Pecked by a Turkey

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‘Tis the Season for Scarves, Boots, and Zinc

INFECTIOUS FINDINGS

We’ve assumed for months that Adele’s new album would take our breath away, but as of this week, our ears can finally confirm its Adele-level quality. Similarly, we’ve assumed consuming zinc could help fight a respiratory infection, but we now have published data to substantiate that claim.

Researchers conducted a rapid systematic review and a meta-analysis, identifying 28 randomized controlled trials with >5,000 participants to determine the role of oral or intranasal zinc in the prevention and treatment of acute viral respiratory tract infections (RTIs).

Compared to placebo, zinc showed the following:

  • Prevention of five RTIs per 100 person-months; number needed to treat (NNT)=20
  • A shorter duration of symptoms by an average of two days in individuals who took zinc within the first week of symptoms
  • Reductions in day-three symptom severity but not in average daily symptom severity
  • No serious adverse events
  • A higher number of nonserious adverse events (NNHarm=7)

While the review’s authors noted several caveats and limitations to the analysis, it did show modest benefits of taking zinc. Therefore, you may want to advise patients to stock up on zinc this cold season if tolerability is not an issue. Or consider suggesting it as an alternative treatment for patients seeking antibiotics to hasten their recovery. Lastly, if zinc doesn’t work to improve a patient’s well-being in these winter months, may we suggest recommending the soul-soothing tracks of Adele’s new album?

Red-Flag Symptoms for Pancreatic Cancer

CANCER CONCLUSIONS

A large case-control study out of the United Kingdom has identified symptoms linked to pancreatic cancer in a push to promote early diagnosis and improve abysmal survival rates. The only caveat is that most of these symptoms are as non-specific as Aaron Rodgers’ declaration of his vaccination status.

Researchers compared a list of suspected symptoms against those experienced by patients with pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine neoplasms (PNEN) over a 17-year period. Their findings showed 23 symptoms significantly associated with PDAC and nine with PNEN, and they even identified two symptoms associated with PDAC not previously reported in other studies.

Two common red flags for PDAC or PNEN

The most telling symptoms for either type of cancer were gastrointestinal bleeding and jaundice.

Other symptoms of PDAC

Trouble swallowing, changes in bowel habits, diarrhea, vomiting, abdominal mass, abdominal pain, weight loss, constipation, back pain, fat in stool, indigestion, abdominal swelling, nausea, flatulence, heartburn, fever, tiredness, loss of appetite, itching, thirst, and dark urine—the last two are the newcomers to the list.

Other symptoms of PNEN

Diarrhea, change in bowel habits, vomiting, indigestion, abdominal mass, abdominal pain, and weight loss.

We know that pancreatic cancer is notoriously challenging to identify early because of its nonspecific constellation of symptoms. The takeaway here is that if your patient experiences red-flag symptoms along with the other symptoms listed above, consider raising your suspicion early for pancreatic cancer.

COVID-19 Rapid-Fire Updates

COVID QUICK HITS

Optimal Bedtime to Lower CV Risk

CARDIO CORNER

We’re sure you discuss with your patients how much sleep they get, but how often do you inquire about what time they fall asleep? A new study suggests you may want to ask that question because the answer could hold implications for patients’ cardiovascular (CV) health.

Researchers collected seven days of sleep data via accelerometers on >88,000 people from the UK Biobank. After approximately five years, >3,000 of the participants developed CV disease, and several interesting patterns emerged, linking CV risk with time of sleep onset.

Congratulations to everyone who nods off between 10 and 11pm!

In comparison to that magic hour, individuals who

  • Stayed up past midnight demonstrated a 25% higher relative risk of CV disease
  • Fell asleep between 11 and 11:59pm showed a 12% greater relative risk of CV disease
  • Fell asleep before 10pm had a 24% greater relative risk of CV disease

Interestingly, the association between sleep onset and CV risk was stronger in women.

“I don’t buy any of this!” declares Jimmy Fallon on behalf of all late-night hosts.

Okay, Jimmy didn’t really say this, but if he had, his skepticism would be reasonable. What makes 10 to 11pm an ideal bedtime?

Study author Dr. David Plans provides a partial theory. “Our study indicates that the optimum time to go to sleep is at a specific point in the body’s 24-hour cycle and deviations may be detrimental to health. The riskiest time was after midnight, potentially because it may reduce the likelihood of seeing morning light, which resets the body clock.”

Although this study shows a link and not causation, it provides evidence that focusing on the timing of sleep onset plus overall sleep hygiene may be a simple way to improve patients’ CV risk.

For all you night owls now concerned about your elevated CV risk, at least you got to see this SNL clip in real time—laughter is the best medicine.

Thanksgiving Humor

We hope you enjoy this Thanksgiving with a hearty serving of family, friends, food, and football and that you were one of the 3,000 people who secured a $45 Reese’s peanut butter cup pie before they sold out—in two hours. But no matter how thankful we all feel this coming Thursday, we are embarking on a holiday, which can mean stress. And aggravation.

If your holidays look more like the Griswolds’ than Martha Stewart’s, then the following list is for you. It’s our favorite ten ICD-10 codes from lists compiled by MedicalCodingNews.org and Medscape. We hope you don’t end up needing them this holiday season.

  1. 1. W61.43: Pecked by a turkey
  2. 2. Z63.1: Problems in relationship with in-laws
  3. 3. X10.2: Contact with fats and cooking oils
  4. 4. R14.1: Gas pain
  5. 5. W29.1: Contact with electric knife
  6. 6. Y93.E2: Injury due to activity—laundry
  7. 7. W60: Contact with sharp leaves
  8. 8. Y93.G3: Activities involving baking
  9. 9. W21.01: Struck by football
  10. 10. Y93.D: Activities involving arts and crafts

Does the Hyperthyroidism-Asthma Link Go Both Ways?

Pulm Ponderings

Studies have shown that hyperthyroidism exacerbates asthma, but does asthma, in turn, affect the development of hyperthyroidism? Researchers set out to answer this question in a large retrospective cohort study comparing patients with and without asthma.

Was there a link?

Yes. Patients with asthma had a 31% greater risk of developing hyperthyroidism than those without asthma. Interestingly, the risk was greater in patients with asthma who were older than 30 years of age. The risk also increased in those who had been diagnosed with asthma less than three years prior.

The takeaway here is that if you provide care to patients with asthma, be vigilant for the onset of hyperthyroidism.

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

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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