It Was the ONE Thing COVID Had Going for It

When COVID-19 first hit, the only solace was that children were mostly spared from its wrath. However, the American Academy of Pediatrics recently shared data that highlight a concerning trend in pediatric cases of COVID-19. Here are the latest numbers:

  • Total pediatric COVID-19 cases equal 3,631,189 (13.6% of all COVID-19 cases)
  • Pediatric cases represented 20.6% of new cases (88,497/429,727) from April 8 to 15 (highest percentage to date)
  • There was a 5% increase from April 1 to 15 in the cumulative number of pediatric COVID-19 cases (3,469,500 to 3,631,189)

The good news is that hospitalizations and deaths in children are still extremely low: 0.1% to 1.9% of children with COVID-19 are hospitalized, and <0.03% of children with COVID-19 die.

Encourage your young patients to mask up, practice social distancing, and wash their hands—as we all know, children typically have NO trouble with any of those requests.

Throwing Shade on the Watermelon 

It’s springtime in the United States. What could be better than chomping into the flesh of a crisp, delicious watermelon, juices running down your chin, swallowing seeds with reckless abandon? Well, the New England Journal of Medicine (NEJM) says not so fast.

The journal is not singling out watermelons per se, but all foods with a high glycemic index. (Watermelons just happen to be one of the highest!) Researchers have uncovered an unfavorable link between those foods and cardiovascular (CV) disease. But wait, you ask, haven’t they studied this before? Yes, but only in smaller, high-income Western populations, whereas this study looked at 137,851 middle-aged to older adults from 5 continents. All participants completed dietary questionnaires and were followed for a median of 9.5 years. The primary outcome was a composite of major CV event or death from any cause. Those who consumed a high glycemic index diet were more likely to experience a major CV event or die prematurely. This held true for those with pre-existing CV disease and those without.

Of course, the researchers are not suggesting Americans eschew all watermelons and other high glycemic index foods. They’re not monsters. But the takeaway message is to make your patients aware of the risks of high glycemic foods in the diet and advise moderation.

Is This Wonder Drug Becoming More Wonderful?

You may have guessed it: we’re talking about metformin. This therapeutic all-star may be on its way to knocking another one out of the park. A new phase 2 study revealed that metformin is safe and tolerable as a potential therapy in autosomal dominant polycystic kidney disease (ADPKD).

The findings from the study, “A Randomized Trial of Administration of Metformin in PKD (TAME PKD),” were presented at the National Kidney Foundation’s Annual Spring Clinical Meetings earlier this month, no doubt to rousing applause—you know those nephrologists can be a rowdy bunch.

This is a promising first step in the potential treatment of ADPKD! Obviously, we need to know more, and the next step will be a larger intervention trial examining those at high risk of disease progression.

Metformin is becoming quite the panacea therapy. We already know of its proven ability to lower glucose and reduce body weight, and nascent research has suggested benefits in cancer, polycystic ovary syndrome, CV disease, dementia, stroke, and even aging. What can’t it do? Have we tried it on COVID-19 yet? KIDDING!

  1. Another Piece of the Healthcare Inequities Puzzle

Not to be outdone by metformin, SGLT2 inhibitors have also cemented their place in the who’s who of diabetes therapies. This drug class boasts the benefit of reducing deaths from CV conditions, hospitalizations from heart failure, and kidney disease progression in people with type 2 diabetes mellitus (T2DM). It’s on your turf, metformin!

But the key to this drug class, like all medications, is getting it to the people who need it. A retrospective cohort study that ran from 2015 to 2019 explored the possible disparity of SGLT2 inhibitor use across race, sex, and socioeconomic status in adult patients with T2DM, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or chronic kidney disease (CKD).

The results were disappointing, if not surprising. Only 8.7% (81,007/934,737) were treated with an SGLT2 inhibitor, and inequities existed with Black and Asian individuals, as well as women. As you may have guessed, higher household incomes were linked to a higher rate of SGLT2 inhibitor use.

The researchers found similar inequities across the HFrEF, ASCVD, and CKD groups, which could help explain the known disparities in outcomes for these diseases.

  1. Snoring Relief Is a Tongue Workout Away

Given the high prevalence of snoring in the United States (about half the adult population), we’re guessing not a week goes by when a patient doesn’t confide in you about a snoring issue. As you know, it’s a serious problem. First, it’s associated with obstructive sleep apnea (OSA) and a slew of CV conditions. Second, it severs more relationships than infidelity—well, we don’t know that for sure; we’ll need some retrospective studies to confirm.

Either way, the more treatment tools in your sleep disorder toolbox the better, right? The FDA has approved eXciteOSA, a prescription-only device that delivers electrical stimulation to improve tongue function and leads to a reduction in snoring and mild OSA. Picture a silicone mouthpiece that fits around the tongue, with 2 electrodes on the top and 2 on the bottom of the tongue. It doesn’t sound terribly comfortable, but here’s the good news: the patients wear the device for only a short length of time while they’re awake! Just 20 minutes a day for 6 weeks and once weekly after that. The bad news is the list of side effects: excessive salivation, tongue or tooth discomfort, tingling of the tongue, dental filling sensitivity, metallic taste, jaw tightness, and gagging. Yikes!

How does it work? By strengthening weak tongue muscles. The idea is that a stronger tongue will not easily slump backward and block the airway. Think of it as high-intensity interval training (HIIT) for the tongue. “One more, tongue! You can do it, no excuses! Hold your form and don’t forget to breathe!”

  1. Healthcare Humor

A hospital physician says to the nurse practitioner on his floor:
“I’m having trouble getting Wi-Fi on my laptop here. Have you had any luck?”
Nurse practitioner: “Head upstairs. All the hotspots are on the infectious disease floor.”

Potential Game-Changer in Alzheimer Research

We cling to certain truths in life: everything is better with bacon, Tyrion Lannister drinks and knows things, “fetch” isn’t going to happen, and of course, all Alzheimer plaques wreak havoc in the brain. On second thought, one of these may no longer be true.

New research calls into question the long-standing belief that all amyloid-beta plaques are destructive in the brain. The researchers claim that instead of microglia (the immune cells in the brain) gobbling up all plaques, they promote the growth of dense-core plaques, and these plaques play a protective role. This is HUGE! It means that treatments designed to eliminate these dense-core plaques may be causing the opposite of the desired effect. No wonder clinical trials of Alzheimer drugs have proved largely ineffective. We smell a paradigm shift here!

One of the researchers, Dr. Greg Lemke, suggests that scientists should “stop trying to focus on breaking up dense-core plaques and start looking at treatments that either reduce the production of amyloid-beta in the first place or therapies that facilitate transport of amyloid-beta out of the brain altogether.”

This Alzheimer breakthrough is so fetch! Nope, still not going to happen.

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

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