One of the recurrent nightmares faced by emergency medicine physicians is: What to do with a severely depressed and suicidal patient when there are no beds in a psychiatric facility?
Recent studies have indicated that one option may be ketamine. Previous studies of injected ketamine had indicated some benefits, but raised real concerns about the need for vital signs monitoring and prolonged observation prior to discharge.
This new study published in the American Journal of Psychiatry shows significant improvement in suicidal ideation and depression after administration of ketamine vía nasal aerosol.
In a double blind, multi-center prospective study, 68 people with severe depression or suicidal ideation were randomly assigned to receive 84 mg of intranasal ketamine or placebo twice weekly for 4 weeks. Significant improvement of depression was observed at 4 hours and at 24 hours in the group which received ketamine. Ketamine also improved suicidal ideation at 4 hours, although not at 24 hours.
Ketamine is not innocuous. Adolescents in particular may experience a adverse reaction where they become transiently agitated. Someone experienced with the use of ketamine should be present. While certainly this is far from definitive treatment, it possibly provides an additional treatment option for emergency situations.
Canuso CM, Singh JB. Fedgchin M, Alphs L et al. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. American Journal of Psychiatry 2018
In a cross sectional study published in the Journal of the American Heart Association looking at 4,426 participants with a median age of 50 years in Sao Paolo Brazil, researchers found that consumption of > 3 cups of coffee per day by persons who have never smoked led to a 63% decrease in the odds of finding significant coronary artery calcifications by CT scan. (OR: 0.37 [95% confidence interval, 0.15–0.91])
Miranda AM, Steluti J, Goulart AC et al. Consumption and Coronary Artery Calcium Score: Cross‐Sectional Results of ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health) Journal of the American Heart Association. 2018;7:e007155, originally published March 24, 2018
Multiple recent medical research studies have shown that exercise, even just walking for several hours a week, can prolong life, decrease the risk of 13 types of cancer, and even prolong survival time in patients with advanced colon cancer.
A prospective cohort study published in October 2017 in the American Journal of Preventative Medicine followed 62,178 men (mean age 70.7 years) and 77,077 women (mean age 68.9 years) for 13 years. They found that walking between 2 and 7 hours per week decreased mortality by 20% (HR = 0.74 CI 0.72 to 0.76). 
A prospective cohort study published in BMJ in February 2018 followed 1181 men between 71 and 92 years of age without pre-existing cardiovascular disease for 5 years to determine their level of physical activity. This study showed that even mild physical activity such as gardening or walking the dog, decreased mortality by 17% (HR = 0.83 CI 0.77 to 0.90) and if it accumulates 150 minutes per week the mortality decreases by 41% (HR = 0.59 CI 0.43 to 0.81). 
In an investigation published in JAMA in June 2016 with 1.44 million participants and an average age of 59 years showed that exercise decreases the probability of contracting 13 of 26 types of cancer: adenocarcinoma of the esophagus (HR, 0.58, 95% CI, 0.37-0.89), liver (HR, 0.73, 95% CI, 0.55-0.98), lung (HR, 0.74, 95% CI, 0.71-0.77), kidney (HR, 0.77, 95% CI, 0.70-0.85 ), gastric (HR, 0.78, 95% CI, 0.64-0.95), endometrial (HR, 0.79, 95% CI, 0.68-0.92), myeloid leukemia (HR, 0.80, 95% CI, 0.70-0.92), myeloma ( HR, 0.83, 95% CI, 0.72-0.95), colon (HR, 0.84, 95% CI, 0.77-0.91), head and neck (HR, 0.85, 95% CI, 0.78-0.93), rectal (HR, 0.87 95% CI, 0.80-0.95), bladder (HR, 0.87, 95% CI, 0.82-0.92), and breast (HR, 0.90, 95% CI, 0.87-0.93). 
Surprisingly, even patients who already have colon cancer have benefited from walking. In a study conducted by Harvard University of 992 men with stage III colon cancer, it was shown that 30 minutes of exercise per day decrease mortality compared to similar patients, in 42%. 
How does exercise prolong life, even in cancer patients?
It is theorized that because exercise increases glucose metabolism, and therefore decreases the level of circulating glucose in the blood, this results in a decrease in insulin levels and eventually a decrease in obesity.
High levels of insulin result in a decrease in insulin-like growth factor binding proteins 1 and 2 (IGFBP1 and IGFBP2), resulting in high levels of insulin-like growth factor-1 (IGF-1.). High levels of IGF-1 increase the risk of cancer of the breast and prostate, but also accelerate cell proliferation. and therefore the growth of several types of tumors with IGF-1 receptors. An increase in exercise and decrease in carbohydrate consumption results in a decrease in insulin and IGF-1 and therefore decreases the proliferation of cancer cells. 
In summary, in patients with cancer it has been shown that the benefit may come from the decrease in circulating insulin levels, because insulin helps multiply the tumor cells. 
In addition to decreasing insulin levels, and therefore IGF-1, exercise decreases estrogen levels. 
1. Patel AV, Hildebrand JS, Leach CR, et al. Walking in relation to mortality in a large prospective cohort of older US adults. Am J Prev Med 2018 Jan;54(1):10-19.
2. Jefferis BJ, Parsons TJ, Sartini C, et al. Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation? Br J Sports Med Published Online 12 February 2018.
3. Moore SC, Lee I, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016;176(6):816–825.
4. Blarigan EV, Fuchs CS, Niedzwiecki D, et al. American Cancer Society Nutrition and Physical Activity Guidelines after colon cancer diagnosis and disease free, recurrence free, and overall survival in CALGB 89803 J Clin Oncol 35, 2017 (suppl/abstr 10006)
5.Manjinder S. Sandhu, David B. Dunger, Edward L. Giovannucci; Insulin, Insulin-Like Growth Factor-I (IGF-I), IGF Binding Proteins, Their Biologic Interactions, and Colorectal Cancer, JNCI: Journal of the National Cancer Institute, Volume 94, Issue 13, 3 July 2002, Pages 972–980,
6. Brown JC, Rickels MR, Troxel AB, et al. Dose response effects of exercise on insulin among cancer survivors. Endocr Relat Cancer. 2018 Jan;25(1):11-19.
7. Brown JC, Kontos D, Schnall MD, Wu S, Schmitz KH. The Dose–Response Effects of Aerobic Exercise on Body Composition and Breast Tissue among Women at High Risk for Breast Cancer: A Randomized Trial. Cancer prevention research (Philadelphia, Pa). 2016;9(7):581-588. doi:10.1158/1940-6207.CAPR-15-0408.
Noone has definitively proven the cause of Alzheimer's disease yet, however there are certain things that everyone agrees on. There is a genetic predisposition in some types. The biomarker is the deposition of beta amyloid protein in plaques found on autopsy, and more recently by PET scan, and this deposition is detectable a decade before symptoms begin. However attempts to cure the disease by eliminating beta amyloid protein have been less than successful.
What has been shown over the years is that there is a diffuse inflammatory process, perhaps a single common pathway with many causes, which leads to the deposition of beta-amyloid. The heartening finding on epidemiological and retrospective case control studies was the effect of Ibuprofen on disease initiation and progression. These results have not been born out by clinical trials, and many have suggested the failure of clinical trials is due to the need to initiate treatment before symptoms begin. The enthusiasm by researchers for this idea is understandable, even as geriatricians around the world shake their heads. What about the side effects of ibuprofen in the elderly which include gastrointestinal bleeding and renal insufficiency? How do we figure out who these people are that need treatment?
This study is a first step in solving the answer to the first question: How to figure out who needs treatment? These researchers report developing an ELISA test on saliva for beta amyloid protein which can detect Alzheimer's disease prior to clinical manifestations. Once that is solved the next question will be what delivery system (perhaps a nasal aerosol?) do we need to bypass the kidneys and GI tract.
McGeer PL, Guo JP, Lee M et al. Alzheimer's Disease Can Be Spared by Nonsteroidal Anti-Inflammatory Drugs. J Alzheimer's Dis (2018) 62 (3): 1219-1222