doctor’s meeting

Studies have shown that transdermal nitroglycerin does not have a significant effect on hot flashes in postmenopausal women.

In the first 5 weeks, the frequency of occurrence decreased by about once a day, but when the dosing cycle was increased to 12 weeks, there was no statistically significant difference from the placebo group.

The results of a study on transdermal nitroglycerin treatment for women with postmenopausal hot flashes conducted by researchers including Allison Hwang of the University of California Medical School, USA, were published in the international journal JAMA Internal Medicine on the 5th (doi:10.1001/jamintered.2023.1977).

About 70% of postmenopausal women experience hot flashes in the face and neck area due to changes in hormone secretion and the skin turns red.

Since the symptoms themselves are caused by estrogen deficiency, hormone replacement therapy that administers estrogen can be used, but in this case, attention is focused on non-hormonal therapies because of the increased risk of venous thrombosis, stroke, and cardiovascular disease.

As physiological studies revealed that nitric oxide is a key factor in mediating vasodilation associated with hot flushes, the researchers hypothesized that inducing nitrogen tolerance with nitroglycerin administration could have an effect on vasomotor symptoms.

The researchers divided participants who reported seven or more hot flashes per day during menopause or postmenopause into two groups: one group received a transdermal nitroglycerin 0.2-0.6 mg/h patch (n=65) and the other group received a placebo (n=69). was administered for 12 weeks to examine the degree of symptom relief.

Participants reported an average of 11 hot flashes and 8.4 severe hot flashes per day.

As a result of the analysis, in the group that applied the transdermal nitroglycerin patch for 5 weeks, the frequency of hot flushes per day decreased by 0.9 times, and severe hot flushes by 1.1 times.

On the other hand, when the duration of treatment was increased to 12 weeks, there was no significant difference in the frequency of occurrence from the placebo group.

Compared to the placebo group, the group using the transdermal nitroglycerin patch reduced hot flashes by an average of 0.1 times per day, and severe hot flashes by 0.5 times, and no significant reduction was observed.

In an analysis combining 5- and 12-week data, there was no significant change in incidence compared to the placebo group.

In addition, a negative effect was observed in the nitroglycerin group, with 47 patients (67.1%) in the nitroglycerin group and 4 patients (5.6%) in the placebo group reporting headaches in the first week of administration.

“This randomized clinical trial confirmed that transdermal nitroglycerin administration did not result in sustained improvement in the frequency or severity of hot flashes compared to placebo,” the researchers said. concluded that

Amid the recent trend of increasing patients with benign prostatic hyperplasia due to the aging population, the related treatment market is also excited.

Among them, ‘Saw Palmetto Extract (Serenoa repens)’ is attracting attention again. In the clinical field, it has already been recognized for its therapeutic effect in Europe, etc.

According to the pharmaceutical industry on the 28th, pharmaceutical companies are competitively launching over-the-counter medicines and health functional foods one after another in line with the recent increase in patients with benign prostatic hyperplasia.

In the case of over-the-counter medicines, recent Dongkuk Pharmaceutical and Hyundai Pharm’s ‘Karitopoten’ and ‘Urintamine Capsule’ are representative. Here, Karitopoten is composed of herbal medicine ingredient cucurbit seed oil extract (Western pumpkin seed oil extract), and urintamine is composed of three main ingredients: L-glutamic acid, L-alanine, and glycine.

Both products claim to improve symptoms of benign prostatic hyperplasia, and have recently been actively engaged in sales and marketing.

Their direct competitor items are dry season foods with ‘saw palmetto extract’ valued at a market of about 100 billion won.

Since last year, the Ministry of Food and Drug Safety has strengthened management, such as establishing new ingredient standards for quality control of dried foods made with saw palmetto extract. While announcing that there is no basis, it is attracting attention as an item that replaces it.

The market is rapidly being reorganized as over-the-counter drugs targeting the niche market are appearing while the withdrawal of dry food items with insufficient content is accelerating due to the stricter ingredient standards for Serenoa Repens, an extract of saw palmetto.

However, in the clinical field, it is evaluated that the need for Serenoa Refens ingredient medicine, which means saw palmetto extract, is still needed in the treatment of mild benign prostatic hyperplasia. This means that it is still used in the pharmaceutical market, apart from dry food, which has an insufficient content.

A representative item is Someto 320mg soft capsule (Serenoa Repens), a treatment for prostatic hyperplasia of Pharmbio Korea.

“In fact, in the early 2000s, the Serenoa Repens component was negative for improving prostate enlargement, but in recent years, it has been changing positively,” said Min Seung-gi, vice president of the Korean Urology Association (Goldman Urology Department, Jamsil Branch).

In fact, Serenoa Repens, the main ingredient of Someto, has already been recognized for its effectiveness in treating enlarged prostates in the European Union and elsewhere.

According to the global medical journal ‘Biological and Pharmaceutical Bulletin’, free fatty acids such as ‘oleic acid’ and ‘lauric acid’, the main ingredients of Serenoa repens, produce dihydrotestosterone, which causes enlargement of the prostate. It was found to inhibit the enzyme ‘5α-Reductase’.

If the dry season food contains 40% of such free fatty acids, Someto, which is classified as a drug, contains 80%, twice as much.

In addition, through Urology Times (Urology Times 2022), although not constant, an interview was published saying that Serenoa Repens ingredients should not be overlooked in the treatment of benign prostatic hyperplasia.

Accordingly, in the clinical field, it is evaluated that Someto, the only Serenoa Refens product that can be applied by health insurance, can be used as a treatment for benign prostatic hyperplasia. Moreover, it is believed that there is an advantage in that it has sufficient clinical data compared to other drugs that have recently been sold and marketed.

Min Seung-ki, Vice Chairman of Insurance, said, “As the Ministry of Food and Drug Safety strengthens the standards for dry foods, many of them are expected to be withdrawn from the market. Accordingly, it seems that OTC drugs are also attracting attention recently.” Medicines still have uses in the clinical field,” he explained.

He added, “It is possible to use medicines sufficiently for patients with mild benign prostatic hyperplasia,” adding, “Moreover, in the case of pharmaceuticals with the corresponding component, reimbursement is possible, but even if they are prescribed for non-reimbursement, they are cheaper than dry food on the market.”

A study has found that being infected with the coronavirus during pregnancy increases the risk of neurodevelopment, such as autism spectrum disorder, in a child born.

These effects were particularly concentrated in male children, and experts say that long follow-up measures are needed for pregnant women and children who have been infected with the corona.

On the 26th local time, JAMA Network open published the results of a large-scale study on the effect of corona infection during pregnancy on a child (10.1001/jamanetworkopen.2023.4415).

As the corona pandemic goes over to endemic, the research in the medical system is also shifting weight due to long covid and its aftereffects.

In particular, the medical community is constantly paying attention to how it affects the child if the mother is infected with corona.

In some studies, it has been reported that being infected with corona during pregnancy can cause a disability in the child’s neurodevelopment, but this is because opinions are mixed as opposite studies are also coming out.

It is because of this background that a research team led by Professor Andrea G. Edlow of Harvard Medical School started a follow-up study on this.

In fact, it is to check whether corona infection during pregnancy directly affects the child.

Accordingly, the research team followed and observed the effect of corona infection on the child for 18,355 mothers who gave birth during the corona pandemic.

As a result, 3% of babies of mothers who contracted COVID-19 during pregnancy were diagnosed with neurodevelopment within 12 months of age. A child of a mother who did not get corona is a significant percentage compared to staying at 1.8%.

Even if all other factors such as race, mother’s age, and premature birth were excluded, corona infection had a great impact on the child.

In particular, these results showed significant differences according to the sex of the child. Boys are affected more strongly than girls.

In fact, if the child born after being infected with corona during pregnancy was a male, the risk of being diagnosed with a neurodevelopmental disorder was 1.94 times, almost doubled.

However, if the child born after being infected with COVID-19 is a female child, the risk is somewhat lower. Conversely, a 10% lower risk of neurodevelopmental disorders compared to the mean (OR=0.89).

However, even in boys, if these signs did not appear by 18 months, the risk of being diagnosed with a neurodevelopmental disorder was reduced by 1.42 times.

Professor Andrea explained, “This is a result that clearly supports previous studies that corona infection during pregnancy can affect neurodevelopment, such as autism spectrum disorder.”

“Due to these risks, a longer follow-up and observation of mothers and children who are infected with COVID-19 are needed,” he said.