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Rousing New Study on E-Cigs and ED
The ever-insightful George Costanza must have been talking about e-cigarettes when he opined, “This thing is like an onion. The more layers you peel, the more it stinks.” Smoking e-cigarettes, the product once touted as a healthier alternative to regular cigarettes, equates to drinking organic soda for its health benefits. E-cigarettes, or electronic nicotine delivery systems (ENDS), have been linked to cardiovascular disease, asthma, and COPD. And researchers are now adding erectile dysfunction (ED) to the growing list of concerns.
Using the transitive property
We know smoking is associated with ED. We also know cigarettes and e-cigarettes share ingredients. So, it’s not a far leap to assume that ENDS could potentially link to ED. Researchers conducted a large observational study to test this theory.
Summing up the main finding
Men aged 20 to 65 with no history of cardiovascular disease who used ENDS daily were nearly two and a half times more likely to report ED than were men who had never used ENDS. Interestingly, men who engaged in physical activity lowered these odds.
Key takeaway for managing ED
After ruling out metabolic causes (eg, diabetes hypogonadism), ask all patients with ED if they use nicotine products, including ENDS. If the answer is yes, recommend cessation. To quote Dr. Frank Domino, “Give it up to get it up; using a medication, like sildenafil, without first trying nicotine cessation seems at best a fool’s errand.”
COVID Is Everywhere—Except in Breast Milk
The past two years have raised countless burning questions. Should we be hosing down groceries? Who’s at risk for breakthrough symptoms? What’s going on in my coworkers’ background? And what really happened to Carole Baskin’s husband? But a new study offers an answer to another important question:
Does breast milk from a SARS-CoV-2–infected mother pose a risk to her baby?
Drumroll please … no! Breast milk transfers nutrients and antibodies but not infectious SARS-CoV-2 from mom to baby, according to this recent study.
The study examined multiple samples of breast milk from 110 women: 66 women who tested positive via RT-PCR testing for SARS-CoV-2 infection, nine who had symptoms but a negative test result, and 36 with symptoms who were not tested. Although the breast milk of seven women (mostly from the confirmed infection group) contained SARS-CoV-2 vRNA, “infectious virus was not detected in any culture and none had detectable sgRNA.”
Given the lack of evidence for the presence of infectious replicating virus in these breast-milk samples, this study concludes that “recent SARS-CoV-2 infection or detection of its RNA in human milk is not a contraindication to breastfeeding.”
The authors did note that although this is the largest study of its kind to date, the sample size is small. They also acknowledged their reliance on the mothers to accurately report their infection results and carefully collect milk samples. Despite these limitations, these findings offer a healthy dose of optimism—more optimism than we have for the whereabouts of Carole’s husband.
Rapid-Fire COVID-19 Updates
COVID QUICK HITS
- WHO finds ‘no evidence’ that healthy children, adolescents need boosters
- Omicron survives longer on plastic, skin than prior variants; nose swabbing found best for rapid tests
Updated Recommendations From the USPSTF
The United States Preventive Services Task Force (USPSTF) has been busier than the US stock market this past couple of weeks. The expert panel issued both a final recommendation statement and a draft recommendation statement. See below.
Final recommendation (Grade I)
In the update to its 2018 recommendation, the USPSTF again concludes that insufficient evidence is available to determine the balance of benefits vs harms of screening asymptomatic adults aged 50 or older. However, this time, the task force expanded its review to encompass screening tests beyond ECG.
Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease (CVD) prevention in adults without CVD risk factors
Draft recommendation (Grade C)
If your patient does not have risk factors for CVD, engage in a shared decision-making approach when determining the merit of diet and exercise counseling to prevent myocardial infarction and stroke. Task force member Lori Pbert, PhD, encapsulated the USPSTF’s rationale as follows: “We found that people who are interested in making changes to their diet and physical activity are most likely to benefit from counseling, so clinicians are encouraged to talk with their patients and decide together if behavioral counseling is right for them.”
Cartoon Caption Contest
If you think you have an amusing caption for the following image, please leave your idea in the comments section of this Facebook post by Monday, January 31, at 11:59 pm ET for a chance to win our caption contest.
We will feature the winning caption, chosen by the Pri-Med team, in the next issue of Morning Report. Oh, and we’ll also send the winner a $50 Amazon gift card!* We know we have some creative readers, so give it a go!
*Restrictions apply, see www.amazon.com/gc-legal.
Stairway to Lower Glucose and Insulin Levels
ENDO END POINTS
This one’s for the patients who don’t have time to exercise. Tell them to head to their nearest staircase or high school bleacher, press play on their workout mix, and start climbing. They’ll need only one song to get them through a workout that will lower their glucose and insulin levels. Better yet, if that one song stretches as long as Meat Loaf’s epic “I’d Do Anything for Love (But I Won’t Do That)“—a song we all relistened to this week—then they’ll see improvements in their glucose sensitivity as well.
A recent crossover study examined the effects of 1-minute, 3-minute, and 10-minute stair-climbing sessions (going up and down) on glycemic response and antioxidant capacity. Thirty healthy participants (mean age 26 years) were randomly assigned to each duration of stair climbing on three separate visits. Participants maintained a moderate, self-selected intensity level throughout all three durations of stair climbing. An oral glucose tolerance test accompanied each stair-climbing session. Baseline values of glucose, insulin antioxidant capacity, and lactate were compared with those taken during each of the three sessions.
Results of each stair-climbing duration, in ascending order:
- After 1 minute of stair climbing, no significant changes occurred
- After 3 minutes of stair climbing, glucose concentrations decreased (−15.37 mg/dL) and insulin concentrations decreased (−2.589 μIU/dL); insulin sensitivity showed no significant change
- After 10 minutes of stair climbing, glucose concentrations further decreased (−22.69), as did insulin concentrations (−6.11 μIU/dL); insulin sensitivity significantly increased
One study drawback is the inclusion of only healthy individuals; however, the authors logically assumed those with diabetes would experience a starker improvement with this exercise intervention.
Overall, we were encouraged that a bite-sized time commitment could confer positive effects on three key aspects of metabolic health. Given these findings, you may want to share with your patients that 10 minutes of stair climbing can induce meaningful gains. And if patients have only three minutes, they’ll still lower their glucose and insulin levels, even if their glucose sensitivity remains unchanged. And as Meat Loaf proclaimed, “Two out of three ain’t bad.”
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Is cognitive performance of women sensitive to the severity of menopausal symptoms?
- Diagnosis and management of acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians
- Weight gain and lifestyle factors in women with and without polycystic ovary syndrome
- Research team identifies genes associated with suicide
- Intervention leads to increase in primary care screenings for older adults
- FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain
Morning Report is written by:
- Alissa Scott, Lead Author
- Aylin Madore, MD, MEd, Author and Editor
- Shira Page, RN, NP, Author and Editor
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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.
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