly effective treatments for COVID-19, combining isolation and intensive contact tracing with physical distancing measures—such as limits on daily social or workplace contacts—might be the most effective and efficient way to achieve and maintain epidemic control, according to new modelling research published in The Lancet Infectious Diseases journal.

Using social-contact data on more than 40,000 individuals from the BBC Pandemic database to simulate SARS-CoV-2 transmission in different settings and under different combinations of control measures, the researchers estimate that a high incidence of COVID-19 would require a considerable number of individuals to be quarantined to control infection. For example, a scenario in which 5,000 new symptomatic cases were diagnosed each day would likely require 150,000-200,000 contacts to be quarantined every day if no physical distancing was in place.

The study is the first time researchers have used social contact data to quantify the potential impact of control measures on reducing individual-level transmission of SARS-CoV-2 in specific settings. They aimed to identify not only what would theoretically control transmission, but what the practical implications of these measures would be in terms of numbers quarantined.

However, the authors note that the model is based on a series of assumptions about the effectiveness of testing, tracing, isolation, and quarantine—for example about the amount of time it takes to isolate cases with symptoms (average 2.6 days) and the likelihood that their contacts adhere to quarantine (90%)—which, although plausible, are optimistic.

“Our findings reinforce the growing body of evidence which suggests that we can’t rely on one single public health measure to achieve epidemic control”, says Dr. Adam Kucharski from the London School of Hygiene & Tropical Medicine, UK. “Successful strategies will likely include intensive testing and contact tracing supplemented with moderate forms of physical distancing, such as limiting the size of social gatherings and remote working, which can both reduce transmission and the number of contacts that need to be traced.”

He adds: “The huge scale of testing and contact tracing that is needed to reduce COVID-19 from spreading is resource intensive, and new app-based tracing, if adopted widely alongside traditional contact tracing, could enhance the effectiveness of identifying contacts, particularly those that would otherwise be missed.”

In the study, researchers analysed data on how 40,162 people moved about the UK and interacted with others prior to COVID-19 to simulate how combinations of different testing, isolation, tracing, and physical distancing scenarios—such as app-based tracing, remote working, limits on different sized gatherings, and mass population-based testing—might contribute to reducing secondary cases. They also modelled the rate at which the virus is transmitted—known as the reproductive number (R), or the average number of people each individual with the virus is likely to infect at a given moment—under different strategies. To keep the COVID-19 epidemic declining, R needs to be less than 1.

In the model, the secondary attack rate (the probability that a close contact of a confirmed case will be infected) was assumed to be 20% among household contacts and 6% among other contacts. The researchers calculated that, had no control measures been implemented, R would be 2.6—meaning that one infected person would infect, on average, 2-3 more people.

The model suggested that mass testing alone, with 5% of the population undergoing random testing each week (i.e. 460,000 tests per day in UK), would lower R to just 2.5, because so many infections would either be missed or detected too late.

Compared with no control measures, self-isolation of symptomatic cases (at home) alone reduced transmission by an estimated 29% (lowering R to 1.8); whilst combining self-isolation, household quarantine, and tracing strategies could potentially lower transmission by as much as 47% (R 1.4) when using app-based contact tracing (assuming the app is adopted by 53% of the population), and by 64% with manual tracing of all contacts (R 0.94).

Achieving such a thorough level of contact tracing may be impractical, but the new study suggests that a large reduction in transmission could also be achieved by supplementing with moderate physical distancing measures. For example, they estimate that, limiting daily contacts outside home, school, and work to four people (e.g. by restricting mass gatherings) along with manual tracing of acquaintances only (i.e. people they have met before) and app-based tracing, would have the greatest impact, reducing disease spread by 66%, and lowering R to 0.87. However, they note that the effectiveness of manual contact tracing strategies is highly dependent on how many contacts are successfully traced, with a high level of tracing required to ensure R is lower than 1, especially if it takes time to isolate symptomatic cases.

The researchers also modelled the number of contacts that might need to be quarantined under different contact tracing strategies. They estimate that a scenario in which 1,000 new symptomatic cases were reported daily would likely require a minimum of 15,000 contacts quarantined every day (isolation plus app-based testing) and a maximum of 41,000 (isolation plus manual tracing all contacts). This could increase to an average of 150,000-200,000 contacts quarantined daily in a scenario where 5,000 new symptomatic cases were diagnosed each day.

“Our results highlight several characteristics of SARS-CoV-2 which make effective isolation and contact tracing challenging. The high rate of transmission, the short time between one person becoming infected and infecting another, and transmission that occurs without symptoms all make things difficult”, says co-author Dr. Hannah Fry from University College London, UK. “If there are a lot of symptomatic COVID-19 cases, then tracing, testing, and trying to quarantine a huge number of contacts will be a big challenge. How well we manage it will affect how and when it is possible to reduce transmission predominantly through targeted isolation and tracing measures or whether ongoing physical distancing measures will be required to control the epidemic.”

According to co-author Professor Julia Gog from the University of Cambridge, UK, “Planning for control based on isolation and contact tracing should consider the likely need for large numbers of cases to be tested and also a large number contacts rapidly quarantined. Crucially, this work is able to quantify the scales of what is needed for a successful control strategy involving tracing and isolation by making use of the dataset from the BBC pandemic project. The BBC data gives a uniquely detailed picture of how people in the UK mix and thus the extent of contact tracing necessary if we return to social mixing patterns as they were before the pandemic.”

The authors highlight several limitations to their study, including that it did not consider more detailed settings beyond home, school, work, or ‘other’ categories, or explicitly include imported infections, which may be detected at a different rate to local infections.

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New York City had 24,000 'excess deaths', CDC report finds

Coronavirus blamed for 75% of New York City’s 24,000 ‘excess deaths’ as fatalities tripled the usual rate at the height of the outbreak, CDC report finds

  • Between March 11 and May 2, a total of 32,107 deaths were reported in New York
  • Researchers found that 24,172 were ‘excess’, three times the typical number of 7,935 usually reported during this time
  • The excess deaths included about 14,000 confirmed COVID-19 deaths and 5,048 probable COVID-19 deaths
  • The CDC says the high number of excess deaths may be linked to people with pre-existing conditions or those who waited to seek life-saving medical care
  • Here’s how to help people impacted by Covid-19

The number of people who died in New York City during the height of the coronavirus pandemic is more than triple what would be expected in a normal year, a new report finds.   

Between March 11 and May 2, there were more than 24,000 ‘excess deaths’, compared to years prior, researchers from the Centers for Disease Control and Prevention (CDC) revealed on Monday. 

That means, in a typical year, there are about 8,000 deaths during the same period.

More than three-quarters of those deaths were associated with COVID-19, the highly-infectious disease caused by the virus.  

Between March 11 and May 2, a total of 32,107 deaths were reported in New York and 24,000 were found to be ‘excess,’ a new CDC report reveals (pictured)

The excess deaths included about 14,000 confirmed COVID-19 deaths and 5,048 probable COVID-19 deaths.Pictured: Ventilator tubes attached to a coronavirus patient in the ICU of the Veterans Affairs Medical Center in New  York, NY, April 24

The CDC says the high number of excess deaths may be linked to people with pre-existing conditions or those who waited to seek life-saving medical care. Pictured: A COVID-19 patient, in a medically induced coma, is connected to life-sustaining devices at Mount Sinai South Nassau Hospital in Oceanside, NY, April 14

Excess deaths are defined as over and above the number of people that would have died anyway – the typical mortality rate of a population.  

For the report, the researchers looked at mortality data from January 1, 2015 through May 2, 2020. 

Next, the team calculated the difference between the seasonal number of expected deaths and the number of all deaths.

A total of 32,107 deaths were reported to New York Department of Health and Mental Hygiene over the study period. 

Of that number, 24,172 were found to ‘excess’, three times the typical number of 7,935 that usually occur during the two-month window.  

The excess deaths included nearly 14,000 laboratory-confirmed COVID-19-associated deaths and 5,048 probable COVID-19–associated deaths. 

According to the CDC, the high number of excess deaths might be due to the added risk of coronavirus in people with pre-existing conditions, such as diabetes.

Additionally, the researchers say that due to social distancing measures and the increasing demand place on hospitals, people may have delayed seeking life-saving medical care. 

The 5,000 deaths not linked to the virus are likely from other pathogens circulating during the 2019-20 flu season. 

‘Tracking excess mortality is important to understanding the contribution to the death rate from both COVID-19 disease and the lack of availability of care for non-COVID conditions,’ the authors concluded. 

The report comes on the heels of a joint investigation by Yale University and The Washington Post, which found there were 15,400 ‘excess deaths’ that occurred between March 1 and April 4. 

According the study, pre-printed on medRxiv.org, there were 280,016 total deaths  over the five-week period.

Of those, 15,400 were deemed excess deaths due to pneumonia and influenza.

The researchers say the preliminary findings suggest many more Americans may have died of coronavirus than previously believed.  

In the US, there are currently more than 1.3 million confirmed cases of the virus and more than 80,000 deaths. 

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Laws that punish pregnant drug abusers aren’t working, new study finds

A new study co-authored by a University of Central Florida researcher shows that laws that punish substance use during pregnancy actually do more harm than good.

These unintended consequences include keeping women from getting the treatment they need and failing to reduce the number of babies addicted to drugs.

The study, which was published Monday in the journal Health Affairs, compared the effects of punitive polices in states that implemented them and those that didn’t.

The findings are increasingly important as instances of opioid use disorder at delivery continue to rise.

“Opioid use during pregnancy can harm both the mother and baby, and rates of opioid use disorder at delivery increased over 300 percent between 1999 and 2014,” said Danielle Atkins, an assistant professor in UCF’s College of Community Innovation and Education and study co-author.

“States have taken various approaches to address prenatal substance use, including policies that consider prenatal substance use as equivalent to child abuse or neglect,” Atkins said. “In our study, we did not find evidence that having a punitive prenatal-substance-use policy reduced rates of babies born with withdrawal symptoms or maternal narcotic exposure at birth.”

“We found evidence, however, that punitive policies reduce substance use treatment admissions among pregnant women and that a smaller share of pregnant women are referred to treatment by health care providers in states with punitive policies,” she said.

For the study, Atkins and co-author Christine Piette Durrance, an associate professor in the Department of Public Policy at the University of North Carolina at Chapel Hill, used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases, which has records for 95 percent of hospital discharges from 37 states.

From that data, they counted the number of babies born with withdrawal symptoms and affected by maternal narcotics exposure from 2000 to 2014.

They also used data from the Treatment Episode Data Set—Admissions, a national data system of annual admissions to substance abuse treatment facilities, to identify the number of pregnant women admitted to treatment by state and year.

For prenatal substance use policies implemented in different states, they used information from the Guttmacher Institute, State Policies in Brief, Substance Abuse During Pregnancy, bi-annual reports.

When they compared the proportion of pregnant women admitted to treatment before punitive policies were enacted to after, and with states that had those policies and those that didn’t, they found that treatment admissions for pregnant women dropped by 29 percent and referrals to treatment by health care professionals decreased by 18 percent when punitive laws were put in place.

Furthermore, punitive policies were not statistically significantly related to the number of babies born with withdrawal symptoms or exposed to narcotics.

“These results provide population-based evidence of the effect of punitive prenatal substance use policies on birth outcomes and substance use treatment admissions,” Atkins said. “Although proponents of punitive prenatal-substance-use policies often cite improved birth outcomes for infants as one policy aim, our results do not support this.”

She said alternatives to punitive laws include improved access to medication-assisted treatment with methadone or buprenorphine, along with prenatal care and behavioral health counseling.

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