Debbie Downer’s Annual Yankee Swap

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Before we dig into the medical news, we want to wish all our readers a happy and healthy holiday season!

We also want to note that Morning Report will be taking a holiday hiatus, so you won’t be seeing a newsletter on January 1. With any luck, you’ll be resting from a bit of New Year’s Eve overindulgence and won’t even notice.

New Guidelines Cast a Wider Net for PrEP Use

INFECTIOUS FINDINGS

As you may already know, the use of preexposure prophylaxis (PrEP) has been proven safe and effective in reducing the risk of sexual HIV acquisition. The problem is that it’s not getting prescribed to everyone who needs and wants it. The Centers for Disease Control and Prevention (CDC) reports that only a quarter of the estimated 1.2 million Americans who could benefit from this prevention strategy actually take the medication.

New CDC guidelines offer a potential solution

To combat this low uptake, the CDC is calling for all clinicians to discuss the use of PrEP with all sexually active adolescent and adult patients. If the patient then decides that PrEP is right for them, clinicians are encouraged to prescribe it—regardless of whether the patient chooses to disclose any high-risk behavior that would warrant the need for HIV prevention. Sometimes you don’t need to know the answers—we don’t question why Rick Astley’s never gonna give you up; we just know he won’t.

These recommendations are a key part of the newly published “Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2021 Update, A Clinical Practice Guideline.” You can also check out the aptly named “Clinician’s Quick Guide” for a helpful summary of the guideline.

The CDC hopes that this universal offering of PrEP will not only help promote its use in those who need it but also reduce the stigma of taking it. Another goal is to narrow the racial and gender gap that exists in PrEP use; currently, White men claim the lion’s share of prescriptions. We’re hopeful this new guideline will help expand the reach of PrEP to more ofthose who could benefit.

Sixteen Candles During a Pandemic

MENTAL HEALTH MUSINGS

As any John Hughes film will tell you, adolescence is tough on everyone—in every generation. Feeling comfortable in a changing body, navigating relationships, covering up acne. But what the Breakfast Club didn’t have on their plate was climate change, an opioid epidemic, school shootings—oh, and a global pandemic. Add in ongoing concerns of income inequality and racial injustice. Then sprinkle on self-esteem struggles inflamed by social media. It’s a cocktail likely to induce mental health challenges in the younger generation. And according to the nation’s top physician, it has.

The US surgeon general, Dr. Vivek Murthy, rang this alarm bell last week in a 53-page public advisory report that lays out “significant increases in self-reports of depression, anxiety and emergency-room visits for mental health challenges” in young people. His report “calls for more resources to be devoted to understanding and addressing mental health challenges.”

His advisory adds to the cacophony of alarms sounded earlier this season by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association. They declared “a national emergency” in pediatric and adolescent mental health.

This report is an important reminder to identify and address mental health challenges in the younger population—especially while the pandemic looms large. We’ll leave you with some useful resources included in the report to help you better care for your adolescent patients:

What’s the Verdict on Peppermint Oil for IBS?

GI GIST

We’re knee deep into the holiday season, so we thought it only fitting to mention a study involving peppermint—the Michael Jordan of holiday flavors (get off our lawn with those Lebron James arguments). This recent study examines the efficacy of peppermint oil in treating irritable bowel syndrome (IBS).

We’re sure some of our readers have prescribed peppermint oil for patients suffering from IBS. After all, the American College of Gastroenterology (conditionally) recommends it, the oil possesses antispasmodic properties, and some “low-quality evidence” supports it.

But how would peppermint oil stack up in a randomized, double-blind, placebo-controlled trial?

Researchers randomly assigned 133 patients with moderate-to-severe IBS (averaging 285 points on a 500-point symptom severity scale) to either 180 mg of enteric-coated peppermint oil capsules or a soybean oil placebo three times daily for six weeks.

Patients in the peppermint oil group experienced a 100-point improvement in symptoms, and nearly three-quarters of the group showed a clinically meaningful response. Excellent! Break out the peppermint schnapps! But wait—the placebo group experienced nearly identical results. So, this doesn’t exactly offer the conclusive evidence we were hoping for.

Much like the “Is Die Hard a Christmas movie?” debate, this one won’t be solved this holiday season. Clearly, we need larger, more rigorous trials to determine if peppermint oil can effectively treat IBS. In the meantime, patients are welcome to try it within reason, if not for its symptom-relieving qualities, then for its holiday vibes.

COVID-19 Rapid-Fire Updates

COVID QUICK HITS

Did You Know?

‘Tis the season for fuzzy socks, gingerbread houses, A Christmas Story on loop, and—wait—myocardial infarctions? Unfortunately, yes, according to the American Heart Association. The week between Christmas and New Year’s Day has historically been the worst week of the year for MIs, shared Debbie Downer at her annual Yankee Swap celebration.

This not-so-fun fact is no surprise given the stress, disruption of routines, and overindulgence that occur this time of year. When you see patients this holiday season, remind them to carve out time for self-care and to pay attention to any cardiac warning signs.

Most of all, for our own health and sanity, let’s remember that the holidays don’t need to be perfect. We’re looking at you, Clark W. Griswold.

A Jab for UTIs?

EMERGING TRENDS

When it comes to the fight against urinary tract infections (UTIs), antibiotics face an uphill battle. The threat of antimicrobial resistance suggests that the antibiotic treatment strategy may one day become as effective as wielding a pinky in a thumb war. But we have reason for optimism—scientists are developing a vaccine method to fight Escherichia coli, the most common cause of UTIs.

This UTI vaccine method is still in an early “proof of principle” development stage, but we want to share the potentially good news given that a preventive option in UTI management would be as welcome as a virtuous character on Succession.

What’s taking so long?

As the past year has taught us, vaccine technology can be complicated. For several reasons, including the “genetic diversity of bacteria” in UTIs, the creation of a long-lasting and durable immune response from a UTI vaccine has been a challenge. However, researchers from the University of Texas “recently demonstrated the use of metal-organic frameworks to encapsulate and inactivate whole bacterial cells to create a ‘depot’ that allowed the vaccines to last longer in the body.” This method proved more efficacious in mice than did standard preparation methods for whole-cell vaccines. To understand more, see the trial.

Next up? Human trials. The science looks promising, so we are keeping our fingers crossed that a UTI vaccine method may be available soon—maybe even before Logan Roy names his successor.

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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