Category Archives: Internal Medicine

Internal Medicine

You asked, we answered: Is syncope a symptom of COVID? – Nebraska Medicine

Question: Can COVID cause syncope?

Answered by internal medicine doctor Andrew Vasey, MD

Syncope is the medical term for fainting or passing out. Generally, this condition arises when you have a sudden, temporary decrease in blood flow to your brain. Many syncopal occurrences are benign and result from a short-term cause. Syncope can happen because of the following:

There are a few reports of people presenting post-COVID who experience syncopal issues. Still, the difficult part for health care providers is that various processes can cause syncope, even without post-COVID complications. Similarly, defining a post-COVID symptom versus a symptom from another pre-existing cause is challenging.

Patients with post-COVID issues can have symptoms related to most organ systems. For example, many post-COVID symptoms are believed to be related to autonomic nervous system dysfunction. With autonomic dysfunction, a person can have inappropriate changes in their heart rate such as increasing more than it should with movement or position changes and can feel like they are going to pass out or do pass out. Many medical conditions can cause autonomic dysfunction, not just post-COVID issues.

Given all these factors, the short answer is, it is difficult to determine if syncope is definitively a symptom of COVID-19.

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You asked, we answered: Is syncope a symptom of COVID? - Nebraska Medicine

Internal Medicine

Penn Medicine Residents Vote to Unionize | MedPage Today – Medpage Today

University of Pennsylvania residents and fellows voted to unionize, with the vast majority green-lighting the historic move.

"With 88% of participants voting in favor, the frontline Penn Medicine doctors are the first statewide to gain union representation," according to the Committee of Interns and Residents/Service Employees International Union (CIR/SEIU), which reported Monday that the vote was 892 to 110.

Specifically, the residents and fellows at the Philadelphia health system "look forward to advocating for the conditions they need to provide top-quality care without compromising their mental, physical, or financial wellbeing," the union stated.

House staff unionization efforts continue to multiply across the country. Just last month, MedPage Today reported that house staff at Mass General Brigham in Boston will proceed with their own unionization efforts despite a salary bump.

Kendall Major, MD, an internal medicine resident at Penn Medicine, told MedPage Today that house staff are thinking about their goals in two ways -- advocating for patients in terms of factors like the design of new buildings and resource allocation, and advocating for themselves when it comes to salaries and benefits.

"We are the ones on the frontlines working 80 hours a week," Major said, adding that it's important "that we have a seat at the negotiating table."

A Penn Medicine spokesperson said in a statement provided to MedPage Today via email that house staff voted for union representation in an election conducted by the National Labor Relations Board (NLRB) on May 3-5. The statement noted that the result has not been certified. Penn Medicine has been informed the process can take up to 7 business days, according to the statement.

"We are proud of Penn Medicine's long history as home to many top residency and fellowship programs, and we have appreciated the ongoing opportunity to hear directly from residents about their concerns during this unionization campaign," the spokesperson said. "We have an obligation to stay true to our shared goals to provide the very best care to our patients, and to ensure that new physicians are able to train in an environment that allows them resources to flourish academically, professionally, and personally."

"We respect our trainees' collective decision and remain committed to continuing our work to improve their training experience and ensure that they are fully supported during these transformative years of their medical careers," the spokesperson added.

"Getting 892 people -- inspiring them to come out and vote -- is really a testament to how much we needed this union at Penn Medicine," Major told MedPage Today, adding that residents and fellows are hopeful that their win will inspire others in what has become a nationwide conversation.

"This is bigger than just the University of Pennsylvania," she said. "I'm hopeful that we will see many, many more to come." she said.

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

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Penn Medicine Residents Vote to Unionize | MedPage Today - Medpage Today

Internal Medicine

Can Digital Psychiatry Really Fill the Mental Health Care Gap? – Smithsonian Magazine

Many new digital psychiatry solutions have attracted funding in recent years, and experts have questions about how helpful or harmful they will be. Illustration by Emily Lankiewicz / Public Domain

Imagine youre in a room with a hundred American young adults, bright-eyed and bushy-tailed. Over their lifetimes, about 25 of them will have a stroke; 40 will get cancer. And an astounding half the room will develop a mental illness, if they havent done so already.

The United States mental health epidemic has been simmering for decades, with Covid-19 both illuminating and exacerbating the crisis. Given the social isolation, job insecurity and weakened support systems over the past few years, the World Health Organization estimated a 25 percent increase in anxiety and depression worldwide, with women and young people worst hit.

A large part of the challenge are the cavernous gaps in care: 158 million Americans live in an area with a shortage of mental health workers. And while the rise of telehealth and creation of the 988 suicide and crisis lifeline have helped, they are only Band-Aids, barely holding together a system failing at its seams. Were at a point in the U.S. where it almost couldnt get worse, says Kenneth Pages, a Florida doctor and former chief of psychiatry at Tampa General Hospital. Describe worse to me at this point.

Daunting as they may be, these challenges have inspired a new wave of digital psychiatry solutions, offering automated promise where humans have fallen short. Largely developed by computer scientists and consumer tech entrepreneurs, the new field leverages smartphones and wearable sensors to provide mental health insights, attracting more than $10 billion in funding worldwide between 2020 and 2022, according to technology market intelligence firm CB Insights. John Torous, director of the Digital Psychiatry Division at Beth Israel Deaconess Medical Center in Boston, argues that the mental health crisis were all talking about really requires more transformative solutions.

Left open are broad questions over this nascent field and the trend toward shifting health care into a digital-first field. What does it mean to remove humans from something as fundamentally interpersonal as our mental health? And is digital psychiatry worth all the hype?

When you first consider digital psychiatry, you might think about the laundry list of apps ready to download on your smartphone: Calm, Headspace, Sanvello, Bearable, Happify and many others with similarly cheery names. These apps are personal assistants of sorts, helping users engage in guided meditations, mindfulness exercises, anxiety management and other activities, with customized wellness plans based on user preferences and lifestyles. While most of these apps offer free versions, accessing the full range of contentparticularly the personalized toolsrequires subscriptions ranging between $27.99 to $350 per year.

These companies advertise slogans like Become the architect of your health, and they say that Youll be surprised at how soon youll start feeling a positive change, but they are also quick to note that the apps are not meant for clinical use. We are not a health care or medical device provider, nor should our products be considered medical advice, Headspace emphasizes, before adding that its app makes no claims, representations or guarantees that the Products provide a physical or therapeutic benefit. Most others offer similar disclaimers.

That being said, some of these apps can be helpful. Recent data from nonclinical participants suggest that Calm and Headspace offer modest improvements across mindfulness, well-being, stress, anxiety and depression. Clinical psychologist Vara Saripalli says a lot of her patients already use these apps, and she even recommends some of them for patients who are anxious or want practice sorting through their thoughts and feelings. As an adjunct where your provider is checking in about your use of one of these tools, she continues, that can be helpful.

Beyond the consumer-facing apps, firms also offer software to help clinicians better care for their patients. The TrakStar platform, for instance, helps clinicians manage transcranial magnetic stimulation, an FDA-approved therapy for major depressive disorder, obsessive-compulsive disorder, migraines and smoking addiction. More specifically, TrakStar helps determine patient eligibility and insurance coverage, tracks patient-reported outcomes during treatment to assess efficacy and adverse events, and continues to monitor patients post-treatment through questionnaires in case they relapse. The platform notifies a provider if a patient gets worse so the provider can reengage with the patient.

Many of our patients waited until they completely crashed into a deep depression in order to seek help, even if they had previously recovered, says Cory Anderson, the companys vice president of clinical affairs and medical operations. What TrakStar is doing is monitoring these patients after their treatment to make sure they dont crash. He calls it an early warning system, with the ultimate goal being to expand health care capacity. In Andersons ideal world, mental health providers could quickly divert their attention to patients experiencing severe crises rather than being spread thin across all patients.

This mission to use digital tools to augment professional care is shared by academic researchers. Beth Israels Torous, for instance, invented MindLAMP, a digital psychiatry platform that collects info on sleep patterns, physical activities, physiological symptoms and call and text logs to offer patients customized mindfulness, meditation and breathing interventions. Although the app can take in data across wearable technology, surveys and GPS tracking, Torous emphasizes that clinicians and patients collaboratively decide which particular data streams to collect and then interpret them together in the clinic. We built it to be a more customizable, flexible way to use smartphones to augment care, Torous says.

So far, this approach appears promising: Across India, China, Australia, Canada and the U.S., MindLAMP has been used to digitally provide therapy to patients with schizophrenia, track memory loss in patients with Alzheimers, and understand differences in the disease trajectories of bipolar disorder and depression. If we can, in the future, start using algorithmsones that are evidence-basedI think we can begin to offer people a lot more responsiveness and features on LAMP to help them feel better quicker, says Torous.

Right now, MindLAMP is run by a research protocol without any investors, and there are no plans currently to spin the platform out into a business. Wed like to keep it as a common tool that people can use, Torous continues. They can do replicable science in this spacethey can add to it, augment it. He wants to provide a free platform for other researchers to validate and build off, in a field sometimes devoid of data-driven solutions.

Like Torous, Paola Pedrelli, associate director of the Depression Clinical and Research Program at Massachusetts General Hospital, and Judith Law, CEO of Anxiety Canada, value these types of academia-led innovations in digital psychiatry. For the past seven years, Pedrelli has been working with Rosalind Picard at MIT to develop machine learning algorithms that detect the severity of depressive symptoms among patients. And since 2012, Law has been collaborating with Mayo Clinic, University of British Columbia, University of Waterloo and other institutions on MindShift CBT, an anxiety management coaching app. Based on cognitive behavioral therapy, the goal is to challenge patients thoughts, beliefs and attitudes to improve their emotional well-being.

Pedrelli hopes that eventually, by collecting heart rate, sweat gland activity, temperature and movement from wearables, she and Picard will be able to prioritize patients experiencing acute relapses and proactively modify treatments before they fall into a deep depression. But in the meantime, MindShift CBT doesnt collect physiological data and instead contains modules to educate users on anxiety and engage them in skill-building exercises to support coping. A distinctive aspect of this free app is its community forum where users can learn from others experiences in a moderated space, providing and receiving peer-to-peer support. According to Lance Rappaport, a clinical psychologist at the University of Windsor and senior author of an upcoming study on MindShift CBT, anxiety, depressive symptoms and functional impairment decreased and quality of life increased among a cohort of more than 200 people who used the app for 16 weeks.

For digital psychiatry to succeed, Law says, the field will need to build its evidence base, actually proving that these tools have a clinical benefit in users. And if they dont, regulators may need to step in and hold companies accountable to produce the evidence. If Calm, Headspace and all these other products, ultimately, are more interested in the evidence base versus profitability, then I think were headed in the right direction, says Law.

Unfortunately, with billions of dollars of investor funding, some companies have tested ethical and legal boundaries in how they offer patient care. The platform Koko recently admitted to using artificial intelligence chatbots in place of humans to provide emotional support to customers without their consent. And last year, mental health telemedicine company Cerebral was placed under investigation by the Department of Justice for overprescribing the controlled substances Adderall and Xanax without requiring in-person evaluations. Companies that are for-profit are going to cut corners, says Saripalli. Im really concerned about the lack of quality of care that is going to proliferate the more these apps proliferate.

Vanderbilt Universitys Bradley Malin, an expert in biomedical informatics, offers similar concerns: With VC support behind it, theres this push toward quick return as fast as possiblegrow, grow, grow. With around 20,000 mental health apps currently available on the marketplace, ensuring these technologies are validated and demonstrate tangible benefit is thus of utmost importance. And doing this properly requires a lot of data collection, independent studies and replicated results.

But how much data is too much? Malin says, Its this push forward toward, We dont know what were looking for. And therefore, were just going to blitz it and collect as much as we want, and then were going to let the computer figure out the answer.

With this shotgun approach to data collection, data breaches, either because of internal mistakes or external hacking, become increasingly risky. Cerebral had been using pixel trackerscode that collects activity datato monitor user engagement for the past four years. And only in 2023 did the company realize that this data was being shared with Meta, TikTok and Google in a breach affecting 3.2 million patients. Similarly, a security flaw in the IT systems of Vastaamo, referred to as the McDonalds of psychotherapy, led to its entire patient database being leaked to the internet, including email addresses, social security numbers and therapists notes. Around 30,000 people received ransom demands from hackers threatening to publish their private information.

And some companies have even shared data willfully. The Federal Trade Commission went after the online counseling service BetterHelp for pushing people to give sensitive health information while promising absolute privacybut then BetterHelp handed that data over to Facebook, Pinterest, Snapchat, Criteo and other advertisers. BetterHelp has since agreed to a $7.8 million settlement for alleged data misuse. Digital psychiatry may promise mental health care from the privacy of peoples homes, but what does that privacy mean in a world of seemingly endless leaks?

According to Malin, any health care provider can search a patients physical informationlab tests, imaging, vitals. But mental health information is only known to those doctors whom it is shared with in consult. And our thoughts are sensitivethey concern other people, about things that have yet to happen, about the world that only we can see. It does make it very juicy information, for lack of a better term, Malin adds. The question is: How much support are you going to provide for personal rights and protection versus the end application?

Such sensitive information leaves little room for error. The penalties of being wrong are severe, says Colin Walsh, an internal medicine physician at Vanderbilt. If an algorithm says an individual is high-risk and they arent, they may receive an intervention that they dont need. Walsh brings up the example of the military, where these kinds of false positives can be career altering: A commander might take that information and not want to send them on deployment.

Already were seeing students forced to withdraw from college after university medical staff inform administrators of their conditionsand workers are getting fired from their jobs after voluntarily disclosing their mental illnesses. With the propagation of digital psychiatry, providers, supervisors and administrators could get access to even richer personalized data, collected through routine onboarding processes or employer-provided mental health services. While these data usually tend to be de-identified, Walsh notes that they can always be re-identified. In his eyes, the rise of digital psychiatry could bring a rise in stigma and discrimination against those with psychiatric conditions.

For the time being, medical health professionals think its unlikely that digital psychiatry will fully replace human clinicians. Apart from the lack of scientific evidence to support these technologies, apps are simply unable to provide a humanistic experience. One of the biggest factors in successful therapy is the quality of the relationship between the individual and the therapist, says Saripalli. I dont think youre going to get a human personalized touch if this is your primary provision of treatment.

If anything, digital psychiatry might exacerbate the very inequities it hoped to address. Indeed, left unregulated, mental health companies can profit off those who cant afford traditional care by offering cheap, ineffective treatments. At the higher end of the income spectrum, people are going to pay for a premium product, and theres no question that in-person, one-on-one individualized attention is going to be superior, Saripalli adds.

Nonetheless, everyone interviewed for this story believes that the digital psychiatry movement is far from slowing downand that providers need to actively participate to ensure it doesnt harm patients. While part of this movement is undoubtedly driven by hype and feckless profiteering, real potential exists for digital solutions to alleviate the burdens of a mental health care system on the brink of collapse. The question becomes how to identify these promising use-cases and bring together mental health providers, data privacy officials and patients to ensure that we are progressing in an evidence-based, secure way.

Theres this idea, move fast and break thingsthat old Silicon Valley mantra, says Walsh. In health care, that means people get hurt.

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Can Digital Psychiatry Really Fill the Mental Health Care Gap? - Smithsonian Magazine

Internal Medicine

Global Osteoarthritis Leaders Host OA Innovation Shark Tank Meeting at U.S. Congress to Showcase Promise of New Cures Call for Increased Federal…

Rep. Connolly and Congressional Arthritis Caucus Cheer the New Science Salute Innovation and Mark National Arthritis Awareness Month

WASHINGTON, May 12, 2023--(BUSINESS WIRE)--Marking National Arthritis Awareness Month in May, Angry@Arthritis and the Arthritis Foundation yesterday hosted the annual OA Innovation "Shark Tank" meeting on Capitol Hill to spotlight the promise of new treatments to cure osteoarthritis (OA). As researchers and industry demonstrate the success of OA treatments in clinical trials, the arthritis community is saluting innovation and asking Congress for increased OA funding to help cure this disease that afflicts one in seven American adults.

Clinical trials are very expensive. Today, its impossible to see the current level of federal research funding for OA treatments or to understand the impact of the investments Congress is currently making. The community is asking for the Government Accountability Office or the Congressional Research Service to audit current federal OA investment levels and impact, as well as generate an integrated annual report on federal OA research progress.

More than 32.5 million American adults suffer with OA, and more than five percent of the global population are afflicted with the disease. As our population ages, OA is a growing concern 100 percent of people will suffer with OA if we live long enough. OA can afflict any and all joints in the body and today, Americans receive 790,000 knee and 450,000 hip replacements per year, while far larger numbers live with the pain and avoid troublesome joint replacements. There is no effective treatment of OA in the hands and many other joints. Each year, OA costs the U.S. economy $71 billion in lost productivity and inflicts $65.5 billion in medical expenses. While there are a number of treatments in the FDA approval process, currently there is no FDA approved OA treatment. The guidance to lose weight, exercise, and eat healthy is great but this is a much bigger problem.

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This annual OA Innovation Shark Tank program brings together the leading minds in OA research and clinical disciplines from across America and around the world to present their treatments, opinions, research, and human clinical trial data. The treatments target OA in a series of different joints. The program puts a spotlight on the promise of cures and makes the case for additional investment from government and the pharmaceutical industry. In addition to opening remarks from Rep. Gerry Connolly (D-VA), the program featured:

Dr. Elizabeth "Blair" Solow, M.D., Associate Professor of Rheumatology, Department of Internal Medicine at University of Texas Southwestern Medical Center; and chair of the America College of Rheumatology Government Affairs Committee. Dr. Solow provided a rheumatologists clinician perspective and spoke to the disease modifying OA treatment desert in patient care. She underlined the urgent need for new innovation and increased federal research and development funding to improve patient care and outcomes.

Dr. Ivan Martin, Chair of the Department of Biomedicine at the University of Basel, Switzerland. Dr. Martin reviewed his teams Nasal Tissue Engineered Cartilage (N-TEC) treatment that harvests cells from nasal cartilage and grows them into cartilage patches which are surgically inserted into cartilage defects and damaged OA joints. His team has treated more than 100 human patients knees, shoulders, and ankles with N-TEC.

Dr. Jennifer Elisseeff, Director of the Translational Tissue Engineering Center at Johns Hopkins University. Dr. Elisseeff is a pioneer in regenerative immunology treatments that empower patients bodies to repair their joints themselves. She created the original recipe for the anti-aging, senolytic OA drug UBX0101 that recently exited FDA clinical trials. Dr. Elisseeff talked about the promise of regenerative immunology and senoyltics.

Dr. Brad Estes, CEO and founder, CytexOrtho, in North Carolina. Dr. Estes reviewed his teams work restoring damaged joints using a cutting-edge regenerative medical implant designed to mimic native tissues. CytexOrtho recently received Breakthrough Device Designation for its joint repair product and is currently in the process of entering human clinical trials in the hip later this year.

Dr. Yusuf Yazici, Chief Medical Officer at Biosplice Therapeutics Inc. based in San Diego, California. Dr. Yazici presented data on Lorecivivint, an injectable CLK/DYRK inhibitor thought to modulate Wnt and inflammatory pathways, in development as a potential pain and disease-modifying treatment for knee osteoarthritis. Lorecivivint is currently in phase 3 clinical trials.

"Osteoarthritis is crippling Americans and our economy," said Steve OKeeffe, founder, Angry@Arthritis. "But it is not inevitable and its not incurable. To steal a line from CytexOrtho, people dont want to replace their joints they want to renew them. We need to disrupt the inevitability of the failing status quo. We have many innovative new treatments that are proving effective in clinical trials America needs to know. Our government and industry players need to jump into this fight and invest in osteoarthritis research and cures. We encourage you to contact your Congressional representative 32.5 million Americans thats a powerful voting block."

"Scientific advancements are moving at a lightning speed, and they can really make a difference in OA treatment but were disappointed that the funding and support just dont add up," said Anna Hyde, Vice President of Advocacy and Access for the Arthritis Foundation. "As part of our commitment to leading the way to scientific breakthroughs, were pushing for lawmakers to increase the federal investment in arthritis research and help make real progress in helping millions of Americans live free from OA pain."

About Angry@Arthritis

Angry@Arthritis is a new 501(c)(3) focused on attacking and eliminating osteoarthritis http://www.angryarthritis.org. Angry@Arthritis provides the patients guide to OA, raises money to fund new cures, and advocates for OA to the U.S. Congress.

About the Arthritis Foundation

The Arthritis Foundation is fighting for all people who live with arthritis. As Champions of Yes, the Arthritis Foundations mission is to turn the obstacles arthritis causes into opportunities. The Arthritis Foundation champions life-changing solutions and medical advancements, and it also provides ways for people to connect, break down barriers in health care and join the fight to conquer arthritis uniting hearts, minds and resources to change the future of arthritis. To join the fight to conquer arthritis, visit arthritis.org.

View source version on businesswire.com: https://www.businesswire.com/news/home/20230512005358/en/

Contacts

Whitley TaylorOKeeffe & Companywtaylor@okco.com (757) 287-2167

Marlena ReedArthritis Foundationmreed@arthritis.org (470) 588-9755

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Internal Medicine

Consistent poverty linked to higher mortality rates – Healio

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Poverty should be considered a major risk factor for death in the United States, according to the results of research published in JAMA Internal Medicine.

The United States consistently has a poverty rate much higher than similarly wealthy countries, which presents an enormous challenge to population health, given that considerable research demonstrates that being in poverty is bad for ones health, David Brady, PhD, a professor of public policy at University of California, Riverside, and colleagues wrote.

Although previous research has offered valuable contributions on income and mortality, the researchers wrote that the quantity of mortality connected with U.S. poverty is unknown. So, they conducted a cohort study to estimate the associations between mortality and poverty and quantify the proportion of deaths linked to poverty.

Brady and colleagues evaluated the Panel Study of Income Dynamics 1997 to 2019 data merged with the Cross-National Equivalent File, ultimately including 18,995 respondents aged 15 years or older. The survey observed mortality from surviving family members and validated with the National Death Index. When it came to measuring socioeconomic status, the higher quality household income measure included all income sources and taxes and was adjusted for household size.

Brady and colleagues found that poverty was linked to a greater mortality hazard of 1.42 (95% CI, 1.26-1.6). Consistently being in poverty referred to as cumulative poverty was linked to a greater mortality hazard of 1.71 (95% CI, 1.45-2.02).

Current poverty was associated with 6.5% of deaths (95% CI, 4.1-9) among those aged 15 years or older in 2019. Among that same demographic, cumulative poverty was linked to 10.5% of deaths (95% CI, 6.9-14.4).

Current poverty was connected to higher mortality than major causes like stroke, accidents and lower respiratory diseases, according to the researchers. It was also linked to higher mortality than far more visible causes, they wrote. For instance, current poverty mortality was responsible for 2.6 times as many deaths as drug overdose, 3.9 times as many deaths as suicide, 4.7 times as many deaths as firearms and 10 times as many homicides.

However, cumulative poverty was linked to approximately 60% greater mortality than current poverty and higher mortality than obesity and dementia. The researchers wrote that the only causes or risks with greater mortality than cumulative poverty were cancer, smoking and heart disease.

Because the U.S. consistently has high poverty rates, these estimates can contribute to understanding why the U.S. has comparatively lower life expectancy, Brady and colleagues wrote. Because certain ethnic and racial minority groups are far more likely to be in poverty, our estimates can improve understanding of ethnic and racial inequalities in life expectancy.

Brady and colleagues additionally noted that disparities in survival between those in poverty and those not in poverty begin to emerge at around 40 years of age. The gap peaks around 70 years of age, they wrote, and then begins to converge again.

The mortality associated with poverty is also associated with enormous economic costs, the researchers wrote. Therefore, benefit-cost calculations of poverty-reducing social policies should incorporate the benefits of lower mortality.

Brady and colleagues also noted that poverty likely aggravated the mortality impact of COVID-19, which occurred after our analyses ended in 2019.

Therefore, one limitation of this study is that our estimates may be conservative about the number of deaths associated with poverty, they wrote. Ultimately, we propose that poverty should be considered a major risk factor for death in the U.S.

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Internal Medicine

Poor performance in non-lame Standardbreds often involves several … – Horsetalk

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Poor performance in Standardbred racehorses without lameness issues often involves multiple problems, researchers in Italy report.

Chiara Lo Feudo and her fellow researchers, writing in the Journal of Veterinary Internal Medicine, said poor performance is a common and complex condition of racehorses, usually associated with subclinical disorders.

In addition to musculoskeletal conditions, medical disorders are common, and their identification can be challenging for veterinarians.

In fact, poorly performing horses are mostly normal on physical examination, and the identification of underlying medical diseases often requires dynamic tests. Multiple disorders can affect horses at the same time, and it can be difficult to determine the contribution of each to impaired racing performance.

The study team, with the University of Milan, set out to describe the prevalence and distribution of medical disorders diagnosed in a population of poorly performing Standardbred trotters and their associations with fitness variables measured during a standardized treadmill test.

In addition, the associations between simultaneously encountered diseases was evaluated, and the contribution of each disorder on changes in fitness-related variables in a multifactorial setting was determined.

The medical records of Standardbred trotters referred for poor performance to the Equine Sports Medicine Unit of the Veterinary Teaching Hospital at the University of Milan between 2002 and 2021 were reviewed.

All of the 259 non-lame horses identified were in full training upon admission. The age of the horses varied from 2 to 9years. They were made up of 93 females, 146 stallions and 20 geldings.

All underwent a standard diagnostic evaluation for poor performance, with identification of subclinical causes.

The diagnostic protocol included a resting examination, plasma lactate concentration, a treadmill test with continuous heart monitoring and assessment of fitness variables, creatine kinase activity, a treadmill endoscopy, postexercise tracheobronchoscopy, bronchoalveolar lavage, and gastroscopy.

The prevalence of different disorders was evaluated, including cardiac arrhythmias, exertional myopathies, dynamic upper airway obstructions, exercise-induced pulmonary hemorrhage (bleeding from the lungs), moderate equine asthma and gastric ulcers.

Moderate equine asthma and gastric ulcers were the most common disorders identified, followed by bleeding from the lungs, dynamic upper airway obstructions, cardiac arrhythmias, and exertional myopathies diseases that affect the muscles that control voluntary movement.

Hemosiderin scores were positively correlated with levels of neutrophils, eosinophils, and mast cells in lavage fluid. Increased creatine kinase activity was linked with neutrophilia in lavage fluid, dynamic upper airway obstructions, premature complexes (when the lower chambers of the heart contract before they should), and gastric disease affecting the upper squamous portion of the stomach.

Treadmill velocity at a plasma lactate concentration of 4mmol/L and at a heart rate of 200 beats per minute was negatively affected by neutrophilia in lavage fluid, multiple dynamic upper airway obstructions, exertional myopathies, and squamous gastric disease.

The multifactorial nature of poor performance was confirmed, the researchers said, with moderate equine asthma, dynamic upper airway obstructions, myopathies and equine gastric ulcer syndrome representing the main diseases involved in fitness impairment.

Two or more disorders were simultaneously observed in almost 90% of the horses.

The most commonly diagnosed disorders were gastric ulcer syndrome and moderate equine asthma, followed by bleeding in the lungs, equine glandular gastric disease and dynamic upper airway obstructions.

All disorders, except for premature complexes, were associated with one or more fitness variables.

The greatest impairment of fitness was related to the diagnosis of exertional myopathies, severe and multiple dynamic upper airway obstructions, neutrophilic inflammation of the lower airway, and severe grades of squamous gastric disease.

A definitive diagnosis was reached for 254 of 255 horses, which suggests that the diagnostic protocol performed in our study was comprehensive enough to evaluate the most common subclinical non-orthopedic causes of racing poor performance.

Gastric ulcers were diagnosed in almost all horses, with severe squamous gastric disease (grade 3 or 4) detected in 87% of the horses, whereas the prevalence of glandular gastric disease was approximately 58%.

Respiratory diseases represented an equally common cause of poor performance among the study horses. A diagnosis of mild to moderate asthma was made in 97% of the horses, with the majority of them affected by a mixed inflammatory form.

The authors noted that mild to moderate asthma is universally recognized as one of the most common causes of impaired athletic capacity in horses.

Based on endoscopy, around 60% of the horses had blood in the trachea, but only 17% were positive for exercise-induced pulmonary hemorrhage (EIPH) based on their total hemosiderin score and could therefore be considered bleeders.

Clinically relevant premature complexes were detected in 18% of the horses during treadmill exercise.

Finally, post-exercise creatine-kinase activity was higher than normal in 11% of the horses, whereas clinical myopathies (observed during hospitalization or inferred by history) affected 17% of the horses.

Exertional rhabdomyolysis is reported to have a prevalence of 6% among Standardbred racehorses, which may be higher in our study because of the inclusion of only poorly performing horses.

The researchers said the horses in the study came from different training centers over a period of 20years. Therefore, different training techniques may have influenced the results.

Finally, because our study was performed retrospectively and only included poorly performing Standardbred racehorses, future studies should verify whether or not the identified associations are found in a mixed population, including a control group of well-performing horses.

The study team comprised Lo Feudo, Luca Stucchi, Bianca Conturba, Giovanni Stancari, Enrica Zucca and Francesco Ferrucci, all with the University of Milan.

Lo Feudo, CM, Stucchi, L, Conturba, B, Stancari, G, Zucca, E, Ferrucci, F. Medical causes of poor performance and their associations with fitness in Standardbred racehorses. J Vet Intern Med. 2023; 1- 14. doi:10.1111/jvim.16734

The study, published under a Creative Commons License, can be read here.

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Internal Medicine

Q&A: What impact did ID experts have on the COVID-19 pandemic? – Healio

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Throughout the COVID-19 pandemic, infectious disease experts made contributions to help control the outbreak and improve public understanding of the new disease.

Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, and colleagues wrote in a recent paper that these efforts went well beyond their usual responsibilities and often led to hours of additional work without additional compensation.

We spoke with Adalja about the impacts infectious disease (ID) experts had and what they mean for the future for both ID experts and potential pandemics.

Healio: What prompted this paper?

Adalja: The prompt for this paper which is a distillation of a larger report was the tremendous ID expertise the nation relied upon throughout the pandemic. This expertise was not just in-hospital treatment of patients but extended far outside hospital walls into communities and added much resiliency to communities and organizations. Often, this work was voluntary and uncompensated but so vital.

Healio: What were some of the most notable contributions the ID workforce made to the COVID-19 response?

Adalja: The ID workforce helped reopen schools, gyms and workplaces. Some ID physicians even helped sports teams, entertainment venues, consulted on movie filming and provided expert forecasting to financial firms.

Healio: What were the impacts of these contributions?

Adalja: Its hard to quantify the impact, but it was core to resiliency and recovery of many communities and organizations.

Healio: What recommendations does the paper suggest to help fortify the ID workforce for future pandemics, and why is it important to do so?

Adalja: The recommendations are to recognize the enormous value that ID physicians provide to communities by making the specialty attractive to training physicians. ID is not a highly compensated subspeciality paradoxically because it is a cognitive specialty and not one that is procedure based. The extra training, for example, an internal medicine physician undergoes to become an ID physician will actually lower their salary. The formula that the government and other payers employ undervalues mental effort and must change. Loan repayment programs can also play a role.

Healio: Do you think the U.S. is in better shape for the next pandemic than it was before COVID-19?

Adalja: Although I think the pandemic opened peoples eyes to how calamitous and deadly a pandemic could be in the 21st century, complacency is already setting in. This is just not a priority for political leaders whose time horizon is just the next election. The missteps that occurred in the early mpox response illustrate this. However, there is hope that the public will demand competence in this field from governments because the pandemics toll was magnified by government failures at all levels.

Healio: What is the main take away from this paper?

Adalja: ID physicians are on all the front lines protecting individuals and society from the threat of infectious diseases. The modern human way of life is one in which an individual benefits from much that ID physicians do, even if they have never seen one for medical care.

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Q&A: What impact did ID experts have on the COVID-19 pandemic? - Healio

Internal Medicine

Nagasaki University Presented Results Of a Specified Clinical Trial On The Use of L. lactis strain Plasma For Patients With COVID-19 – Yahoo Finance

TOKYO, May 11, 2023--(BUSINESS WIRE)--Nagasaki University presented the results of a specified clinical trial on patients with COVID-19 using Lactococcus. lactis strain Plasma*1 (L.lactis Plasma, a postbiotic), researched and developed by Kirin Holdings Company, Limited (Kirin Holdings). The results of this research was presented at the 63rd Annual Scientific Meeting of the Japanese Respiratory Society on Sunday, April 30. Nagasaki University and Kirin Holdings have jointly filed a patent application for the findings of this specified clinical trial.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20230510005547/en/

Specified Clinical Research Contents (Graphic: Business Wire)

1 Lactococcus lactis subsp. lactis JCM 5805 is owned by the RIKEN BioResource Research Center (https://web.brc.riken.jp/en/)

Since December 2019, COVID-19 infections have repeatedly caused pandemics, infecting 676.57 million people worldwide and killing 6.88 million (as of March 10, 2023). With the emergence of Omicron variants, the number of cases in Japan has increased, and the COVID-19 has become a more familiar infectious disease. Although SARS-CoV-2 vaccines have introduced widely and patients with mild illnesses account for a large proportion of the affected population, only a limited number of drugs are available in patients with mild illnesses who are not at risk of developing severe illnesses, and treatment is mainly based on symptomatic therapy.*2 Therefore, there is eagerly awaited for an easily accessible, safe, and effective treatment for COVID-19 in the community.

L. lactis strain Plasma was discovered by Kirin in 2010 as a lactic acid bacteria that activates plasmacytoid dendritic cells (pDC), which are a leader of the immune system. Previous basic studies showed that L.lactis Plasma stimulated pDC to have a first-line defense to viral infectious diseases. Previous clinical studies have also shown that L.lactis Plasma stimulated pDC and suppress the onset of an illness from influenza virus, rotavirus, and dengue. These scientific evidence of its immune function brought L. lactis Plasma registered as the first*4 Food with Functional Claims in Japan on August 2020.

Story continues

Based on the results of Kirin Holdings research on L. lactis Plasma, Nagasaki University, as a research institute with significant achievements in the field of infectious diseases, interested in L. lactis strain Plasma which may effect in relieving symptoms in patientis with COVID-19, and has decided to conduct a specified clinical trial from December 2021.

Since December 2021, Kirin Holdings has been engaged in a specific clinical research project led by Dr. Kazuko Yamamoto, a lecturer at the Department of Respiratory Medicine, Nagasaki University Hospital (currently a professor and chair at the Division of Infectious Diseases, Respiratory and Gastroenterological Medicine (First Department of Internal Medicine), University of the Ryukyus Graduate School of Medicine). This is a multicenter, double-blinded, randomized controlled trial conducted at Nagasaki University Hospital as a core facility. The efficacy and safety of 14 days oral intake of 4 hard capsules containing L. lactis Plasma (400 billion L. lactis Plasma in total) or 4 hard capsules without L. lactis Plasma (placebo) was to be evaluated*5 by having 50 patients with COVID-19 in each group.

2 Approach to Pharmacotherapy for COVID-19 Version 15.1- the Japanese Association for Infectious Diseases3 Secrets of Immunity - Kirin's L. lactis strain Plasma Research https://health.kirin.co.jp/en/about/about.html 4 The first brand in Japan to be registered with the Consumer Affairs Agency as a food with a functional claims for immune function.5 Yamamoto K, et al. BMJ Open 2022;12:e061172

1, Change in subjective symptom overall score (primary endpoint)

The results of an overall score analysis of seven subjective symptoms (Cough, Shortness of breath, fatigue, Headaches, Anosmia and Dysgeusia, Anorexia, and Chest pain) on a 4-point scale (0 points: not affected, 1 points: little effect, 2 points: affected, 3 points: severely affected) showed no difference between the two groups.

2, Anosmia and Dysgeusia (secondary endpoints) (Graph1)

The percentage of patients who scored 0 (not affected) for smell and taste dysfunction among subjective symptoms were high in the L. lactis strain Plasma group compared to placebo group after day 9.

3, Percent change in blood pDC (secondary endpoint) (Graph2)

While the placebo group showed a significant decrease in % pDC in the blood during COVID-19 clinical course, the L. lactis strain Plasma group maintained % pDC in the blood.

4, Percent change in SARS-CoV-2 viral load (secondary endpoint) (Graph3)

The L. lactis strain Plasma group showed a significant reduction of SARS-CoV-2 viral load at day 4 of treatment whereas placebo group showed reduction at day 8.

5, Safety and adverse events

No critical adverse events of safety were observed in this study.

Although this study did not show an effect on the primary endpoint, the subjective symptom total score, these results suggested that maintained pDC by the intake of L. lactis strain Plasma may have resulted in an early reduction of SARS-CoV-2 and early recovery of smell and taste dysfunction.

Nagasaki University and Kirin hope that L. lactis Plasma will become one of the new treatment or adjunctive care to patients with mild COVID-19.

About Kirin Holdings

Kirin Holdings Company, Limited is an international company that operates in the Food & Beverages domain (Food & Beverages businesses), Pharmaceuticals domain (Pharmaceuticals businesses), and Health Science domain (Health Science business), both in Japan and across the globe.

Kirin Holdings can trace its roots to Japan Brewery which was established in 1885. Japan Brewery became Kirin Brewery in 1907. Since then, the company expanded its business with fermentation and biotechnology as its core technologies, and entered the pharmaceutical business in the 1980s, all of which continue to be global growth centers. In 2007, Kirin Holdings was established as a pure holding company and is currently focusing on boosting its Health Science domain.

Under the Kirin Group Vision 2027 (KV 2027), a long-term management plan launched in 2019, the Kirin Group aims to become A global leader in CSV*, creating value across our world of Food & Beverages to Pharmaceuticals. Going forward, the Kirin Group will continue to leverage its strengths to create both social and economic value through its businesses, with the aim of achieving sustainable growth in corporate value.

* Creating Shared Value. Combined added value for consumers as well as for society at large.

View source version on businesswire.com: https://www.businesswire.com/news/home/20230510005547/en/

Contacts

Press ContactCorporate Communication DepartmentKirin Holdings Company, LimitedNakano Central Park South, 4-10-2 Nakano, Nakano-ku, Tokyo+81-3-6837-7028https://www.kirinholdings.com/en/ kirin-cc@kirin.co.jp

General Affairs Section, Nagasaki University Hospital (Public Relations and Evaluations)1-7-1 Sakamoto, Nagasaki, Nagasakihttp://www.mh.nagasaki-u.ac.jp/en/ mhweb@ml.nagasaki-u.ac.jp

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Nagasaki University Presented Results Of a Specified Clinical Trial On The Use of L. lactis strain Plasma For Patients With COVID-19 - Yahoo Finance

Internal Medicine

Post-Roe abortion bans force pregnant people with life-threatening … – Michigan Advance

Jennifer Adkins first pregnancy was near-perfect.

She sailed through her appointments and screenings with no complications, ticking every box and making lists of all the right questions to ask her medical professionals. By the time her unmedicated labor was over and the nurses placed her newborn son on her chest, Adkins felt like a superhero.

So when she discovered she was pregnant again the day after Valentines Day, she was ready for another home run. The baby would be due on Halloween, and she and her husband affectionately referred to it as Baby Spooky. Maybe theyd find out the sex beforehand, maybe it would be a surprise. They hadnt decided yet.

On April 21, Adkins saw her doctor for a routine screening by ultrasound to measure the collection of fluid behind the fetus neck. And even without a medical degree, she could tell by the picture on the ultrasound that something was wrong. Sitting in the genetic counselors office that afternoon,

Adkins learned her 12-week-old developing fetus likely had Turner syndrome, a chromosomal abnormality that ends in miscarriage in 99% of cases. Turners occurs when one of two X-chromosomes for a female is deleted, often from all cells. The few babies that do survive still have deletions in some cells that cause significant heart defects, fertility issues, kidney abnormalities and a range of other disabilities.

The normal measurement is less than 3 millimeters, according to Dr. Maria Palmquist, a maternal-fetal medicine specialist at Saint Alphonsus Regional Medical Center in Boise, Idaho. Palmquist said Adkins fluid measured at 11.7 millimeters, with additional fluid accumulating under the skin and around the body of the fetus, known as edema. The combination of increased fluid and skin edema is a condition known as hydrops fetalis, a severe form of swelling that is often fatal.

The doctor said basically, lightning struck this pregnancy, theres nothing you can do, Adkins said. This just happens in 1% of all pregnancies.

Following the U.S. Supreme Courts decision in June 2022 to overturn Roe v. Wade and allow states to regulate abortion access, 14 states have enacted near-total or total abortion bans, while others continue to pass abortion ban laws that become tied up in state and federal court. The patchwork laws create reproductive health care deserts, sometimes as much as an eight-hour drive or a flight across the country, forcing pregnant people to travel at great financial and often emotional costs, even if the termination of the pregnancy would prevent devastating health effects.

There are no abortion bans yet that criminalize the pregnant person. Instead, criminal penalties are focused on medical providers or others who help someone obtain an abortion. The charges in most states are felonies, with punishment ranging between two years and life in prison, and physicians face suspension or revocation of their medical licenses.

Because Adkins lives in a state with an abortion ban, she faced one of two options: Either continue carrying the pregnancy knowing it would almost certainly end in miscarriage or stillbirth and jeopardize her own health in the process or make a trip out of state for termination.

Idaho has a near-total ban on abortions that applies to any stage of pregnancy, with exceptions for cases of rape and incest with an accompanying police report during the first trimester or to save a patients life. Health care providers who violate the statute put their medical licenses at risk and face between two and five years in prison, along with civil penalties of $20,000 against individual providers if family members decide to sue.

Since Roe fell, residents in states with bans like Texas have to travel much farther to obtain an abortion. TheTexas Observerreported the average number of miles a resident must travel increased from 44 miles to 497 miles. Texans often go to New Mexico, where some abortion providers fled andopened new clinics. Washington abortion providers have reported seeing patients fromseven statesaround the country within one day.

In the Southeast, where nearly every state has a highly restrictive ban, states such as Louisiana and Mississippi arehours awayfrom the nearest abortion clinic. For many, the closest state is Florida, and the outcome of a Florida Supreme Court case over a law banning abortion at 15 weeks could determine whether a six-week bansigned in Aprilby Republican Gov. Ron DeSantis will go into effect. If it does, the distance to access abortion for many residents in that region of the country will become much greater.

A studyreleased in Aprilconducted by international reproductive health care journal Contraception found that women who were forced to travel for abortion care described it as emotionally burdensome, saying it caused distress, anxiety and shame.

Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs, the study said. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal.

Adkins said seeking care in another state made her feel like a criminal and a medical refugee of sorts, and she worried about what others would think of her for terminating. Another physician she saw for a separate issue wanted to keep the pregnancy out of her record entirely as a precaution.

They make this out to be like people that seek abortions are horrible, horrible people, and murderers, and all this stuff, and Im like, that could not be further from the truth. This is a baby that we love with all of our heart and soul. And because we are loving parents, we are choosing this route, not only to be loving parents to that baby, but also to our living son, because I have to think about whats in my best interest so that I can still be here and be healthy enough to take care of my son who needs me, Adkins said.

Idaho physicians have also stopped making referrals for patients in situations similar to Adkins in the wake of a legal opinion sent by Attorney General Ral Labrador at theend of March. Until there is a decision in a lawsuit over the opinion, physicians and Planned Parenthood facilities in Idaho have said they will not make any referrals for abortion-related care outside of the state.

Adkins said if she wasnt as informed about the states laws, she wouldnt have understood what doctors were saying about her options.

They said that I was welcome to leave the state on my own accord and seek health care outside of the state, Adkins said. It was a very odd experience because we were talking basically in code. I understood the nuance, and I understood what they were implying, but it was a very surreal experience.

A brief filed in the lawsuit on behalf of a health system in Idaho detailed a scenario nearly identical to Adkins on the same day she was diagnosed at a different facility. Like the case outlined in the brief, Adkins would be at risk for developing a condition called mirror syndrome, which causes the pregnant person to experience similar symptoms to that of the fetus. Dr. Palmquist told States Newsroom that it can lead to preeclampsia, a life-threatening state of high blood pressure in pregnant people that can cause seizures and organ damage.

Knowing all of this, Adkins decided it was in the best interests of her family, including the nearly 2-year-old son she already had and the daughter she would never get to hold, to terminate the pregnancy.

She hoped to miscarry within the following week so they wouldnt have to make the emotional three-day trip. So she scheduled another ultrasound, but there was still a heartbeat. She was desperate to fix it desperate to stop being a walking coffin for a dying dream.

Its hard knowing that my body and the fetus are trying so hard to hang on, Adkins said. And we had to make a really hard decision. Do we try? But for what purpose? Theres no sense in bringing a child into this world thats not going to survive anyway or have severe complications. And its not fair to any of us.

Idaho legislators made minor changes to the states abortion law toward the end of the legislative session in March to clarify that certain instances where the fetus has already died or ectopic or molar pregnancies would not fall under Idahos abortion ban, declining to proceed with anearlier iterationof the bill that included a clause exempting medical professionals from criminal liability. In that version, providers had to determine if an abortion was necessary to prevent the death of the pregnant woman or to treat a physical condition of the woman that, if left untreated, would be life-threatening.

Dr. John Werdel, an obstetrician-gynecologist at St. Lukes in Boise, said he wasnt sure if Adkins situation would have qualified under the health language in the original bill. She likely would have had to wait until the health effects were more severe, he said.

Many reproductive care physicians in states where abortions are banned have left to practice in other states in recent months, including one maternal-fetal medicine doctor in Tennessee whomoved to Coloradoin January after starting what she described as a dream job in Tennessee in August.

Idahos abortion laws caused Palmquist, one of three maternal-fetal medicine physicians at Saint Alphonsus, to take a job at Desert Perinatal in Las Vegas, Nevada. She is one of several specialists in the state to leave over the new laws since January. She was packing her belongings on Thursday, hoping the laws change soon and allow her to return.

Since June, its just become so complicated to take care of pregnancy complications. Things before that were so straightforward now make us take an extra four to six hours and multiple meetings, Palmquist said. Making sure were protected by EMTALA, making sure this is an emergency medical condition. Does the hospital administration agree, does legal counsel agree? All of that.

A recent study published in the Journal of General Internal Medicine found from a survey of more than 2,000 current and future physicians on social media that 82% preferred to work or train in states with preserved abortion access. More than 76% of respondents said they wouldnt even apply to states with legal consequences for providing abortion care.

At least monthly, we are faced with caring for moms with significant complications, and theres no chance of a viable outcome. But with Idahos restrictions, theres a lot of anxiety about essentially practicing the standard of care, Palmquist said. A year ago, it wouldve been just so straightforward, and now theres all this caution and hesitancy.

Adkins and her husband left their son with grandparents to make the trip to Oregon on a Thursday for her appointment the following morning. TheNorthwest Abortion Access FundandCascade Abortion Support Collectivehelped pay for a hotel room, a rental car and the surgical procedure, which was $850 by itself without insurance. Friends and family sent her Venmo donations for other expenses.

I just started calling organizations because I was like, I dont know what to do. And they said, Were here to help you. And it was so relieving but also absolutely heartbreaking to hear multiple times from multiple people, You are not the only one. We get stories like yours all the time, every day, Adkins said. Every day.

Abortion access in northern Michigan is already limited. Restrictive laws make it worse.

The Planned Parenthood clinic was supportive and professional, she said, and they honored her request to be deeply sedated for the procedure. When she told them why she needed to terminate the pregnancy, they offered to take ultrasound photos beforehand.

Everybody was like, Oh my god, Im so sorry you had to come all this way for this, Adkins said. And theyre right. I shouldnt have had to leave my son and travel hundreds of miles to do this.

Since the procedure was performed in another state and at a Planned Parenthood clinic, Adkins had to ask the doctor to collect the remains of the fetus, the pregnancy tissue and the placenta and package them properly to be sent to a genetic testing clinic. She was also faced with rushing the package of remains to FedEx herself that same day.

While she doesnt regret the decision, Adkins said it was a painful experience that could have been much easier if she had been able to access care in her own state.

I deserve better, and so does everybody else, she said. We cant stop things from happening in pregnancy. Thats why we have modern medicine, to help guide us and protect the things we do have control over. So if we cant stop those horrible things from happening why make it even worse by making the worst experience someone has to go through learning that they will not give birth to a happy, healthy baby why do we make that even worse by saying, We dont value your life enough to try to save it or prevent something bad from happening to you in the meantime?

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Post-Roe abortion bans force pregnant people with life-threatening ... - Michigan Advance

Internal Medicine

Is mineral water good for you? Benefits and disadvantages explained. – USA TODAY

Delaney Nothaft| Special to USA TODAY

Minerals are essential for our bodies to operate smoothly. Dr. Pedro R. Rodriguez Guggiari, an internal medicine specialist and Chief of Staff at Banner Del E. Webb Medical Center in Sun City West, Arizona, says, Minerals help in a variety of ways: like iodine for thyroid (energy and stamina); calcium fluoride for bone and tooth health; iron for blood cell formation and to prevent anemia; magnesium and potassium for muscular function and structural tissues.

Are the minerals found in mineral water also good for you? Whats the best way to get minerals? We spoke with the experts to find out.

Dr. David Nazarian, a board-certified internal medicine specialist and founder of VitaminMD.net, says, Mineral water comes from springs and underground reservoirs and the mineral content can vary depending on the source and geographic location. In general, it can be a source for essential trace minerals such as calcium, magnesium and potassium.

But, mineral water alone, he says, is not enough. Nazarian adds, While mineral water does have higher mineral content than purified or filtered water, it does not contain all the minerals and should not be the sole source for these nutrients.

Elise Heeney, a clinical dietitian at Banner Del E. Webb Medical Center says, The best way to obtain all the vitamins and minerals our bodies need is by eating a diet that includes a variety of fruits, vegetables, whole grains, beans, nuts and seeds, lean proteins and low-fat dairy products. Aim for a well-balanced plate at each meal.

There are also certain foods you can eat that target specific minerals. For example, to get more calcium in your diet, you can try:

Or, if you are trying to get more potassium into your diet, you can try foods like:

There's no question that the vitamins found in vitamin water are important to one's health. What's more,electrolyte-infused drinks are proven to improve physical performance during exercise and can help hydration.

At the same time, the Centers for Disease Control and Preventionwarns againstconsuming food and drinks with too many "added sugars"because they are known to contribute to obesity, type 2 diabetes and heart disease.

Is vitamin water actually good for you? It's complicated, experts say.

What do minerals do for the body? Calcium, magnesium, iron, zinc and what to know.

More: Zinc is an important nutrient, but get it from food, not supplements, experts say

Many people take daily vitamins. What they should know first.

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Is mineral water good for you? Benefits and disadvantages explained. - USA TODAY