Journal Watch November 2020

COVID

COVID-19 and Long-Term Heart Damage: A three-part journal series, published in the Journal of the American College of Cardiology  takes a deeper dive into the impact COVID-19 has on the heart. Nearly a quarter of hospitalized coronavirus patients experience myocardial injury and many develop arrhythmias or thromboembolic disease. Those with preexisting cardiac conditions, like hypertension, diabetes, obesity, or high cholesterol, have a greater risk of worse outcomes with COVID-19.

 

Study finds tocilizumab improves survival in critically ill patients with COVID-19: Researchers from 68 sites across the country found that when tocilizumab was administered within the first two days of intensive care unit (ICU) admission, there was a 30 percent relative decrease (and a 10 percent absolute decrease) in mortality compared to patients whose treatment did not include early use of tocilizumab. JAMA Internal Medicine 

 

Social Distancing will probably be in place a year or more: Experts say social or physical distancing measures against COVID-19 will probably need to remain in place for at least a year. Until the effectiveness of vaccines are and how many people get them is known, it’s important to maintain physical distancing as well as other safety protocols, such as mask wearing.

 

CDC Plans Cellphone COVID-19 Vaccine Tracking System: When a COVID-19 vaccine becomes available, the U.S. Centers for Disease Control and Prevention will monitor those taking the vaccine for any health problems via text messages and online surveys,CNNreported 

 

Convalescent Plasma Has Limited Benefit for Moderate COVID-19: Randomized phase II trial shows no drop in progression to severe disease, all-cause deaths. BMJ 

 

CDC Broadens Definition of 'Close Contact' in Tracing COVID-19 Infections: The CDC had previously defined a "close contact" as someone who spent at least 15consecutiveminutes within 6 feet of a confirmed COVID-19 case. Now, a close contact will be defined as someone who was within 6 feet of an infected individual for a total of 15 minutes or more during a 24-hour period. State and local health departments rely on this definition to conduct contact tracing.

Immunity From Antibodies May Decline Rapidly: An ongoing study led by Imperial College London (ICL) found that the proportion of people testing positive for COVID-19 antibodies dropped by 26.5% over a 3 month period between June and September. The findings from a non-peer reviewed preprint suggested that infection with SARS-CoV-2 confers only limited protection against re-infection.

COVID-19 Infection Fatality Ratio Is About 1.15%, Study Says: A new study conducted by researchers at Imperial College London found the COVID-19 infection fatality ratio is about 1.15% of infected people in high-income nations and 0.23% in low-income nations. The new study confirms that the coronavirus is deadlier for older people, with the risk of death doubling for every eight years of aging and ranging from 0.1% for people under 40 and 5% among people over 80 years old.

 

Don’t Use N95s for More than 2 Days: When reused for more than 2 days, nearly half of N95 masks fail, new research shows. Medscape

 

Famotidine Has Uncertain Impact on COVID-19 Mortality: Famotidine use within 24 hours of admission does not improve but may worsen 30-day mortality of patients hospitalized with COVID-19, according to a retrospective study. At least two previous studies have reported an association between in-hospital famotidine use and reduced risk of death or intubation in patients with COVID-19. Gastroenterology

 

Wear a Mask Inside Your Household at First Sign of COVID: The CDC's Morbidity and Mortality Weekly Report says more than 100 households in Nashville and Marshfield, WI, were studied from April to September to determine the rate of COVID transmission within a household.  Fifty-three percent of people living with somebody who tested positive ended up becoming infected themselves within a week, with 75% of the secondary infections confirmed within 5 days or less, the CDC said. "Because prompt isolation of persons with COVID-19 can reduce household transmission, persons who suspect that they might have COVID-19 should isolate, stay at home, and use a separate bedroom and bathroom if feasible," the study said 

 

Low-Dose Radiotherapy for Lung Inflammation in Severe COVID-19: The first study to suggest benefit from low-dose radiotherapy for severe COVID-19–induced pneumonia involved only 10 patients with this condition, but the results were so promising that two larger randomized trials are now underway. American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting 

 

COVID-19 is making tinnitus worse, new study finds: New research reveals that tinnitus, a common condition that causes the perception of noise in the ear and head, is being exacerbated by COVID-19—as well as the measures helping to keep us safe. Frontiers in Public Health

 

COVID-19: Quicker recovery may indicate long-term immunity: Researchers recently found that some people who recovered quickly from COVID-19 continued to have antibodies against SARS-CoV-2 for several months. This discovery suggests the potential for long-term protection among those with a strong initial immune response. Cell.

 

Aspirin May Help Covid Patients: Now research indicates aspirin may help COVID patients survive by helping to prevent those blood clots. A study overseen  by the University of Maryland School of Medicine showed that COVID patients had fewer complications when they took aspirin. Anesthesia and Analgesia

 

Antiviral Mouthwash Could Help Curb Coronavirus Transmission: Mouthwashes with antiviral ingredients could help decrease COVID-19 transmission by reducing viral loads in the mouths of infected patients when they cough, sneeze or speak, according to a paper in the Journal of Dental Research. Studies have found that rinses containing cetylpyridinium chloride or povidone-iodine can reduce the oral coronavirus load; other promising compounds include hydrogen peroxide, chlorhexidine, cyclodextrin, Citrox, and certain essential oils. While more studies are needed to determine appropriate regimens, it’s suggested using three doses of antiviral mouthwash the day before a meeting, and one dose the morning of the event. COVID-19 patients should be using mouthwash regularly for seven to 10 days.

 

Pfizer Vaccine Data Show 90% Efficacy in Early Results: A vaccine candidate against SARS-CoV-2 has been found to be 90% effective in preventing COVID-19 in trial volunteers who were without evidence of prior infection of the virus, results from an interim analysis of a phase 3 study demonstrated. press release

 

Cleveland Clinic researchers identify melatonin as possible COVID-19 treatment: Analysis of patient data from Cleveland Clinic's COVID-19 registry also revealed that melatonin usage was associated with a nearly 30 percent reduced likelihood of testing positive for SARS-CoV-2 (the virus that causes COVID-19) after adjusting for age, race, smoking history and various disease comorbidities. Notably, the reduced likelihood of testing positive for the virus increased from 30 to 52 percent for African Americans when adjusted for the same variables. PLOS Biology

 

COVID-19 survival among elderly patients could be improved by arthritis drug : Baricitinib, a type of arthritis drug,  may reduce the risk of dying for elderly patients with COVID-19. Science Advances 

Osteoporosis Drugs Don't Worsen COVID-19 Risk, May Help: Findings from the cross-sectional study of 2102 patients with osteoporosis, osteoarthritis, and/or fibromyalgia — so-called noninflammatory rheumatic conditions — during March 1 to May 3, 2020 were recently published in Aging. Patients taking denosumab, zoledronate, and calcium showed trends toward lower incidence of developing symptomatic presumed COVID-19 (PCR tests weren't widely available at the time), as did those taking the antidepressant serotonin/norepinephrine inhibitor duloxetine. Some analgesics, particularly pregabalin and most other antidepressants, were associated with higher incidences of COVID-19, while oral bisphosphonates, vitamin D, thiazide diuretics, antihypertensive drugs, and chronic nonsteroidal anti-inflammatory drugs had no effect on COVID-19 incidence.

Masks don't impair lung function during physical activity, study finds: While they might feel uncomfortable, facemasks do not significantly change the actual work of breathing or the flow of oxygen and carbon dioxide when worn while exercising, researchers report. Annals of the American Thoracic Society

 

Immune Protection Against Severe COVID-19 Reinfection Appears Lasting: Regardless of their detectable antibody levels, most COVID-19 survivors are likely to have lasting protection against severe COVID-19 if they become reinfected, thanks to other components of the body's immune response that remember the new coronavirus in different ways, researchers say. The new findings "suggest that the immune system can remember the virus for years, and most people may be protected from severe COVID-19 for a substantial time." bioRxiv , online November 16, 2020

 

 

PAIN

Knee or hip replacements cut people's risk for falls, study finds: People who have total joint replacement, or total joint arthroplasty (TJA), experience fewer falls than those who don't undergo the surgery, a new study finds. Journal of the American Academy of Orthopaedic Surgeons 

 

Steroid injections do not hasten the need for knee replacement: New research shows that corticosteroid injections for knee OA treatment do not hasten a patient's progression to a total knee replacement when compared with hyaluronic acid injections. Details of this study was presented at ACR Convergence. (ABSTRACT #1652).

 

Warfarin use significantly increases risk of knee and hip replacement in people with OA: New research presented at ACR Convergence, shows that use of warfarin, a vitamin K drug widely prescribed to prevent blood clots, is associated with a significantly greater risk of knee and hip replacements in patients with osteoarthritis (ABSTRACT #0934).

 

Novel technique 'stuns' arthritis pain in shoulder and hip: A interventional radiology treatment known as cooled radiofrequency ablation (c-RFA)  was tested for pain relief in the setting of advanced degenerative arthritis. The procedure involves the placement of needles where the main sensory nerves exist around the shoulder and hip joints. The nerves are then treated with a low-grade current known as radiofrequency that "stuns" them, slowing the transmission of pain to the brain. "In our study, the results were very impressive and promising," Dr. Gonzalez said. "The patients with shoulder pain had a decrease in pain of 85%, and an increase in function of approximately 74%. In patients with hip pain, there was a 70% reduction in pain, and a gain in function of approximately 66%." The procedure offers a new alternative for patients who are facing the prospect of surgery. In addition, it can decrease the risk of opiate addiction. Radiological Society of North America (RSNA) Meeting

 

COMPLEMENTARY & ALTERNATIVE MEDICINE

CBD: It Won’t Cure Ailments but It Can Help with Pain, Nausea: According to a new studyTrusted Source that analyzed years of user comments on Reddit to determine the effectiveness on health and wellness of this active compound found in cannabis plants,there is no evidence that cannabidiol (CBD) can cure medical ailments. However, they said some research has shown that it can be effective in reducing pain and nausea.

 

Cannabis use prompts need for more anesthesia during surgery, increases pain: Not only might cannabis users require more anesthesia during surgery than non-users, they may have increased pain afterwards and use higher doses of opioids while in the hospital, suggests first-of-its kind research being presented at the ANESTHESIOLOGY® 2020 annual meeting.

 

Acupuncture before surgery means less pain, significantly fewer opioids for Veterans: Veterans who have acupuncture before surgery report less pain and need far fewer opioids to manage their discomfort, according to a randomized, controlled study being presented at the ANESTHESIOLOGY® 2020 annual meeting. Veterans who received acupuncture also reported they were more satisfied with their pain control than those who did not.

 

Complementary and alternative medicine for veterans and military personnel -- update from Medical Care: A growing body of research evidence shows that complementary and alternative medicine (CAM) has health benefits for US military veterans and active duty personnel, according to a special December supplement to Medical Care.

 

 

FDA ACTION

• Approved Sklice (ivermectin) be switched from prescription to over-the-counter for patients 6 months and older

• Approved emergency use authorization for casirivimab and imdevimabe to be administered together for the treatmet of mild to moderate Covid-19

• Approved Zokinvy (lonafarnib) capsules to reduce the risk of death due to Hutchinson-Gilford progeria syndrome

• Approved emergency use authorization or the first COVID-19 diagnostic test for self-testing at home and that provides rapid results.

• Approved emergency use authorization for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients

• Permitted marketing of a new device intended for the temporary reduction of sleep disturbance related to nightmares in adults 22 years or older who suffer from nightmare disorder or have nightmares from post-traumatic stress disorder (PTSD). The device provides gentle vibration through touch based on an analysis of heart rate and motion during sleep.

• Approved a lotion to treat head lice for nonprescription, or over-the-counter (OTC), use through a process called a prescription (Rx)-to-OTC switch.

• Approved the antiviral drug Veklury (remdesivir) for use in adult and pediatric patients 12 years of age and older for Covid-19

 

PREVENTION: Exercise

Bursts of exercise can lead to significant improvements in indicators of metabolic health: Short bursts of physical exercise induce changes in the body's levels of metabolites that correlate to, and may help gauge, an individual's cardiometabolic, cardiovascular and long-term health, a study by Massachusetts General Hospital (MGH) has found. In a paper published in Circulation, the research team describes how approximately 12 minutes of acute cardiopulmonary exercise impacted more than 80% of circulating metabolites, including pathways linked to a wide range of favorable health outcomes, thus identifying potential mechanisms that could contribute to a better understanding of cardiometabolic benefits of exercise.

 

PREVENTION: Diet/Nutrition

High flavanol diet may lead to lower blood pressure: People who consume a diet including flavanol-rich foods and drinks, including tea, apples and berries, could lead to lower blood pressure. Scientific Reports

 

Drinking green tea and coffee daily linked to lower death risk in people with diabetes: Drinking plenty of both green tea and coffee is linked to a lower risk of dying from any cause among people with type 2 diabetes. BMJ Open Diabetes Research & Care

 

Eliminating Processed Foods Could Slash Your Risk of Death from Heart Disease: 2 out of every 3 deaths from heart disease could be prevented by adopting a healthier diet, researchers say in a new study. “More than 6 million deaths could be avoided by reducing intake of processed foods, sugary beverages, trans and saturated fats, and added salt and sugar, while increasing intake of fish, fruits, vegetables, nuts, and whole grains.”

 

Eating less suppresses liver cancer due to fatty liver: An international research team led by Shinshu University School of Medicine were able to show that reducing food intake by 30%, or eating until you are just 70% full is effective in reducing the likelihood of developing liver cancer from fatty liver. 

 

People with type 2 diabetes need not avoid eating potatoes based on glycemic index  New study findings show that people with type 2 diabetes can better maintain overnight glycemic control when high Glycemic Index (GI) potatoes are included in an evening meal versus low GI basmati rice. Clinical Nutrition

 

All weight loss isn't equal for reducing heart failure risk: Reducing the level of body fat and waist size are linked to a lower risk of heart failure in patients with type 2 diabetes. Circulation

 

Chili Peppers Might Extend Your Life: Preliminary research shows that eating chili pepper may reduce your risk of death from heart disease, cancer and other causes, building on past studies that have found chili pepper to have health benefits. American Heart Association Meeting Nov. 13 to 17

 

A few kilograms weight loss nearly halves the risk of diabetes: Losing a few kilograms in weight almost halves people's risk of developing Type 2 diabetes - according to a large scale research study. The research shows how providing support to help people with prediabetes make small changes to their lifestyle, diet and physical activity can almost halve the risk of developing Type 2 diabetes. The findings come from the largest diabetes prevention research study in the world in the last 30 years. The clinical trial involved >1,000 people with prediabetes. JAMA Internal Medicine 

 

Go (over) easy on the eggs: 'Egg-cess' consumption linked to diabetes: The longitudinal study (1991 to 2009) is the first to assess egg consumption in a large sample of Chinese adults. It found that people who regularly consumed one or more eggs per day (equivalent to 50 grams) increased their risk of diabetes by 60 per cent.

 

PREVENTION: VITAMINS/SUPPLEMENTS

Vitamin D lessens symptoms of severe eczema in children: Vitamin D supplementation eased the symptoms experienced by children with severe atopic dermatitis, or eczema, in a recent randomized controlled trial published in Pharmacology Research & Perspectives.

 

Multinutrient Intervention Slows Cognitive Decline in Alzheimer Disease: For individuals with prodromal Alzheimer disease, a multinutrient intervention can slow cognitive decline, according to a study recently published in Alzheimer's & Dementia.

 NIH Dietary Supplements for Eye Conditions There is evidence that a combination of vitamins E and C, beta-carotene, and zinc (known as the AREDS formulation) may reduce the risk of developing advanced AMD. There is also some limited evidence that for less well-nourished populations, the carotenoids lutein/zeaxanthin may be associated with a reduction in progression to cataract surgery; however, whether supplementation would be beneficial for this population requires further study. Current data do not support the use of dietary supplementation with vitamins A, C, and E, or cannabinoids, as treatment for glaucoma. More information about the AREDS formulation for AMD is available from the National Eye Institute.

 

Fish Oil, Vitamin D Supplements Won't Prevent A-Fib: A new study finds the nutrients won't shield against the common and potential heart rhythm disorder known as atrial fibrillation. The results do provide reassurance that these supplements do not increase the overall risk of atrial fibrillation and appear to be generally safe for patients who are taking these supplements for other reasons. Annual AHA meeting 

 

Study Finds Fish Oil May Not Help Your Heart: New research from the Cleveland Clinic has found that common types of fish oil may not be as beneficial for the heart as they were once thought to be.  The studyTrusted Source, published in the Journal of the American Medical Associationon November 15, found that a high dose of omega-3 fatty acids did not reduce people’s chances of experiencing a major cardiovascular event.  Evidence regarding the use of fish oil for heart health has been mixed. Oftentimes, the results are influenced by the type of fish oil and the type of placebo used. “For patients ’fishing for answer on fish oil,’ the current data supports purified EPA prescription fish oil Vascepa as opposed to over-the-counter fish oil, low dose fish oil, and combination DHA and EPA fish oil.

 

Multivitamins Don’t Provide Many Health Benefits, Researchers Say: There’s scant evidence that multivitamins or mineral supplements have any positive impact on health, except for people with known vitamin or mineral deficiencies. And while taking daily vitamins may make you feel better, in most cases that’s likely just the placebo effect at work, a new study suggests. The research, published in the journal BMJ Open, compared self-reported and clinically measurable health outcomes among a group of more than 21,000 multivitamin users and nonusers in the United States.

 

PREVENTION

Residential area may impact risk of chronic conditions: Where you live may increase your risk for uncontrolled diabetes, high blood pressure, obesity, and depression, according to a study. Results indicate that local and regional factors significantly affect individuals with chronic health conditions. Journal of the American Medical Association.

 

Could hard physical labor increase dementia risk?: The rate of dementia in men who once had jobs that involved tough physical work is almost one and a half times greater than in those whose work was sedentary, a study has found. Scandinavian Journal of Medicine & Science in Sports.

 

Rate ofMemory Decline Greater for Mothers Who Do Not Work for Pay: Women whose work-family profiles do not include working for pay after childbearing have a greater rate of memory decline after age 60 years than working mothers, according to a study published online Nov. 4 in Neurology. 

 

Positive outlook predicts less memory decline: A new study finds that people who feel enthusiastic and cheerful -- what psychologists call 'positive affect' -- are less likely to experience memory decline as they age. This result adds to a growing body of research on positive affect's role in healthy aging. Psychological Science

 

Combo pill alone and with aspirin lowers heart disease risk: A 'polypill' is a single pill that includes multiple medications to control more than one health risk factor (such as heart disease, high blood pressure, high cholesterol, Type 2 diabetes, kidney disease, stroke). In this large, international trial, the polypill included blood pressure and cholesterol lowering medications for people at risk for heart disease. Results from the randomized, placebo-controlled trial show that the combination of a polypill plus aspirin reduced cardiovascular disease by 31%, and the polypill without aspirin reduced CVD by 21%. NEJM 

 

TREATMENT

Cholesterol medications linked to lower cancer-related deaths in women: Among women with breast cancer, colorectal cancer, or melanoma, those who were taking cholesterol-lowering medications, were less likely to die from cancer. British Journal of Clinical Pharmacology. 

 

Steroid inhalers / pills for asthma linked to heightened risk of brittle bones andfractures: Taking steroid inhalers or tablets to treat asthma or control flare-ups is linked to a heightened risk of brittle bones (osteoporosis) and increased vulnerability to broken bones (fragility fractures). Thorax.

 

34% of older adults in the US are prescribed potentially inappropriate drugs: The prescription of potentially inappropriate medications to older adults is linked to increased hospitalizations, and it costs patients, on average, more than $450 per year. Journal of the American Geriatrics Society

 

Steroid inhalers/pills for asthma linked to heightened risk of brittle bones and fractures: Taking steroid inhalers or tablets to treat asthma or control flare-ups is linked to a heightened risk of brittle bones (osteoporosis) and increased vulnerability to broken bones (fragility fractures), finds new research. BMJ

 

Hydroxychloroquine not linked to longer heart rhythm intervals in RA or lupus patients: New research presented at ACR Convergence, the American College of Rheumatology's annual meeting, discovers that use of hydroxychloroquine, a generic drug, does not cause any significant differences in QTc length or prolonged QTc, key measures of heart rate, in people with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) (ABSTRACT #0431).

 

Osteoporosis is underdiagnosed and undertreated in older men A new study reveals that many older men who experience a fracture are still underdiagnosed with and undertreated for osteoporosis. Details of the study was presented at ACR Convergence, the American College Rheumatology's annual meeting (ABSTRACT #0533).

 

Romosozumab substantially builds bone density in hip and spine: New research presented at ACR Convergence, the American College Rheumatology's annual meeting, reveals that romosozumab, an osteoporosis drug, produces substantial gains in bone mineral density in the hip and lumbar spine within one year, and that transitioning patients to a potent antiresorptive drug can lead to even more bone density gains (ABSTRACT #1973).

 

Combo-drug treatment for Type 2 diabetes remains effective after two years: Patients with Type 2 diabetes often take metformin as first-line therapy to help stabilize their blood glucose. Eventually, some patients no longer respond to metformin and require additional treatment. A few years ago, pivotal short-term trials showed that a combination of two drugs controlled diabetes progression better than either single drug alone. Now, new research demonstrates that this drug combo of dapagliflozin and exenatide continues to stay effective, without loss of effect, after two years of continual use. Diabetes Care.

 

Older adults are at greater risk of cardiovascular events than younger people, and benefit at least as much from cholesterol-lowering medications, two studies suggest:  An observational study finds risk of heart attack and cardiovascular disease is highest in people aged 70 and over with elevated levels of LDL cholesterol, compared to younger age groups, and estimates the number needed to treat with statins to prevent one heart attack in five years is lowest in people aged 70 to 100 years. A separate systematic review and meta-analysis including data from more than 21,000 people aged 75 years and older finds LDL cholesterol-lowering therapies (including statins) are as effective at reducing cardiovascular events (including stroke and heart attack) in this age group as they are in younger people. Lancet

 

New Cancer Drug Approvals Linked to Drop in Mortality: For the most common cancers, cancer drug approvals between 2000 and 2016 were associated with a reduction in deaths, according to a study published online Nov. 9 in the Journal of Medical Economics. 

 

Panel Recommends Against Approval of Experimental Drug for Alzheimer Disease: An experimental Alzheimer disease treatment should not be approved by the U.S. Food and Drug Administration, an agency advisory panel says. The panel reviewed clinical data on the drug aducanumab and concluded that there is not enough evidence to support its clinical effectiveness, CNN reported. The drug, developed by the pharmaceutical company Biogen and its Japanese partner Eisai, is administered through intravenous infusion for early Alzheimer disease.

 

Diabetes drug can treat and reverse heart failure and reduce: Empagliflozin, a recently developed diabetes drug, can effectively treat and reverse heart failure in both diabetic and non-diabetic patients. Journal of the American College of Cardiology

 

OTHER

Suffering in silence: two-thirds of older adults say they won't treat their depression: A new nationwide poll, the GeneSight Mental Health Monitor, shows that nearly two-thirds (61%) of Americans age 65 or older who have concerns about having depression will not seek treatment. In fact, nearly 1 in 3 (33%) seniors who are concerned they might be suffering from depression believe they can "snap out" of it on their own.