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Thursday, December 27, 2018

CDC Warning: A Respiratory Virus Is Attacking Both Children And Adults


The Centers for Disease Control and Prevention is warning of a respiratory virus that is currently attacking both children and adults. The CDC says that everyone should watch out for Respiratory Syncytial Virus or “RSV.”
RSV may start out by noticeable symptoms that are very similar to those of the common cold and most people will recover in less than two weeks believing they only had a cold. Some symptoms are coughing, wheezing, loss of appetite, runny nose, and a fever.  Those symptoms are very similar to those of the common cold, and most people have actually had RSV before possibly believing it to be a cold.
RSV can spread when an infected person coughs or sneezes. You can get infected if you get droplets from a cough or sneeze in your eyes, nose, or mouth, or if you touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands. Additionally, it can spread through direct contact with the virus, like kissing the face of a child with RSV. -CDC
However, the CDC says that RSV can be serious for infants and the elderly. As of now, the government agency says there is no vaccine to prevent the virus either. There is a medicine that can help protect some of the babies. This medicine (called palivizumab) is a series of monthly shots.
RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. It is also a significant cause of respiratory illness in older adults. But the virus is rather common. According to the CDC’s own website, almost all children will be infected with RSV by their second birthday, building natural immunities to the infection.
Should you be terrified of RSV? Probably not.  The CDC is well-known for the fearmongering to get people to take a flu shot every year (regardless of its efficacy) and often attempts to scare the public into accepting their notions that common illnesses are dangerous.
But, there are ways to help prevent RSV, and these will also help prevent common colds and the flu as well.
  • Wash your hands often. Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Washing your hands will help protect you from germs.
  • Keep your hands off your face. Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.
  • Avoid close contact with sick people. Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.
  • Cover your coughs and sneezes. Cover your mouth and nose with a tissue or upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward and wash your hands.
  • Clean and disinfect surfaces. Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.
  • Stay home when you are sick. If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness.
You could also consider naturally boosting your immune system to help give your body a leg up should you be exposed to the virus or actually come down with any “winter time” illness, such as a cold or the flu.
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Hostile bid for Aphria from billionaire Ohio family’s new US company


A newly formed U.S. cannabis operation — backed by a storied Ohio family that has built a fortune in the retail business — is making a hostile bid for a Canadian pot company with which it has done business in the past.
Backed by the wealthy and powerful Schottenstein family, U.S. marijuana producer Green Growth Brands Ltd. GGBXF, -6.41%  said late Thursday it is making a takeover bid for Aphria Inc., one of Canada’s largest cannabis producers by market value. Aphria’s U.S. listed stock APHA, -4.30%  soared 26% in after-hours trading Thursday after closing down 4.3% at $5.57 during the regular session. Aphria’s Canada-listed shares APHA, +0.13%  were halted after the close.
Green Growth said that its offer values Aphria at C$11 a share, or roughly $2.1 billion, which represents a 46% upside to Aphria’s closing price on Dec. 24. Green Growth’s pitch is based on combining the Schottenstein family’s long experience in the retail business with Aphria’s ability to grow lots of pot.
“What we’ve learned about our own story is that there’s a real demand and need for seasoned and accomplished management in the industry,” Green Growth Chief Executive Peter Horvath said in a telephone interview Thursday evening. “The essence, the idea here, is to take talent and capabilities and join them with [Aphria’s] team and leverage them across multiple geographies.”

Horvath has worked in retail for roughly 35 years and has been an executive for large public companies such as American Eagle Outfitters Inc. AEO, +0.00%   and DSW Inc. DSW, +0.77%  — both of which count the Schottensteins as major investors and executives. Jay Schottenstein is the chief executive and chairman of American Eagle and the chairman of DSW, while the billionaire Schottenstein family has a sprawling retail empire that includes lots of real estate and interests in grocery stores and consumer-goods manufacturing.
The Thursday announcement is not the Schottensteins’ first foray with Aphria. In 2017, the family sought to obtain a medical marijuana cultivation license in Ohio through a joint venture called Schottenstein Aphria LLC. Ultimately the joint venture failed at obtaining an Ohio license, though at the time it planned to appeal the decision.
If Green Growth’s bid to buy Aphria is successful, it will likely mean significant changes for existing Aphria shareholders. At the moment, the Toronto Stock Exchange, or TSX, and the New York Stock Exchange, where Aphria is traded in the U.S., do not allow companies that violate federal regulations to list their stock. Because Green Growth operates illegally under U.S. federal law, it’s likely that the stock would only trade on the CSE — as Green Growth does now — and over the counter.

Horvath acknowledged in the phone interview that listing on the CSE exclusively wasn’t ideal. “It’s not optimal,” he said. “But it doesn’t mean it can’t work.”
For Horvath, the key benefits include bringing management with experience running a global company, which he likened to the current state of cannabis in the U.S. The current legal regime in the U.S. has created a motley collection of laws that vary wildly around the country, much like how each nation has a distinct set of laws that global retailers have to follow.
Green Growth bills itself as a vertically integrated marijuana company with operations in several states. According to the company’s financial statements, it banked losses of $516,344 on sales of $1.7 million during the September quarter. It did not earn revenue in the prior quarter, and lost less than $100,000. It currently has subsidiaries in California, New Jersey, Nevada and Oregon; it also owns several licenses to cultivate, process and sell marijuana in Nevada. Green Growth went public via a reverse takeover of Xanthic Biopharma Inc. and started trading on the CSE last month.
Green Growth said that it had offered a “friendly” bid that included a $50 million investment before making its current bid public, and that it plans to complete “brokered financing” of its own stock at C$7 a share on the Canadian Securities Exchange, to raise C$300 million and fund the business. Green Growth said it is offering 1.5714 shares of its stock for each Aphria share and said it “believes” it has support for the takeover from roughly 10% of current Aphria shareholders.

Aphria stock has declined more than 30% after short seller Hindenberg Research published a note about the company’s business, calling it a “shell game,” among other things. At the time Aphria called the note a “malicious and self-serving attempt to profit by manipulating” the stock price. Since then, Aphria has announced that it has a named a special committee to review the claims.
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Most Drug Treatments Fail to Control Long-term Osteoarthritis Pain


The first meta-analysis of long-term pharmacologic treatments for knee osteoarthritis (OA) found little evidence that most currently prescribed medications improve pain control or preserve joint structure after 12 months of treatment. There was a small but statistically and clinically significant benefit from prescription-grade glucosamine sulfate.
The study, by Dario Gregori, PhD, from the Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy, and colleagues, was published online December 25 in JAMA.
The analysis may have more implications for clinical trial design than for clinical practice. David S. Jevsevar, MD, vice-chairman, Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, told Medscape Medical News that these treatments are not generally recommended with the expectation that they will produce long-term relief.
“All of the conservative interventions for knee OA are generally intended to address relatively acute exacerbations of knee OA or the chronic ache component. By its nature, knee OA is generally a slowly progressive disease. The authors also appropriately highlight that it is challenging to measure the effect of these treatments, and that may also help to explain the small effect sizes. I don’t think there is anything new here,” Jevsevar explained.
Senior author Lucio C. Rovati, MD, CEO, and chief scientific officer of Rottapharm Biotech, which partly funded the study, told Medscape Medical News the authors were gratified to find that the systematic review produced 33 randomized controlled trials (RCTs) of knee OA drug therapy with follow-ups of at least 12 months but that they were disappointed that only 13 of the 33 interventions had been studied in two or more trials.
“The question is, therefore, why, in a chronic and progressive disease, medications are studied mainly over short-term period, and most guidelines are unclear on this. This is a major limitation, and regulators should convince sponsors to run long-term studies or to clearly label drugs for short-term use only. In parallel, clinical practice guidelines should clearly advise what to do for the long-term management of the disease, based on the available evidence,” Rovati said.
Rovati added, “Physicians should be aware that the clinical trial evidence to support long-term pharmacological management of knee OA is scarce.”
The researchers extracted data from the RCTs and performed a Bayesian random-effects network meta-analysis to assess the mean change from baseline in knee pain (the primary outcome, measured using the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] or a visual analogue scale). Secondary outcomes were changes in physical function (measured using the WOMAC physical function scale) and in joint structure (measured as radiologic joint space narrowing).
The authors explain, “Network meta-analyses synthesize direct and indirect evidence in a network of trials that compare multiple interventions. This method allows comparison of all available knee osteoarthritis medications against placebo and between pharmacological agents despite the paucity of head-to-head comparisons of therapies in RCTs.”
The trials included more than 20,000 patients with knee OA (70% women); the mean age ranged from 55 to 70 years. The interventions included analgesics; antioxidants; bone-acting agents, such as bisphosphonates and strontium ranelate; nonsteroidal anti-inflammatory drugs; intra-articular injection medications, such as hyaluronic acid and corticosteroids; symptomatic slow-acting drugs for osteoarthritis, such as glucosamine and chondroitin sulfate; and putative disease-modifying agents, such as cindunistat and sprifermin. The RCTs tested 31 interventions for pain, 13 for physical function, and 16 for joint structure.
The analysis showed no significant association with pain improvement (the primary outcome) for 29 of the 31 treatments. Celecoxib and glucosamine sulfate were initially associated with reduced pain, but about 30% of the RCTs were judged to have high risk for bias. Once these trials were eliminated, celecoxib was no longer significantly effective. Glucosamine sulfate remained associated with a small but significant standardized mean difference (SMD) in pain of -0.29 (95% credibility interval [CrI], −0.49 to −0.09), as well as with a significant improvement in physical function (SMD, -0.32; 95% CrI, −0.52 to −0.12) and on joint space narrowing (SMD, -0.42; 95% CrI, −0.65 to −0.19).
The authors warn that, owing to the paucity of interventions tested in more than two RCTs, “there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo.”
Rovati explained that the glucosamine sulfate included in this analysis is a prescription drug available in Europe and in several countries in Asia. Other formulations, such as those sold in the United States, and which were not effective in this analysis, may be labeled “glucosamine sulfate” because they contain glucosamine hydrochloride, with or without sodium sulfate.
Although it is not the ideal drug, Rovati advised use of glucosamine sulfate as a background treatment until more effective medications are developed.
Rovati said, “The future in OA clinical research is the identification of the different OA phenotypes and the performance of trials specifically addressing the effects of the different medications in these different subsets. These are being identified by the scientific community, and they may include metabolic OA (linked to obesity and other characteristics), inflammatory OA, bone-remodeling OA, neuropathic component OA, etc.”
Rovati advised that physicians make full use of aerobic and strengthening exercise programs and physical therapy and encourage weight loss for patients who are overweight. Then long-term background pharmacologic treatment with prescription glucosamine sulfate should be used, with pain medications used to control breakthrough pain episodes over the short term.
The study was partly funded by Rottapharm Biotech. Dr Giacovelli and Dr Rovati have participated in clinical trials of glucosamine sulfate and hyaluronic acid as scientists and employees of Rottapharm prior to that company’s merger with Mylan. They are now scientists at Rottapharm Biotech, the research and development spin-off of the former Rottapharm. Rottapharm Biotech is engaged in new drug development but has no commercial or other interest in glucosamine sulfate, hyaluronic acid, or any other marketed or experimental pharmaceutical agents considered in the present study. Three coauthors of the article are also scientists and employees of Rottapharm Biotech. Dr Jevsevar has disclosed no relevant financial relationships.
JAMA. Published online December 25, 2018. Abstract
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How skin ages, loses fat and immunity


Dermal fibroblasts are specialized cells deep in the skin that generate connective tissue and help the skin recover from injury. Some fibroblasts have the ability to convert into fat cells that reside under the dermis, giving the skin a plump, youthful look and producing a peptide that plays a critical role in fighting infections.
In a study published in Immunity on December 26, University of California San Diego School of Medicine researchers and colleagues show how fibroblasts develop into fat cells and identify the pathway that causes this process to cease as people age.
“We have discovered how the skin loses the ability to form fat during aging,” said Richard Gallo, MD, PhD, Distinguished Professor and chair of the Department of Dermatology at UC San Diego School of Medicine and senior author on study. “Loss of the ability of fibroblasts to convert into fat affects how the skin fights infections and will influence how the skin looks during aging.”
Don’t reach for the donuts. Gaining weight isn’t the path to converting dermal fibroblasts into fat cells since obesity also interferes with the ability to fight infections. Instead, a protein that controls many cellular functions, called transforming growth factor beta (TGF-β), stops dermal fibroblasts from converting into fat cells and prevents the cells from producing the antimicrobial peptide cathelicidin, which helps protect against bacterial infections, reported researchers.
“Babies have a lot of this type of fat under the skin, making their skin inherently good at fighting some types of infections. Aged dermal fibroblasts lose this ability and the capacity to form fat under the skin,” said Gallo. “Skin with a layer of fat under it looks more youthful. When we age, the appearance of the skin has a lot to do with the loss of fat.”
In mouse models, researchers used chemical blockers to inhibit the TGF-β pathway, causing the skin to revert back to a younger function and allowing dermal fibroblasts to convert into fat cells. Turning off the pathway in mice by genetic techniques had the same result.
Understanding the biological process that leads to an age-dependent loss of these specialized fat cells could be used to help the skin fight infections like Staphylococcus aureus (S. aureus) — a pathogenic bacteria that is the leading cause of infections of the skin and heart and a major factor in worsening diseases, like eczema. When S. aureus becomes antibiotic resistant it is known as methicillin-resistant Staphylococcus aureus or MRSA, which is a leading cause of death resulting from infection in the United States.
The long term goals and benefits of this research are to understand the infant immune system, said Gallo. The results may also help understand what goes wrong in other diseases like obesity, diabetes and autoimmune diseases.
Story Source:
Materials provided by University of California – San Diego. Original written by Yadira Galindo. Note: Content may be edited for style and length.
Journal Reference:
  1. Ling-juan Zhang, Stella Xiang Chen, Christian F. Guerrero-Juarez, Fengwu Li, Yun Tong, Yuqiong Liang, Marc Liggins, Xu Chen, Hao Chen, Min Li, Tissa Hata, Ye Zheng, Maksim V. Plikus, Richard L. Gallo. Age-Related Loss of Innate Immune Antimicrobial Function of Dermal Fat Is Mediated by Transforming Growth Factor Beta. Immunity, 2018; DOI: 10.1016/j.immuni.2018.11.003
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Green Growth plans C$11 per share bid for pot producer Aphria


U.S. cannabis retailer Green Growth Brands is planning to make a hostile approach for Aphria, says Bloomberg. According to Bloomberg, citing confidential sources, Columbus, Ohio-based Green Growth plans to offer C$11 per share in an all-stock bid for Aphria valuing the Canadian marijuana producer at almost C$2.8 billion or $2.1B, according to people familiar with the matter. Shares of Aphria are up over 22% in after-hours trading.
https://thefly.com/landingPageNews.php?id=2841711
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Universal Vaccination for Meningitis B at College Entry Not Cost-Effective


Universal vaccination against Neisseria meningitidis serogroup B (MenB) at college entry does not appear to be cost-effective, according to a study published online Dec. 17 in the American Journal of Preventive Medicine.
Ira L. Leeds, M.D., from Johns Hopkins University in Baltimore, and colleagues estimated the costs and benefits of universal vaccination at college entry versus no universal vaccination with an outbreak response in 2018 in the context of a midsized four-year college from a health sector and societal perspective.
The researchers found that with universal vaccination, the incremental cost per quality-adjusted life-year gained was $13.9 million and $13.8 million under the health sector perspective and societal perspective, respectively; each perspective was compared with a willingness-to-pay threshold of $150,000 per quality-adjusted life-year. Universal vaccination was not the preferred strategy for <$15 million per quality-adjusted life-year in a multivariable probabilistic sensitivity analysis. A universal vaccination strategy became cost-effective for vaccine series costing <$65 under an extremely favorable model.
“Despite the safety and short-term efficacy of MenB vaccination, the extreme low incidence of MenB and high cost of vaccination prevent universal vaccination of college-aged individuals from being a cost-effective strategy,” the authors write.
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New Practice Guidelines for Venous Thromboembolism


The American Society of Hematology (ASH) has developed new guidelines for the treatment of venous thromboembolism (VTE); the clinical practice guidelines were recently published in Blood Advances.
The guidelines address prophylaxis for hospitalized and nonhospitalized medical patients, diagnosis of VTE, heparin-induced thrombocytopenia, treatment of pediatric VTE, VTE in the context of pregnancy, and the optimal management of anticoagulation therapy.
The guidelines strongly recommend provision of pharmacological VTE prophylaxis in acutely or critically ill inpatients at acceptable bleeding risk and use of mechanical prophylaxis when bleeding risk is unacceptable. Using D-dimer as the initial test reduces the need for diagnostic imaging for patients at low VTE risk, while imaging is warranted for patients at high risk. For estimating pretest probability of heparin-induced thrombocytopenia, use of the 4Ts score is recommended rather than a gestalt approach. Researchers agreed on 30 recommendations for management of pediatric VTE, although additional research is needed. For pregnancy-associated VTE, there was a strong recommendation for low-molecular weight heparin (LMWH) over unfractionated heparin. For use of anticoagulant management, strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against LMWH bridging therapy.
“The 2018 ASH guidelines took the latest evidence into account to make recommendations that in some instances will reinforce existing best practices and in other instances will change practice,” Adam Cuker, M.D., chair of the ASH VTE Guidelines Coordination Panel, said in a statement.

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