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A Yoga Maneuver for the Faint of Heart

LIFESTYLE LESSONS

A new pilot study suggests that a nonpharmacologic, cost-free, simple, and quick intervention may help prevent vasovagal syncope (VVS). Excellent! You had us at nonpharmacologic—those treatments are as welcome as pizza and wings on Super Bowl Sunday. The intervention is a single yoga maneuver called tadasana, or “mountain pose,” the bedrock of all standing yoga positions. A video is worth a thousand words.

This study included a modest group of patients with VVS and normal heart structures. All were provided standard care: counseling on physical maneuvers and hydration, and provision of medical treatment if recommended by their individual physicians. Where participants diverged was in their answer to the following question: Would you also like to practice tadasana for 8 to 12 cycles (about 15 minutes) twice a day? Their decision split the group somewhat evenly.

Three key findings

• Both groups (standard care and standard care plus tadasana) saw symptom relief.
• The tadasana group experienced substantially fewer recurrences of syncope and near-syncope.
• Tadasana posed (pun intended) no adverse effects.

Not only was tadasana effective, but its practice was also easy to maintain, as confirmed by a compliance rate of nearly 100%. Hearing of such a simple and effective intervention harkens us back to our days of reviving Nintendo cartridges with a forceful blow of air (diagnosis: dust).

Why does tadasana seemingly work?

According to lead author Dr. Hygriv Rao, “This combination of exercise and breathing influences the neuromuscular reflex malfunction that occurs in vasovagal syncope. The movements focus on strengthening neuromuscular reflexes in the quadriceps and the calf muscles, which can increase the blood circulation and venous return, thus preventing blood pooling in the lower body.”

Key takeaway

While yoga as a practice has outlasted royal dynasties, its list of nascent benefits continues to grow faster than a Super Bowl viewer’s waistband. And possible syncope prevention is just one more bullet on the list. Given the findings from this study—albeit a pilot study—you may want to consider recommending the practice of tadasana for 15 minutes twice a day to patients as an adjunctive therapy for VVS.

Patients Opt for DIY Cervical Cancer Screening

EMERGING TRENDS

Many of you know firsthand the challenge of getting patients to schedule and keep an appointment for a routine Pap smear. Despite its lifesaving benefits, this screening often ranks below standing in line at the DMV on a woman’s to-do list. Not surprisingly, research shows that approximately 11% to 23% of women aged 46 to 70 years have never had a Pap smear or haven’t had one in five years.

But what happens when you give women options?

Researchers did just that—they gave women options. First, they assembled roughly 800 UK women (mostly white, aged 50-64 years) overdue for cervical cancer screening. Those in the intervention arm of this randomized control trial received a letter offering non-speculum clinician-sampling, at-home self-sampling, or standard clinician-sampling with a speculum. Option four was to continue to forgo the screening. Those in the control arm had only two options upon receiving their letter: standard speculum-assisted clinician-sampling or nothing.

Women given multiple options, i.e., the intervention group, were substantially more likely to undergo cervical cancer screening at either four months (20.4% vs 4.9%) and at one year (30.5% vs 13.6%). This landslide formed on the strength of women’s preferences for the self-sampling option. Rates for the non-speculum clinician-sampling and speculum-assisted clinician-sampling options were similar.

This study suggests that many women appreciate having choices when it comes to cervical cancer screening. While the options presented aren’t as appealing as choosing between watching Bridesmaids or Pretty Woman, they were choices, nonetheless. The next step for researchers is to determine why women preferred the non−clinician-sampling options.

Key takeaway

What is a clinician to do with these findings? Nothing yet. Neither self-sampling nor non-speculum clinician-sampling for cervical cancer screening has garnered FDA approval, but the underlying message is that providing choices and removing barriers could be a boon to cancer screening. More to come!

And the Winner Is . . .

Thank you all for posting your cartoon caption contest ideas. We were impressed! It was a tough call, but the Pri-Med team agreed that the following caption gave us the heartiest chuckle.

Which podcast informed you that this ivermectin-impregnated marshmallow will cure hemorrhoids?

Congratulations to ­­­­­­­­­­Jerry Bruggeman, MD of Columbia, Missouri, for penning this excellent caption!

Check out future issues of Morning Report for more cartoon caption contests.

Do Any Salt Replacements Curry Favor With Older Adults?

SENIOR SUMMARIES

Often when you replace a proven entity with an unknown, the end product suffers. But if the replacement is appealing enough, you forget what you’re missing. In 1987, we were sure we’d lose our appetite for Cheers when Diane hung up her apron. Then Rebecca entered stage left, and the Boston watering hole served up beer and hijinks for six more seasons. Diane’s replacement added just the right spice. That’s what scientists in this next study were in search of: the right spice.

We know that as adults age, their senses of taste and smell often diminish. Many older adults become unsparing with the saltshaker to appease their eroding tastebuds. This tactic leads to obvious risks. Could herbs and spices replace extra salt while maintaining a meal’s flavor?

Researchers enlisted nearly 40 adults older than 60 years to taste-test several varieties of a white sauce, each using different amounts of salt and replacement herbs. Would participants notice the lower salt volume in sauces laden with herbs?

Main findings

• Participants did not detect the lower volume of salt when sauces contained both herbs and chipotle seasoning together.
• Participants did notice the lower salt content when it was masked with only herbs (eg, basil, garlic powder, and ground pepper)—and not chipotle seasoning.

These findings make sense. Like Rebecca Howe, herbs had some big shoes to fill (salt’s), and only stronger flavors like chipotle seemed to fill them. Here to share his expertise on chipotle seasoning is Cheers’ expert on all things, Cliff Clavin, “It’s a little-known fact that the chipotle pepper may also help lower a person’s risk of cancer, hypertension, diabetes, and heart disease.”

Key takeaway

If your older patients note a decline in taste, consider recommending against adding the extra sprinkle of salt and instead reaching for the chipotle seasoning (if tolerated) with other herbs. Patients may be as pleasantly surprised as viewers of Cheers’ sixth season.

Did You Know?

Every four years the Winter Olympics refamiliarizes the casual winter sports fan with the terms twizzles, hog line, super-G, Lutz, and the dreaded flutz (a failed Lutz). While the Games offer us an endless display of frosty feats of strength, the quest for more air, additional rotations, and faster twists is a hotbed for fractures and concussions. We’re only halfway through this five-ringed frozen fortnight and have already seen countless shattered ankles and dreams.

That set us down a morbid path of wondering how many injuries athletes typically incur at a Winter Olympics. Lucky for us, the British Journal of Sports Medicine has published a study after each of the past three Games, detailing the injuries suffered and which sports are most culpable. Here’s their injury report from the PyeongChang 2018 Games:

• Percentage of athletes with at least one injury: 12% (out of 2914 athletes)
• Most common injury locations: knee, ankle, hand/finger, and lower back
• Most common injury types: sprain/ligament rupture and bone contusion
• Sports with the highest incidence of injury: ski halfpipe, snowboard cross, ski cross, snowboard slopestyle, and aerials
• Sports with the lowest incidence of injury: Nordic combined, biathlon, snowboard slalom, moguls, and cross-country skiing
• Women sustained more injuries than men
• 89% of injuries were acute, 10% recurrent, and 1% chronic

Sometimes those are the breaks of going for the gold. Just in case you find Mikaela Shiffrin or Shaun White (or more likely a weekend warrior inspired by them) in your waiting room, here’s a refresher on concussion guidelines  and acute musculoskeletal pain management.

Rapid-Fire COVID-19 Updates

COVID QUICK HITS

• Multiple early factors anticipate post-acute COVID-19 sequelae
• Effectiveness of face mask or respirator use in indoor public settings for prevention of SARS-CoV-2 infection — California, February–December 2021
• Necessity of COVID-19 vaccination in persons who have already had COVID-19

Potential New Treatment for Alcohol Use Disorder?

SUBSTANCE SOLUTIONS

A recent study showed that a potential new treatment option based on the hormone FGF₂₁ may one day be available to patients suffering from alcohol use disorder. In the clinical trial, a new analogue compound of FGF₂₁ reduced alcohol consumption by 50% in alcohol drinkers. Astounding! But before we toast this breakthrough, we must share one caveat: the alcohol drinkers in the study were monkeys.

Before you dial the ASPCA to report these irresponsible researchers for liquoring up a troop of monkeys in the name of science, let us tell you about the colony of green vervet monkeys from the island of St. Kitts recruited for this study. They enjoy their alcohol, especially dirty banana martinis (we speculate). We’re not suggesting they have a problem, but rumor has it many swing from tree to tree howling “I just love you, man.”

Okay, we’ll stop monkeying around and get back to the study. The researchers split these bibulous primates into two groups—one receiving the FGF₂₁ analogue and the other a placebo—and then invited them to imbibe as much alcohol (from fermented fruit) as they wished.

Well, I’ll be a monkey’s uncle

The primates taking the FGF₂₁ analogue consumed half as much alcohol as those taking the placebo. One study author, Dr. Kyle Flippo, noted, “This is the first illustration that FGF₂₁ analogues potentially reduce alcohol consumption in non-human primates,” which could pave the way for a novel therapeutic approach for alcohol use disorder.

Key takeaway

This novel treatment still has a long road before it may be available to humans, but we found the prospect of suppressing alcohol consumption via a hormone analogue intriguing and encouraging. This study wets our whistle for human studies, where we expect to see similar results—we’re a glass-half-full kind of bunch.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

• Highly infectious, more damaging HIV variant found in the Netherlands
• Exercise harder if you want to ward off pain due to ageing
• Primary care physician gender and electronic health record workload
• The impact of pictorial health warnings on purchases of sugary drinks for children: A randomized controlled trial
• Proton pump inhibitors and risk of gastric cancer: population-based cohort study

Morning Report is written by:

• Alissa Scott, Lead Author
• Aylin Madore, MD, MEd, Author and Editor
• Shira Page, RN, NP, Author and Editor

Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.

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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