Biden Admin Asks Supreme Court To Strike Down Bans On Trans Procedures For Minors

 by Caden Pearson via The Epoch Times,

The Biden administration filed a petition with the Supreme Court earlier this week to overturn Tennessee's ban on gender transition procedures for minors...

This move by the Department of Justice follows lower court decisions that allowed similar bans to progress in Tennessee and two other states earlier this summer.

Lawyers for the DOJ argued that the bans, which include one in Kentucky, violate the Equal Protection Clause of the 14th Amendment to the U.S. Constitution.

DOJ lawyers argued in the petition that the question of whether the "recent wave of bans on gender-affirming care are consistent with the Equal Protection Clause" is of national importance and "requires a definitive resolution.”

“Absent this Court’s review, families in Tennessee and other States where laws like SB1 have taken effect will face the loss of essential medical care," DOJ lawyers wrote in the petition.

Parallel petitions were filed in the last week on behalf of transgender plaintiffs and their families, asking the nation's highest court to hear cases over similar bans in Kentucky and Tennessee.

However, the DOJ's Monday filing asked the Supreme Court to resolve only the question of whether the ban in Tennessee violates equal protection. The basis for this argument is the categorization of the law as a sex-based classification, with a focus on how it "discriminates against transgender individuals."

The two private petitions related to the Tennessee and the Kentucky prohibitions ask an additional question of whether the bans violate the constitutional due process rights of parents to direct the upbringing of their children.

In March, Tennessee Gov. Bill Lee enacted SB1 into law, prohibiting transgender treatment for minors, which took effect in July. The legislation requires children who began such treatments prior to July 1 to cease them by March 31, 2024.

In April, several groups, including the American Civil Liberties Union (ACLU), filed a lawsuit challenging this law on behalf of families with "trans-identifying" children.

On Sept. 28, the Sixth Circuit Court of the U.S. Court of Appeals rejected a petitioner’s challenge in a 2–1 ruling, upholding Tennessee’s ban on transgender treatment for children.

In July, a panel of judges on the Sixth Circuit Court of the U.S. Court of Appeals lifted an order that blocked part of the ban and allowed it to take effect.

The DOJ's brief argues that the U.S. Court of Appeals for the Sixth Circuit made an error in September by deeming the Tennessee and Kentucky bans likely constitutional.

They argue that these bans should be subject to heightened scrutiny and that they fail this stricter standard.

"The Sixth Circuit did not suggest that laws like SB1 could survive heightened scrutiny. Instead, it applied only the deferential rational-basis standard because it held that some laws that draw sex-based lines do not trigger heightened scrutiny—and that laws discriminating based on transgender status never warrant heightened review," the DOJ lawyers wrote.

"Those holdings are wrong, and they create or deepen circuit conflicts on the proper application of the Equal Protection Clause to laws targeting transgender individuals, both in the specific context of bans on gender-affirming care and more broadly."

The DOJ also requested that the Supreme Court consider all three cases together and address the equal protection issue.

However, the DOJ's stance differs from that of the other petitioners, who have asked the Supreme Court to evaluate whether the bans infringe on the constitutional due process rights of parents to guide their children's upbringing.

In a footnote, the DOJ lawyers asserted that, in the government's view, the due process question "does not warrant this Court's review."

"[B]ecause that aspect of the Sixth Circuit’s decision does not conflict with any decision of another court of appeals and does not otherwise satisfy this Court’s traditional certiorari standards," they wrote.

"Accordingly, the Court should grant the petitions limited to the equal-protection issue and consolidate the cases."

If the justices agree to hear the case, any decision will have significant implications for the 19 states that have implemented laws limiting transgender youths' access to transition-related care.

The DOJ emphasized in its petition that allowing these bans to take effect could result in "predictable and significant harms" for transgender adolescents in many parts of the country, including "escalating distress, anxiety, and suicidality."

Tennessee's legislation is part of a broader trend where multiple states are taking measures against transgender treatments for minors.

Gender transition procedures pose serious health risks, from mental health issues to glandular misfunction, heart complications, and even death.

In May, lawmakers demanded answers after two youths participating in a transgender hormone study, funded by the National Institutes of Health, took their own lives. In addition, 11 participants reported having suicidal thoughts.

https://www.zerohedge.com/political/biden-admin-asks-supreme-court-strike-down-bans-trans-procedures-minors

Infection with common cat-borne parasite associated with frailty in older adults

 A common, cat-borne parasite already associated with risk-taking behavior and mental illness in humans may also contribute to exhaustion, loss of muscle mass, and other signs of "frailty" in older adults, suggests a study published Nov. 6 in the Journal of Gerontology: Medical Science.

The research, by an international team of scientists including University of Colorado Boulder, University of Maryland School of Medicine and the University of A Coruña in Spain, is the latest to explore how the tiny, single-celled organism Toxoplasma gondii (T. gondii) could have big impacts on human health.

"We often think of T. gondii infection as relatively asymptomatic, but this study highlights that for some people it may have significant health consequences later on," said co-author Christopher Lowry, a professor in the Department of Integrative Physiology at CU Boulder.

Approximately 11% to 15% of people in the U.S. have been infected with T. gondii at some point and rates tend to be far higher in older individuals. In some countries, more than 65% have been infected. Once infected, people can unknowingly harbor the parasite for life.

For the study, the team examined the blood of 601 Spanish and Portuguese adults over 65, along with measures of a common geriatric syndrome known as "frailty" -- which includes unintentional weight loss, tiredeness, loss of cognitive sharpness and other indications of declining health.

A whopping 67% of study subjects were "seropositive" showing markers in their blood of a latent infection.

The researchers did not, as they originally hypothesized, find an association between any infection to T. gondii and frailty. But they did find that, among those infected, those with higher "serointensity" or a higher concentration of antibodies to the parasite, were significantly more likely to be frail.

Higher serointensity could reflect a more virulent or widespread infection, multiple infections or recent reactivation of a latent infection, the authors said.

"This paper is important because it provides, for the first time, evidence of the existence of a link between frailty in older adults and intensity of the response to T. gondii infection," said co-author Blanca Laffon, a professor of psychobiology at the Interdisciplinary Centre of Chemistry and Biology at University of A Coruña.

How cats spread T. gondii

Wild and domestic felines are considered the definitive host of the parasite, while warm-blooded animals like birds and rodents serve as secondary hosts: When cats eat infected animals, T. gondii takes up residence and multiplies in their intestines, shedding eggs in their feces.

People are typically infected via exposure to those eggs (via litter boxes, contaminated water or dirty vegetables) or by eating undercooked pork, lamb or other meat that's infested.

Most people never know they've been infected, with only about 10% initially having brief flu-like symptoms. But T. gondii tends to linger dormant for decades, cloaked in cysts in muscle and brain tissue (specifically the emotion-processing region known as the amygdala) with some insidious impacts, mounting research suggests.

In a creepy evolutionary trick seemingly designed to benefit the parasite's favorite host, rodents infected with T. gondii tend to lose their fear of felines, making it easier for cats to catch rats and mice. In the wild, infected chimpanzees have been shown to actually grow attracted to the smell of the urine of their feline predator, the leopard.

People who have been infected also tend to engage in risky behavior, with research showing they tend to be more impulsive, more entrepreneurial and more likely to get in a car accident. They also have higher rates of schizophrenia, certain mood disorders, cognitive problems and are more likely to attempt suicide, according to research by Lowry and Dr. Teodor Postolache, a professor in the Department of Psychiatry at University of Maryland School of Medicine and senior author on the new study.

A declining immune response?

The authors caution that the new study does not prove that exposure to T. gondii causes frailty, but rather identifies a compelling association that warrants further study.

They found that frail people with high T. gondii seropositivity also had higher levels of certain inflammatory markers, suggesting that infection with the parasite could exacerbate inflammation that already occurs with aging -- a.k.a. "inflammaging."

Because latent T. gondii tends to hide out in muscle tissue, Postolache suspects it could also play a role in hastening sarcopenia, or age-related muscle wasting.

Lowry's research centers around the impact microorganisms have on the immune system and, thus, mental health. He notes that many microbes that humans have evolved with impact health in a positive way -- a theory known as the Old Friends hypothesis.

Even T. gondii may have health benefits we aren't yet aware of, he said.

But in some cases, a switch flips, and friends become enemies.

In the case of T. gondii, certain medications or immune compromising diseases like HIV or cancer can enable a latent infection to escape suppression and reactivate, with adverse effects. Even in people with healthy immune systems, Lowry notes, immune function can decline with age, potentially enabling dormant T. gondii to rear up.

The researchers hope their study will inspire more research into the relationship between T. gondii and frailty, and ultimately lead to new ways of keeping the parasite from doing harm.

For now, they encourage people -- especially pregnant and immune compromised people -- to take steps to avoid infection.

Tips for preventing infection:

Change litter box daily, and wash hands afterward.

Avoid eating undercooked meat.

Rinse fruits and vegetables.

If pregnant or immunocompromised:

Avoid changing the litter box if possible (T. gondii infection during pregnancy can cause serious problems to a developing fetus).

Keep cats indoors.

Avoid stray cats.

Journal Reference:

1. Hira Mohyuddin et al. Toxoplasma gondii IgG Serointensity Is Positively Associated With Frailty. The Journals of Gerontology: Series A, 2023 DOI: 10.1093/gerona/glad228

https://www.sciencedaily.com/releases/2023/11/231107131909.htm

New antibiotic approach proves promising against lyme bacterium

 Using a technique that has shown promise in targeting cancer tumors, a Duke Health team has found a way to deploy a molecular warhead that can annihilate the bacterium that causes Lyme disease.

Tested in cell cultures using the Borrelia burgdoferi bacterium, the approach holds the potential to target not only bacteria, but also fungi such as yeast and viruses. The findings appear in the journal Cell Chemical Biology.

"This transport mechanism gets internalized in the bacterium and brings in a molecule that causes what we've described as a berserker reaction -- a programmed death response," said lead author Timothy Haystead, Ph.D., professor in Duke's Department of Pharmacology and Cancer Biology. "It wipes out the bacteria -- sterilizes the culture with a single dose of light. And then when you look at what occurs with electron microscopy, you see the collapse of the chromosome."

Haystead and colleagues used a molecular facilitator called high-temperature protein G (HtpG), which is involved in protecting cells that are undergoing heat stress. This family of proteins has been the focus of drug development programs for possible cancer therapies.

Studies of this protein as an antimicrobial have also been encouraging, but the Duke team's work appears to be the first to tether an HtpG inhibitor to a drug that enhances sensitivity to light.

The researchers found that the HtpG inhibitor, armed with the photosensitive drug, was rapidly absorbed into the cells of the Lyme bacteria. When hit with light, the bacteria's cells went into disarray and ultimately collapsed, killing them.

"Our findings point to a new, alternate antibiotic development strategy, whereby one

can exploit a potentially vast number of previously unexplored druggable areas within bacteria to deliver cellular toxins," Haystead said.

In addition to Haystead, study authors include Dave L. Carlson, Mark Kowalewski, Khaldon Bodoor, Adam D. Lietzan, Philip Hughes, David Gooden, David L. Loiselle, David Alcorta, Zoey Dingman, Elizabeth A. Mueller, Irnov Irnov, Shannon Modla, Tim Chaya, Jeffrey Caplan, Monica Embers, Jennifer C. Miller, Christine Jacobs-Wagner, Matthew R. Redinbo, and Neil Spector (deceased).

The study received funding support from the Steven and Alexander Cohen foundation and Bay Area Lyme Foundation.

Journal Reference:

1. Dave L. Carlson, Mark Kowalewski, Khaldon Bodoor, Adam D. Lietzan, Philip F. Hughes, David Gooden, David L. Loiselle, David Alcorta, Zoey Dingman, Elizabeth A. Mueller, Irnov Irnov, Shannon Modla, Tim Chaya, Jeffrey Caplan, Monica Embers, Jennifer C. Miller, Christine Jacobs-Wagner, Matthew R. Redinbo, Neil Spector, Timothy A.J. Haystead. Targeting Borrelia burgdorferi HtpG with a berserker molecule, a strategy for anti-microbial development. Cell Chemical Biology, 2023; DOI: 10.1016/j.chembiol.2023.10.004

https://www.sciencedaily.com/releases/2023/11/231102162621.htm

New culprit in amyloid beta buildup and neurodegeneration

 Researchers at Weill Cornell Medicine have demonstrated how amyloid beta, a peptide associated with Alzheimer's disease, can interact with a protein receptor on immune cells in the brain. This triggers a reaction that damages blood vessels and causes neurodegeneration.

The findings, published Oct. 3 in Molecular Neurodegeneration, may help researchers understand how dementia develops in diseases such as Alzheimer's and cerebral amyloid angiopathy (CAA), which often coexist, and discover much-needed treatments.

Amyloid beta is a normal peptide byproduct of brain function, but in CAA and Alzheimer's, these small molecules build up and damage the walls of blood vessels in the brain. The injured arteries can cause brain bleeds and contribute to cognitive impairment, but the mechanism of how this happens has been unknown.

Previous studies have shown border-associated macrophages—immune cells that surround blood vessels in the brain—have CD36 receptors on their surface that can bind to amyloid beta. It turns out that amyloid beta activates CD36, triggering the release of oxygen free radicals, which damage arterial walls and suppress necessary blood flow in the brain.

"The brain normally removes amyloid beta very efficiently because our blood vessels help pump it out of the brain to stay healthy. But we found when amyloid beta accumulates, it 'tickles' border-associated macrophages, which release large amounts of toxic free radicals," said study senior author Dr. Costantino Iadecola, director and chair of the Feil Family Brain and Mind Research Institute and the Anne Parrish Titzell Professor of Neurology at Weill Cornell Medicine.

The researchers found that the free radicals paralyze blood vessels in the brain.

"Amyloid then accumulates in the smooth muscle of the vessel walls, which blocks the vessel's ability to pump blood to the brain," Iadecola said. "CAA and cognitive impairment are the unfortunate result."

The study team also included co-corresponding author Laibaik Park, associate professor of neuroscience at the Feil Family Brain and Mind Research Institute, and first author Dr. Ken Uekawa, who was a visiting fellow at Weill Cornell Medicine during this research.

Starting with a preclinical model of Alzheimer's disease with CAA and cognitive impairment, the researchers eradicated CD36 in the border-associated macrophages.

"We showed that eliminating CD36 receptors in border-associated macrophages improved vascular function and reduced amyloid beta accumulation around blood vessels. Most importantly, the cognitive function of the mice improved," Park said.

The researchers also found that without CD36, the macrophages produced less reactive oxygen radicals.

These findings demonstrate a new role for border-associated macrophages in cognitive decline: Amyloid beta induced production of oxygen free radicals, which damages arteries, causes beta amyloid deposits in the arterial walls and cognitive decline. Iadecola and his colleagues concluded that deleting CD36 in border-associated macrophages suppressed oxidative stress, improved neurovascular function and promoted amyloid beta clearance out of the brain, so it didn't injure arteries.

Therefore, targeting CD36 in border-associated macrophages may benefit CAA and other conditions associated with amyloid accumulation on blood vessels. For instance, the researchers speculate that this finding may help find a treatment for amyloid-related imaging abnormalities (ARIA). This is a potentially serious reaction to monoclonal antibody drugs, like aducanumab, used to treat patients with mild cognitive impairment and Alzheimer's disease.

In a large proportion of patients receiving this amyloid beta immunotherapy at the highest dose, MRIs show that brain edema or hemorrhages occurred since starting treatment. Currently, these patients must discontinue the drug, but counteracting ARIA may enhance the success of amyloid beta immunotherapy.

Iadecola concluded, "After completing our translational work in the coming years, we hope to determine if blocking CD36 in brain macrophages or otherwise manipulating them could eliminate abnormal accumulations of amyloid beta in patients treated with amyloid beta immunotherapy."

More information: Ken Uekawa et al, Border-associated macrophages promote cerebral amyloid angiopathy and cognitive impairment through vascular oxidative stress, Molecular Neurodegeneration (2023). DOI: 10.1186/s13024-023-00660-1

https://medicalxpress.com/news/2023-11-team-culprit-amyloid-beta-buildup.html

'Moving Targets': Adjusting GLP-1 Agonists and Insulin

 We've all been hearing about the weight loss benefits of glucagon-like peptide 1 (GLP-1) receptor agonists, but it's important to remember that they are also diabetes medications. If you have a patient who's on an insulin secretagogue and/or insulin, it's important to remember that you need to adjust those medications to avoid hypoglycemia as you start and uptitrate the GLP-1 receptor agonist.

This isn't really cookbook, in the sense that you have to think about each patient, but I'll tell you what I do. First, I try to have most of my patients on continuous glucose monitors (CGM) because if they're on CGM, I can look at the trends to see what's happening as I'm adding a GLP-1 receptor agonist. If they're not on CGM, it's helpful if they test a fasting glucose level and perhaps a postprandial, though it's harder to get people to do, because you want to know whether to reduce the basal insulin or the prandial insulin.

Regardless of testing, you need to review with the patient the signs and symptoms of hypoglycemia and how to treat it if it occurs. In a patient on insulin, you may want to make sure they have glucagon at home because there have been episodes of severe hypoglycemia when a GLP-1 receptor agonist was added to insulin.

As a rule of thumb, I start by looking at the A1c. If the A1c is above 8%, I'm probably not going to do much reduction in the insulin secretagogue or the insulin right off the bat. I'll watch the patient as they begin to respond to the GLP-1 receptor agonist and then start tapering down the insulin if their glucose levels fall.

I often reduce the prandial insulin levels first because you're going to start seeing the patient eating less and be at increased risk for hypoglycemia between meals. If I start seeing the fasting glucose fall, then I'll start reducing the basal insulin. Usually, I reduce the doses by 10%-20%.

As I said, in somebody who starts out with a higher A1c, I don't right off the bat reduce the insulin. I watch what happens as the dose is increased. As the dose is increased in someone who's on an oral insulin secretagogue, I'll tend to cut that dose in half as I see glucose levels coming down.

On the other hand, if someone's starting A1c is below 8%, I might start by reducing their prandial insulin by 50% and maybe their basal insulin by 10%-20%, depending on their glucose levels. I think patients who are closer to target on insulin and/or a sulfonylurea agent are going to be at increased risk for going low.

Ideally, one can taper the patient off their insulin — and if not entirely off their insulin, off their prandial insulin — because it's much easier to give basal insulin and a once-weekly GLP-1 receptor agonist than to be on a multiple daily insulin regimen. Potentially, you'll be able to taper your patient off their insulin secretagogue as well.

The important thing to remember is that there's more than one moving target. You're uptitrating the GLP-1 receptor agonist or the GIP/GLP-1 receptor agonist and you're downtitrating the insulin secretagogue and/or the insulin. You want to downtitrate in gradual steps to keep ahead of any risk for hypoglycemia. Usually, that is done in slow steps, say, 10%-20% at a time.

It also means that you pay attention to your patients and that you may need to follow them every week or two, particularly if their A1c starts out below 8%, where they're likely to be at more risk for hypoglycemia.

If you pay attention to this process, you should be able to get your patient to a better point, hopefully on less medication that can cause hypoglycemia, and onto a medication that not only improves glucose but also helps with weight reduction, improves cardiovascular outcomes, and may have a renal benefit.

Thank you.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

https://www.medscape.com/viewarticle/997976

What Not to Prescribe to Older Adults and What to Use Instead

 I'm Dr Neil Skolnik. Today we are going to talk about the American Geriatrics Society 2023 updated Beers Criteria guidance for medication use in older adults. These criteria have been updated and revised approximately every 5 years since 1991 and serve to alert us to medications for which the risk-benefit ratio is not as good in older adults as in the rest of the population.

These are important criteria because medications are metabolized differently in older adults and have different effects compared with younger patients. For the sake of these criteria, older adults are 65 years of age or older. That said, we know that everyone from 65 to 100 is not the same. As people age, they develop more comorbidities, they become more frail, and they are more sensitive to the effects and side effects of drugs.

The guidance covers potentially inappropriate medications for older adults. The word "potentially" is important because this is guidance. As clinicians, we make decisions involving individuals. This guidance should be used with judgment, integrating the clinical context of the individual patient.

There is a lot in this guidance. I am going to try to cover what I feel are the most important points.

Aspirin. Since the risk for major bleeding increases with age, for primary prevention of atherosclerotic cardiovascular disease, the harm can be greater than the benefit in older adults, so aspirin should not be used for primary prevention. Aspirin remains indicated for secondary prevention in individuals with established cardiovascular disease.

Warfarin. For treatment of atrial fibrillation or venous thromboembolism (deep vein thrombosis or pulmonary embolism), warfarin should be avoided if possible. Warfarin has a higher risk for major bleeding, particularly intracranial bleeding, than direct oral anticoagulants (DOACs); therefore the latter are preferred. Rivaroxaban should be avoided, as it has a higher risk for major bleeding in older adults than the other DOACs. Apixaban is preferred over dabigatran. If a patient is well controlled on warfarin, you can consider continuing that treatment.

Antipsychotics. These include first- and second-generation antipsychotics such as aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and others. The guidance says to avoid these agents except for FDA-approved indications such as schizophrenia, bipolar disorder, and adjuvant treatment of depression. Use of these antipsychotics can increase risk for stroke, heart attack, and mortality. Essentially, the guidance says do not use these medications lightly for the treatment of agitated dementia. For those of us with older patients, this can get tricky because agitated dementia is a difficult issue for which there are no good effective medications. The Beers guidance recognizes this in saying that these medications should be avoided unless behavioral interventions have failed. So, there are times where you may need to use these medicines, but use them judiciously.

For patients with dementia, anticholinergics, antipsychotics, and benzodiazepines should be avoided if possible.

Benzodiazepines. Benzodiazepines should also be avoided because older adults have increased sensitivity to the effects of benzodiazepines due to slower metabolism and clearance of these medications, which can lead to a much longer half-life and higher serum level. In older adults, benzodiazepines increase the risk for cognitive impairment, delirium, falls, fractures, and even motor accidents. The same concerns affect the group of non-benzodiazepine sleeping medicines known as "Z-drugs."

Nonsteroidal anti-inflammatory drugs (NSAIDs). Used frequently in our practices, NSAIDs are nevertheless on the list. As we think through the risk-benefit ratio of using NSAIDs in older adults, we often underappreciate the risks of these agents. Upper gastrointestinal ulcers with bleeding occur in approximately 1% of patients treated for 3-6 months with an NSAID and in 2%-4% of patients treated for a year. NSAIDs also increase the risk for renal impairment and cardiovascular disease.

Other medications to avoid (if possible). These include:

• Sulfonylureas, due to a high risk for hypoglycemia. A short-acting sulfonylurea, such as glipizide, should be used if one is needed.

• Proton pump inhibitors should not be used long-term if it can be avoided.

• Digoxin should not be first-line treatment for atrial fibrillation or heart failure. Decreased renal clearance in older adults can lead to toxic levels of digoxin, particularly during acute illnesses. Avoid doses > 0.125 mg/day.

• Nitrofurantoin should be avoided when the patient's creatinine clearance is < 30 or for long-term suppressive therapy.

• Avoid combining medications that have high anticholinergic side effects, such as scopolamine, diphenhydramine, oxybutynin, cyclobenzaprine, and others.

It is always important to understand the benefits and the risks of the drugs we prescribe. It is also important to remember that older adults are a particularly vulnerable population. The Beers criteria provide important guidance which we can then use to make decisions about medicines for individual patients.

Neil Skolnik, MD

Professor, Department of Family Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia; Associate Director, Department of Family Medicine, Abington Jefferson Health, Abington, Pennsylvania

Disclosure: Neil Skolnik, MD, has disclosed the following relevant financial relationships:
Serve(d) on the advisory board for: AstraZeneca; Teva; Eli Lilly and Company; Boehringer Ingelheim; Sanofi; Sanofi Pasteur; GSK; Merck; Bayer
Serve(d) as a speaker or a member of a speakers bureau for: AstraZeneca; Boehringer Ingelheim; Eli Lilly and Company; GSK
Received research grant from: Sanofi; AstraZeneca; Boehringer Ingelheim; GSK; Bayer
Received income in an amount equal to or greater than $250 from: AstraZeneca; Teva; Eli Lilly and Company; Boehringer Ingelheim; Sanofi; Sanofi Pasteur; GSK; Merck; Bayer

https://www.medscape.com/viewarticle/997792

Assistance Dogs Benefit Patients With Various Diseases

 Following extensive training and appropriate assessments, assistance dogs are helping people with physical disabilities or diseases in everyday life. The responsibilities can differ vastly; dogs use their olfactory sense as a diagnostic tool for cancer and COVID-19 and even to open doors for disabled people. Assistance dogs also perform other duties, including the following:

• Guide dogs lead people with impaired vision, direct them through traffic, and help them with tasks such as crossing the street.

• Service dogs help patients with multiple sclerosis, spina bifida, Parkinson's disease, cerebral palsy, or other diseases through targeted assistance. They turn on light switches, open doors, or pick up small objects that have fallen down.

• Signal dogs, also called hearing dogs, react to noises such as the telephone, doorbell, or fire alarm. They lead deaf people to the source of the noise.

• Medical signal dogs have vastly different responsibilities, depending on the person's disease. For patients with diabetes, alert dogs recognize a dangerous metabolic state before clinical symptoms develop. For patients with epilepsy, dogs warn patients that a seizure is about to occur.

• Researchers are investigating whether dogs can sniff out various diseases, such as cancer, COVID-19, or bacterial infections. It is likely that they recognize these diseases through volatile organic compounds (VOCs) in exhaled air. Each disease changes individual metabolic steps in the body, which is a topic of research in metabolomics.

Researchers in this field are measuring a positive side effect of the household pet. Clinical studies show that dog owners exhibit less mental stress and are at lower cardiovascular risk than people without a dog.

Sniffing Out COVID

Since the beginning of the pandemic, researchers such as Holger Volk, PhD, chair of small animal diseases at the University of Veterinary Medicine in Hannover, Germany, have been investigating whether dogs can recognize SARS-CoV-2 infections. Following a range of laboratory experiments, they have published the results of a mass screening at a large-scale event.

Eight dogs were trained to detect samples that were positive for chemically inactivated SARS-CoV-2 RT-qPCR. To assess the animals' performance, the researchers collected real-world data from 2802 attendees at four concerts.

Sweat samples from 2802 participants were presented to the dogs. SARS-CoV-2 specific antigen rapid tests and RT-qPCR tests were then used. The participants' infection status was not known at the time the samples were taken.

The dogs achieved a diagnostic specificity of 99.93% and a sensitivity of 81.58%. The participants' vaccination status, whether they had been previously infected with SARS-CoV-2, whether they had chronic diseases, and medications the participants were taking had no effect on the dogs' performance.

COVID Screening

Researchers also saw a large amount of potential in schools for dogs to detect SARS-CoV-2 infections. The use of tracking dogs is one strategy for a fast, noninvasive, cost-effective, and environmentally friendly COVID-19 screening method.

Experts trained two tracking dogs to recognize the VOC of COVID-19. The canine screening was performed before the actual practice phase in volunteers on the days on which antigen tests were planned in schools. The participants stood 1.5 m away from each other. The dogs, led by the dog handlers, sniffed at their ankles and feet.

After 2 months of training with COVID-19 odor samples in the laboratory, the dogs achieved a sensitivity and specificity of more than 95% for detecting the virus.

Dog Owners Benefit

During the COVID-19 pandemic, dog owners were potentially better protected from depressive moods than people without dogs. This was the conclusion of US researchers who analyzed the results of a survey.

In all, 768 dog owners and 767 potential dog owners who did not have a pet took part in the online study. Potential dog owners were defined as people who did not have a dog at the time of the survey but who showed interest in owning a dog in the future.

Participants completed six tests, including tests regarding depression, anxiety, and happiness. The scientists' hypothesis was that dogs make their owners feel loved, treasured, and needed, which suppresses stress, anxiety, and depression and triggers or reinforces feelings of happiness.

Dog owners indicated that they had access to much more social support than potential dog owners; their depression scores were also lower than those of the comparator group. However, there were no significant differences between the two groups in the scores for anxiety and satisfaction.

Dogs and Diabetes

Researchers showed that well-trained signal dogs react more sensitively to changes in blood sugar levels of patients with type 1 diabetes than had previously been observed. Therefore, these dogs could improve the quality of life of patients with type 1 diabetes, especially for patients who have not experienced a hypoglycemic attack. These patients could be children or adolescents who have little experience in dealing with the metabolic disease.

The authors investigated 28 dogs and their owners, as well as more than 4000 episodes of hypo- or hyperglycemia. Dogs who had passed through a well-structured training program alerted their owners to 83% of hypoglycemic episodes and 67% of hyperglycemic episodes. Four of the dogs recognized episodes in which blood glucose levels were overly high or low 100% of the time. The median rate for all dogs was 81%.

Nevertheless, even well-trained animals are inferior to continuous glucose measurement.

Urogenital Tract Infections

Urinary tract infections are problematic for patients with neurologic diseases and for the elderly. These patients do not always recognize the symptoms and sometimes seek medical attention too late. Delayed diagnoses can lead to severe infections such as pyelonephritis and life-threatening sepsis. It is here that dogs come into play. They are able to detect bacteriuria.

In a double-blind, case-control validation study, researchers collected daily urine samples from participants for 16 weeks. The dogs were trained to differentiate urine samples that were culturally positive for bacteriuria and from culturally negative control samples.

The samples were collected from 687 people aged from 3 months to 92 years. About 34% of the samples were culturally positive.

Dogs detected urine samples that were positive for 100,000 colony-forming units/mL of Escherichia coli (250 tests; sensitivity, 99.6%; specificity, 91.5%). The diluting of E coli urine with distilled water had no effect on precision at either a concentration of 1% (sensitivity, 100%; specificity, 91.1%) or of 0.1% (sensitivity, 100%; specificity, 93.6%).

The diagnostic precision was similar for Enterococcus (n = 50; sensitivity, 100%; specificity, 93.9%), Klebsiella (n = 50; sensitivity, 100%; specificity, 95.1%) and Staphylococcus aureus (n = 50; sensitivity, 100%; specificity, 96.3%).

The overall sensitivity — taking into account every dog participating in the study — was at or near 100%, and the specificity was over 90%.

Dogs Detect Cancer

In recent years, researchers have demonstrated that dogs can recognize various cancers long before any clinically relevant symptoms develop. The literature contains at least three examples.

First, two sheep dogs were trained to recognize prostate cancer-specific VOC in urine samples. They were tested on 362 patients with prostate cancer (with low risk to metastases) and on 540 healthy control patients.

Dog 1 had a sensitivity of 100% and a specificity of 98.7%. For Dog 2, the study authors reported a sensitivity of 98.6% and a specificity of 97.6%.

A second study showed that dogs could detect bowel cancer. Breath samples and stool samples were the basis of the test.

Each test group comprised one sample from a patient with bowel cancer and four samples from volunteers without cancer. These five samples were allocated randomly and put into five boxes. A Labrador retriever specially trained to recognize the scent of cancer and a dog handler took part in the tests. The dog first smelled a standard breath sample from a patient known to have colorectal cancer, then smelled each sample station and sat down in front of the station in which a cancer scent was found.

The detection sensitivity for breath samples, compared with colonoscopy, was 0.91 for breath samples, and the specificity was 0.99. The authors stated that the detection sensitivity for a dog's nose was 0.97, and the specificity was 0.99.

The dogs were highly precise at odor recognition, even in the early stages of the cancer. The dogs' odor recognition was not impaired by smoking, benign colorectal diseases, or inflammatory bowel diseases.

Last but not least, dogs can help to locate melanomata, as shown by another, albeit rather small, study. Dog A detected a melanoma that had been clinically suspected and that was subsequently confirmed on biopsy. In a sixth patient, this dog indicated a melanoma at a skin location for which the initial pathologic examination was negative. A more thorough histopathologic examination of this person then confirmed the suspicion. And for a seventh patient in whom a definitive reaction was neither shown by the dog nor dermatologists, a melanoma was determined through a histopathologic examination.

Dog B searched four of these seven patients; in every case, the responses matched those of dog A.

The objective of another study was to check whether trained dogs could detect an imminent epileptic seizure by smell. The odor samples came from five patients who had different kinds of epilepsy.

Three of the five dogs achieved a sensitivity and specificity of 100%. The other two dogs demonstrated a sensitivity of 67% and a specificity of 95%, which are fairly high values.

The authors saw the results as proof that despite patients' individual scents, epileptic seizures are associated with distinctive olfactory characteristics. Epileptic seizures are associated with a specific scent that exhibits similar characteristics in different patients.

Now researchers must clarify whether this scent occurs before the seizure and whether patients therefore have time to call for help or take medicine.

Dogs and Longevity

It is not just therapy dogs that are beneficial to the health of their owners. Ordinary, untrained animals also do a lot of good. Owning a dog has long been associated with a lower mortality risk, which may be attributable to a reduction in cardiovascular mortality.

For a systemic overview and meta-analysis, researchers searched for publications that dealt with associations between dog ownership and overall mortality and cardiovascular mortality. They included ten studies that provide data from 3,837,005 participants with an average follow-up time of 10.1 years.

According to these data, owning a dog was associated with a 24% reduction in the risk of overall mortality, compared with not owning a dog (relative risk, 0.76). Particularly for people with previous coronary events, the effects on overall mortality were much larger (relative risk, 0.35).

When scientists restricted their analyses to studies of cardiovascular mortality, dog ownership was associated with a 31% reduction in the risk of cardiovascular death (relative risk, 0.69).

Possible reasons behind the effect incluide increased movement, reduced stress, and reduced loneliness.

Emergency Department Benefits

A 10-minute visit with a therapy dog leads to a clinically significant reduction in pain and anxiety and to an improvement in the well-being of patients who are visiting the emergency department, according to a randomized controlled study.

Pain, anxiety, depression, and well-being were measured in 97 patients (average age, 56 years; 44% women) before, immediately after, and 20 minutes after the visit by the therapy dog using the revised 11-point rating scale of the Edmonton Symptom Assessment System. At these time points, researchers also recorded participants' blood pressure and heart rate.

The same data were recorded twice at an interval of 30 minutes in 101 control patients (average age, 57 years; 39% women) who were not treated with a therapy dog in the emergency department.

The visit by the therapy dog had a statistically significant, albeit mild, influence on patients' perception of pain, anxiety, and depression. Participants in the therapy-dog group rated their well-being after the interaction with the dog and its handler significantly higher than the participants in the control group did.

https://www.medscape.com/viewarticle/998235