Bitten by a Tick: What's My Risk of Getting Sick?

Climate change is causing the increase in toxic encounters (I don’t mean those people you can’t spend time with), especially during the warmer months, and into the fall.  That means more mosquitoes, more ticks, more chances of getting sick from these insect bites.  But how do you know when it’s reasonable to worry about it?  This article tells a pretty clear story – essentially, the key is 24 hours.  IF you can find the tick BEFORE it’s been on you for a full day, you will most likely NOT get infected with Lyme or similar tick-borne diseases.  BUT YOU’VE GOT TO CHECK!  When you come back inside from being out in nature, give yourself a once-over.  It’s helpful if you don’t expose skin, but it it’s super hot out and you want to be out, that can be tough.  But it’s all a balancing act, after all.

FROM MEDPAGE TODAY / BY KRISTINA FIORE

Here's when you need to call a healthcare provider -- and when you don't

While tickborne diseases have been on the rise across the U.S.opens in a new tab or window, outdoor enthusiasts can take comfort knowing that most common infections aren't transmitted quickly, researchers said.

For instance, Borrelia burgdorferi, the bacteria that cause Lyme disease -- which is "far and away the most common tickborne disease in the U.S." -- take more than 24 hours to be transmitted from the tick to the host, according to Jonathan Oliver, PhD, a public health entomologist at the University of Minnesota.

"If you do tick checks every day and make sure you remove any attached ticks, your risk of Lyme disease is very low, even if the tick was infected," Oliver told MedPage Today.

That's because Borrelia don't live in the salivary glands of the tick. Instead, they live in the mid-gut and "need to be activated by the tick taking a blood meal," he explained. Only then can they migrate to the salivary glands and be transmitted to the host, he said.

Infectious disease physician Del DeHart, MD, of the University of Michigan Health-West, agreed that there's "no need to seek medical care after most tick bites, particularly if you see them and remove them."

"If you catch them early, then you really decrease the risk that they're going to transmit anything to you," DeHart said.

There are many types of ticks and they transmit "a greater diversity of pathogens than any other vector," Oliver noted, from bacteria and viruses to protozoans. The ticks of greatest concern for disease transmission are those with broad host ranges, including the blacklegged tick (Ixodes scapularis), the lone star tick (Amblyomma americanum), and the American dog tick (Dermacentor variabilis).

The blacklegged tick -- also known as a deer tick -- transmits Borrelia burgdorferi, the bacteria Anaplasma phagocytophilum, which cause anaplasmosis, and the protozoan Babesia microti, which causes babesiosis, Oliver said. It can also transmit Powassan virus, which is "pretty rare but can be very bad," he added. "It can cause encephalitis and meningitis and can be lethal."

The lone star tick can transmit the bacteria Ehrlichia, which cause ehrlichiosis, as well as Bourbon virus and Heartland virus, Oliver said. Both viral diseases are "extremely rare as far as we know, but they can cause encephalitis-type symptoms."

The American dog tick can transmit Rickettsia rickettsii, which cause Rocky Mountain spotted fever. "There are a variety of spotted fever diseases of varying severity, but Rocky Mountain spotted fever is the really bad one," he explained.

Luckily for humans, infection risk is not just a function of time the tick has been attached, but also by the proportion of the tick population that's infected with any given disease. Lyme is the most common disease, Oliver said, partly because a third to a half of adult blacklegged ticks carry Borrelia. About a quarter to a third of nymph blacklegged ticks will carry the bacteria, but they're smaller than adults so can be more difficult to spot.

Other diseases are far less common. Oliver estimated that less than 10% of lone star ticks will carry Ehrlichia species that cause ehrlichiosis, and less than 1% of American dog ticks will carry Rickettsia rickettsii.

Nonetheless, "if a tick attached long enough, it will eventually transmit whatever diseases it is carrying," he said.

That's why prevention is of utmost importance, DeHart said, noting that using tick repellent and wearing long pants -- and tucking them into your socks -- are two key ways to prevent tick bites when outdoors. In addition to tick checks after being outside, people should also check themselves periodically "so you can pick them off," he said.

"Make sure to check places you may not think of -- the groin area, between your butt cheeks," DeHart added. "Ticks love to go to warm places, so doing a really thorough tick check is important."

There's no need to call a doctor after most tick bites, DeHart said, particularly if you find them and remove them. If the tick is engorged or has been attached a long time, however, it's not a bad idea to have it identified for potential future reference.

Academic labs can do the identification, or some services can even do identification via images alone, he added.

"If it can be identified and it's a dog tick and you're not in an area where worries about that are significant, then you don't need to worry much about it. If you're in an area with Rocky Mountain spotted fever, then you would," DeHart said. "If it's not a blacklegged tick, you don't need to worry about Lyme disease. So it can be helpful if you get it identified."

People who've been bitten by a tick should seek medical attention if they develop a significant rash, or flu-like symptoms including a fever or a headache, he said, as those are common signs of infection with many of the tickborne diseases.

DeHart noted that CDC's reference manual for healthcare providersopens in a new tab or window on tickborne diseases in the U.S. is particularly helpful for physicians, as it contains images for tick identification, geographic distribution of the most common tickborne diseases, and their most frequent symptoms.

Source: https://www.medpagetoday.com/special-repor...

If you just keep moving, diabetes is a lot harder to get!

Here’s another study that demonstrates the benefit of exercise in avoiding the development of diabetes.  And as I’ve mentioned before, the benefit starts to accrue at literally 5 minutes a day, but has the highest benefit at more than 1 hour a day.  Any activity exceeding a walk of 3 mph, like vacuuming, or walking stairs qualifies.  If you think about being active around an hour a day compared to doing essentially nothing (tv, etc), that drops your risk of developing diabetes by 3/4s.  Get up, get moving.  It’s just not that hard – and it’s just not really exercise!

From british journal of sports medicine / by Mengyun Luo, Chenhao Yu, Borja Del Pozo Cruz, Liangkai Chen, Ding Ding

Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study

Abstract

Objective Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-specific physical activity and incident T2D accounting for and stratified by different levels of genetic risk.

Methods This prospective cohort study was based on 59 325 participants in the UK Biobank (mean age=61.1 years in 2013–2015). Total/intensity-specific physical activity was collected using accelerometers and linked to national registries until 30 September 2021. We examined the shape of the dose-response association between physical activity and T2D incidence using restricted cubic splines adjusted for and stratified by a polygenic risk score (based on 424 selected single nucleotide polymorphisms) using Cox proportional hazards models.

Results During a median follow-up of 6.8 years, there was a strong linear dose-response association between moderate-to-vigorous-intensity physical activity (MVPA) and incident T2D, even after adjusting for genetic risk. Compared with the least active participants, the HRs (95% CI) for higher levels of MVPA were: 0.63 (0.53 to 0.75) for 5.3–25.9 min/day, 0.41 (0.34 to 0.51) for 26.0–68.4 min/day and 0.26 (0.18 to 0.38) for >68.4 min/day. While no significant multiplicative interaction between physical activity measures and genetic risk was found, we found a significant additive interaction between MVPA and genetic risk score, suggesting larger absolute risk differences by MVPA levels among those with higher genetic risk.

Conclusion Participation in physical activity, particularly MVPA, should be promoted especially in those with high genetic risk of T2D. There may be no minimal or maximal threshold for the benefits. This finding can inform future guidelines development and interventions to prevent T2D.

 

Source: https://bjsm.bmj.com/content/early/2023/06...

Why I Always Look Ahead When it Comes to Patient Health

We've been doing this for years! Now the American Heart Association thinks it might be a good idea.

As you may have heard, I think of myself as “ahead of the curve”.  Of course, in US medicine, the curve is around 20 yrs long, so, in itself, that might not be saying much!  Regardless, a recent article in the Journal of the American Heart Association suggests that testing the population for NT-proBNP might be a good idea.  Well, I started doing that ABOUT 10 YEARS AGO!  

NT-proBNP is a small protein that is made in the heart muscle that is released in response to the stretch of the muscle.  Too much stretch, too much NT-proBNP, and as “too much” might suggest, that’s bad.  Long ago it was found that high levels of NT-proBNP are tied to heart failure, and the rise in levels can predict upcoming episodes.  But even modest elevations can show the stretch, and give a window into general heart health.  

The study suggests that the levels may tie to overall mortality, not just cardiovascular deaths.  

I guess I’ll keep doing it.

FROM JAHA / By Justin B. Echouffo‐Tcheugui, Sui Zhang, Natalie Daya, John W. McEvoy, Olive Tang, Stephen P. Juraschek, Chiadi E. Ndumele, Josef Coresh, Robert H. Christenson and Elizabeth Selvin

NT‐proBNP and All‐Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study

Background

NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is strongly associated with mortality in patients with heart failure. Prior studies, primarily in middle‐aged and older populations, have suggested that NT‐proBNP has prognostic value in ambulatory adults.

Methods and Results

We conducted a prospective cohort analysis of adults, aged ≥20 years, in the nationally representative 1999 to 2004 National Health and Nutrition Examination Survey, to characterize the association of NT‐proBNP with mortality in the general US adult population overall and by age, race and ethnicity, and body mass index. We used Cox regression to characterize associations of NT‐proBNP with all‐cause and cardiovascular disease (CVD) mortality through 2019, adjusting for demographics and cardiovascular risk factors. We included 10 645 individuals (mean age, 45.7 years; 50.8% women; 72.8% White adults; 8.5% with a self‐reported history of CVD). There were 3155 deaths (1009 CVD‐related) over a median 17.3 years of follow‐up. Among individuals without prior CVD, elevated NT‐proBNP (≥75th percentile [81.5 pg/mL] versus <25th percentile [20.5 pg/mL]) was associated with a significantly higher risk of all‐cause (hazard ratio [HR], 1.67 [95% CI, 1.39–2.00]) and CVD mortality (HR, 2.87 [95% CI, 1.61–5.11]). Associations of NT‐proBNP with all‐cause and CVD mortality were generally similar across subgroups defined by age, sex, race and ethnicity, or body mass index (all P interaction >0.05).

Conclusions

In a representative sample of the US adult population, NT‐proBNP was an important independent risk factor for all‐cause and CVD mortality. NT‐proBNP may be useful for monitoring risk in the general adult population.

Source: https://www.ahajournals.org/doi/10.1161/JA...

To Drink or Not to Drink? That is the question...

For a long time there’s been this idea that a drink or two a day will actually extend your life.  That’s been at odds with the fact that alcohol is clearly a toxic substance – it is a direct poison to heart muscle, for example.  The concept of hormesis is usually employed as the argument – the idea of whatever doesn’t kill you makes you stronger.  Well, that’s not what the latest up-dated meta-analysis shows.  In fact, there’s no real health difference between not drinking, less than 2 drinks a day and even 2-3 drinks a day.  If you got to 3-4 drinks, though, there’s nearly a 20% increase in all-cause mortality (risk of dying), and at more than 4 ½ drinks a day that risk goes up 35%!

SO, if you want a drink, have one, or even two (assuming your heart can take it!), but going further regularly will cost you. SKOL!

FROM MEDPAGE TODAY / BY KRISTEN MONACO

That glass of red wine with dinner probably won't protect you from an early grave, according to an updated meta-analysis on the longevity impact of alcohol.

Compared with never-drinkers, "low-volume" drinkers who kept daily alcohol intake under two drinks (1.3 to 24 g ethanol) each day didn't see any reduction in the risk for death from any cause (relative risk 0.93, 95% CI 0.85-1.01), found researchers led by Jinhui Zhao, PhD, a scientist and senior data analyst at the University of Victoria's Canadian Institute for Substance Use Research, in British Columbia.

A typical 12-oz beer or 5-oz glass of wine in the U.S. contains about 14 g of pure ethanol.

"Medium-volume" consumers who threw back about three drinks per day (25 to 44 g of ethanol) also didn't see any significant protection or harm from their habits when compared with non-drinkers (RR 1.05, 95% CI 0.96-1.14), the group reported in JAMA Network.

"Our study gives strong grounds for scepticism regarding the comforting idea that alcohol in moderation is good for health," co-author Tim Stockwell, PhD, also of the University of Victoria, told MedPage Today by email, adding that there continues to be controversy on this topic.

"The idea that alcohol is beneficial in moderation has a profound influence on global, national, and regional estimates of alcohol's impact on health and safety," he explained. "It also has profound implications for guidelines prepared by health authorities for alcohol drinkers wishing to reduce health risks."

While low or moderate alcohol intake didn't appear to increase the risk for death in this study, it was consistent with others in suggesting there also weren't any actual health benefits, said Timothy K. Brennan, MD, MPH, chief of clinical services for the Addiction Institute of Mount Sinai in New York City.

"No alcohol is best," he told MedPage Today. "Drinking less is always better for our bodies than drinking more."

"It is clear from this study -- and many others -- that heavy drinking not only increases the likelihood of developing a variety of diseases, but it also increases the risk of dying," noted Brennan, who wasn't involved with the study.

Drinking any more than about three drinks in a typical day started to catch up with folks, the researchers found.

People considered "high volume" drinkers in the study -- this included those who drank anywhere between 45 to 64 g of ethanol each day -- saw a 19% higher relative risk for all-cause mortality (RR 1.19, 95% CI 1.07-1.32).

Following an upward pattern, consumers of more than about 4.5 drinks a day (65 g ethanol) saw the highest risk for an early death, with a 35% higher risk for all-cause mortality compared with lifetime abstainers from booze (RR 1.35, 95% CI 1.23-1.47).

Even when compared with just the occasional drinker -- those who keep it under one drink a week -- high and higher-volume drinkers still saw significantly higher risks for death.

But the "safe" threshold for drinking was lower for women.

When just looking at data on females, even medium-volume drinking wasn't without health risks. Women drinking around two to three servings (25 to 44 g of ethanol) daily saw a 21% higher risk of death from any cause compared with women who completely abstained from alcohol (RR 1.21, 95% CI 1.08-1.36). On top of that, high- and higher-volume female drinkers had a 34% and 61% increased risk for death, respectively.

Overall, Brennan advised that men limit their alcohol intake to two drinks per day or less and women should limit their intake to one drink per day or less.

While all ages generally saw the same pattern -- higher all-cause mortality linked with more than three drinks per day -- the magnitude of this risk was more pronounced for those under age 56. Because of this, the researchers suggested future studies home in on this younger age group.

The fully adjusted models took into consideration factors like abstainer biases, age, sex, study country, drinking patterns, lifestyle factors, and more.

Data on over 4.8 million individuals and 425,564 deaths were compiled as part of this updated systematic review and meta-analysis, which included 107 studies in more than 20 countries published from 1980 to 2021.

These findings support those from two prior meta-analyses conducted by the same research group. In 2016, the researchers found a trend suggesting that low-volume daily drinking might help stave off death from any cause, but this risk reduction disappeared after adjustment for abstainer biases and quality-related study characteristics. A year later, the researchers found mixed results when looking at the link between alcohol and coronary heart disease.

As the third installment in their series, the current meta-analysis was able to incorporate the last few years of new data. "Our study summarized results from every published study on the topic canvassing the life experiences of nearly 5 million individuals," said Stockwell.

"Our focus is on the validity of the hypothesis that alcohol in moderation is beneficial for health," he added.

However, the group said that the available research on the topic is still riddled with drinker misclassification errors, as 86 of the studies included former drinkers or occasional drinkers in the abstainer group used for comparison. Only 21 of these studies were actually free of abstainer biases.

"The importance of controlling for former drinker bias/misclassification is highlighted once more in our results which are consistent with prior studies showing that former drinkers have significantly elevated mortality risks compared with lifetime abstainers," Zhao's group said.

For example, they found former drinkers carried a 26% higher risk for death from any cause than lifelong abstainers (RR 1.26, 95% CI 1.12-1.42). This lends support to the notion of "sick quitters," or former drinkers who quit due to health reasons.

Stockwell also pointed out how studies of older people are the most biased toward finding health benefits from moderate drinking.

"One of the reasons for this is that older people who continue to drink tend to be particularly robust and healthy, while those who stop drinking often do so because they have become unwell," he explained.

"Being able to continue drinking at an older age is a sign -- not a cause -- of good health," said Stockwell.

Source: https://www.medpagetoday.com/primarycare/p...

You CAN reverse Diabetes, but you better do exercise, too!

A really interesting study of prediabetes says that simply reversing prediabetes doesn’t cut your risk of dying. Of course, a big percentage of people will progress to diabetes, and their risk of dying goes up 50%.  But just getting the sugar normal will not, by itself, keep you alive longer.  You have to do exercise!  If you drop your sugar AND you do exercise you cut your risk of dying by around 30%, translating to another 2- 2.5 years of life. 

FROM MEDPAGE TODAY / BY KRISTEN MONACO

Reduced risk only seen in physically active patients, Taiwanese study found

Reversing prediabetes was not associated with a lower mortality risk, according to a Taiwanese cohort study of more than 45,000 adults.

Over 8 years of median follow-up, patients who reversed their condition to a state of normoglycemia didn't experience a significantly lower risk for all-cause, cancer-related, or cardiovascular-related death compared with those who remained in persistent prediabetes, reported Xifeng Wu, MD, PhD, of Zhejiang University in China, and colleagues.

"Interestingly, reversion to normoglycemia combined with the adoption of healthy behaviors, such as a higher level of physical activity and no current smoking, were associated with a substantially lower risk of death and longer life expectancy," the authors wrote in JAMA Network. "These findings highlight the importance of lifestyle modifications among individuals with prediabetes status."

Across multiple analyses looking at modifiable risk factors and all-cause mortality, the only groups with a significantly lower risk were patients who were physically active and either reversed their prediabetes (HR 0.72, 95% CI 0.59-0.87) or remained in a state of prediabetes (HR 0.77, 95% CI 0.66-0.90), with both groups compared with inactive individuals with persistent diabetes. These differences translated to roughly a 2- to 2.5-year longer life expectancy.

Physically active individuals were clocking 7.50 or more metabolic equivalent of task (MET) hours per week, while inactive individuals were getting less than 3.75 MET hours per week. No benefit was seen for individuals who were "moderately" active (3.75-7.49 MET hours per week). Though it depends on someone's body weight, a brisk walk can typically range from 3 to 6 METs, according to the CDC.

While individuals with obesity didn't see a significant death protection by reversing prediabetes (HR 1.10, 95% CI 0.82-1.49) compared with those of normal weight with persistent prediabetes, those who stayed in a prediabetic state with obesity carried an excess risk for death (HR 1.33, 95% CI 1.10-1.62).

And normoglycemia still couldn't offset the risks that came with smoking, as current smokers carried a similar 60-61% higher mortality risk whether they had achieved normoglycemia or remained in persistent prediabetes when compared with never smokers with persistent prediabetes. This translated to roughly 3 to 3.5 years less of life expectancy for the current smokers.

This pattern was not seen with alcohol drinkers, though.

The 45,782-person population-based cohort study gathered data from the Taiwan MJ Cohort Study, which recruited participants from 1996 to 2007. In the entirely Asian cohort, 63% were men, and average age was 44.6 years.

Within the first 3 years after study enrollment, 3.9% progressed to full-blown type 2 diabetes, while 37.2% reversed back to normoglycemia. Over the median 8-year follow-up period, 1,528 deaths occurred, including 671 from cancer and 308 from cardiovascular disease.

Not surprisingly, those who progressed to full-blown type 2 diabetes over the 3-year period had a higher risk for all-cause and cardiovascular-related mortality than those who persistently stayed in the prediabetic state:

  • All-cause mortality: HR 1.50 (95% CI 1.25-1.79)

  • Cardiovascular-related mortality: HR 1.61 (95% CI 1.12-2.33)

Wu and co-authors noted that the results of their study "extended previous findings by confirming that the association between prediabetes and the risk of death might be explained by progression from prediabetes to diabetes."

Diabetes status was ranked according to fasting plasma glucose level by American Diabetes Association criteria: normoglycemia (<100 mg/dL), prediabetes (100-125 mg/dL), diabetes (≥126 mg/dL). All were measured with overnight fasting blood samples taken in the morning.

Source: https://www.medpagetoday.com/endocrinology...

Genetic evaluation should be used for more than chemotherapy!

Currently, in conventional medical practice, the term “personalized medicine” routinely refers to identifying the genetics of some cancerous tumor so as to “tune” chemotherapy.  Of course, I’ve been using genetic evaluations from a wide variety of providers depending on specific needs, none of which involves a cancerous tumor.  The attached abstract hints at the value that an appropriate genetic evaluation could have for both individuals and populations.  By running patients with high blood pressure through a genetic test panel (only 10 genes) that then translated into much more effective high blood pressure treatment in a much shorter time than in the population receiving usual care.  Since about 45% of strokes occur in patients with hypertension who aren’t adequately controlled, controlling blood pressure more quickly through genetic could easily pay for itself in better outcomes (and it real dollars!).  

One could ask why we don’t do this… but that would just be a silly question, right?

FROM SCIENCE TRANSLATIONAL MEDICINE / BY QI SHEN HONGHONG ZHANG, YIMING HUANG, MINGYU LI, HAO ZHAO, ZHIWEN YANG, HAIJING ZHAO, QI LIU, ZIHAO FU, SHU WANG

Genetic variants among individuals have been associated with ineffective control of hypertension. Previous work has shown that hypertension has a polygenic nature, and interactions between these loci have been associated with variations in drug response. Rapid detection of multiple genetic loci with high sensitivity and specificity is needed for the effective implementation of personalized medicine for the treatment of hypertension. Here, we used a cationic conjugated polymer (CCP)–based multistep fluorescence resonance energy transfer (MS-FRET) technique to qualitatively analyze DNA genotypes associated with hypertension in the Chinese population. Assessment of 10 genetic loci using this technique successfully identified known hypertensive risk alleles in a retrospective study of whole-blood samples from 150 patients hospitalized with hypertension. We then applied our detection method in a prospective clinical trial of 100 patients with essential hypertension and found that personalized treatment of patients with hypertension based on results from the MS-FRET technique could effectively improve blood pressure control rate (94.0% versus 54.0%) and shorten the time duration to controlling blood pressure (4.06 ± 2.10 versus 5.82 ± 1.84 days) as compared with conventional treatment. These results suggest that CCP-based MS-FRET genetic variant detection may assist clinicians in rapid and accurate classification of risk in patients with hypertension and improve treatment outcomes.

SNPing out hypertension

Essential hypertension has multiple genetic risk factors that can affect both its incidence and response to treatment. Here, Shen and colleagues developed a simple, high-throughput fluorescent assay for detection of two different single nucleotide polymorphisms (SNPs) in a single reaction. They applied this method in a prospective study to screen for variants at a total of 10 loci associated with hypertension and guide medication use based on drug class-associated risks. Patients treated according to this precision medicine approach had improved blood pressure control over a 7-day period compared with those treated using standard guidelines. These results suggest that this assay should be further studied and may be useful in resource-limited settings.

Source: https://www.science.org/doi/10.1126/scitra...

With a Simple Blood Test, It’s Easier than Ever to detect Brain Injuries

Concussions are common and can have serious consequences.  If you show up at the ER with a head injury, chances are you’ll get a CT scan of your head.  But going forward that may be overkill – a blood test will reliably be able to tell you if you don’t need one.  That could save hours and hours at the hospital.  That would be great for most people.  Of course, conventional medical practice does little to help those who end up having a concussion, but we can help you with that.  There’s lots of options, all of which will help improve the condition more quickly, so long as you actually do something about it.  The usual advice is rest, take it easy.  Yes, but there are supplements and therapies that can be applied and accelerate healing.  Keep that in mind should you have this issue.  I’m here to help!

FROM ABBOTT LABS

Abbott has received U.S. Food and Drug Administration clearance for what will be the first commercially available laboratory traumatic brain injury (TBI) blood test, making it widely available to hospitals in the United States. The test, which runs on Abbott's Alinity® i laboratory instrument, will provide clinicians with an objective way to quickly assess individuals with mild TBIs, also known as concussions.

Abbott's Alinity i TBI lab test offers a new reliable result in 18 minutes to help clinicians quickly assess concussion and triage patients. For those with negative results, it rules out the need for a CT scan and can eliminate wait time at the hospital. The test measures two biomarkers in the blood that, in elevated concentrations, are tightly correlated to brain injury.

For decades, standard concussion assessment has remained the same, with doctors leveraging the Glasgow Coma Scale, a subjective doctor assessment, and CT scans to detect brain tissue damage or lesions. Having a blood test available could help reduce the number of unnecessary CT scans by up to 40%, potentially reducing costs to the healthcare system and the patient as well as the amount of time they spend in the emergency department.

Millions of people in the U.S. suffer a concussion each year, but more than half of people who suspect they have a concussion never get it checked.

"People sometimes minimize a hit to the head, thinking it's no big deal. Others wonder if a visit to the doctor or emergency room for a possible concussion will provide them with meaningful answers or care," said Beth McQuiston, M.D., medical director in Abbott's diagnostics business. "Now that this test will be widely available in labs across the country, medical centers will be able to offer an objective blood test than can aid in concussion assessment. That's great news for both doctors and people who are trying to find out if they have suffered a traumatic brain injury."

TBIs are caused by a bump, blow or whiplash to the head and can pose risk of both short- and long-term effects. People who experience a TBI may experience impairment of memory, movement, sensation (e.g., vision and hearing), and emotional functioning (e.g., personality changes, psychological symptoms). Effects of TBI can last anywhere from a few days post-injury or may be permanent. People who sustain a TBI are more likely to have another one – similarly to how a sprained ankle or torn ligament is more susceptible to future injury.

These effects are worsened by misdiagnosis or lack of diagnosis, so providing tools that can objectively aid in the evaluation of a TBI or concussion is essential to giving people the answers and treatment they need.

Abbott has been pioneering breakthroughs in TBI testing technology for over a decade. This FDA clearance complements Abbott's i-STAT TBI Plasma test, the first rapid blood test for concussion, which is already cleared by the FDA. With the Alinity i clearance, a TBI blood test can now be run on Abbott's high throughput Alinity i laboratory instrument. The advancement will make TBI testing more available because the Alinity i instrument is widely used in hospitals and laboratories across the U.S.

The Alinity i test can be used when a patient shows up to the hospital with a suspected mTBI within 12 hours of injury. A blood sample is drawn from the arm and sent to the lab for preparation and the test is run on the Alinity i instrument. Results are available in as little as 18 minutes and shared with the treating healthcare provider for evaluation.

Broadening the availability of the TBI blood test for use on lab-based instruments is an important step in Abbott's strategy to ensure its tests are available in all settings where people seek care for head injuries.

About Alinity i laboratory test for TBI

The Alinity i TBI test measures complementary biomarkers in blood plasma and serum - Ubiquitin C-terminal Hydrolase L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP), that, in elevated concentrations, are tightly correlated to brain injury. It provides test results with 96.7% sensitivity and 99.4% negative predictive value.

Testing for these two biomarkers in the immediate aftermath of an injury can help health care providers decide appropriate next steps and develop a plan to care for patients. The test is for use to aid in the evaluation of patients, 18 years of age or older, presenting with suspected mild traumatic brain injury (Glasgow Coma Scale score 13-15) within 12 hours of injury, to assist in determining the need for a CT (computed tomography) scan of the head.

The test previously received European Union clearance and has been available in markets outside the U.S. since 2021.

Source: https://abbott.mediaroom.com/2023-03-07-Ab...

Cognitive Functioning Improves After Cochlear Implant

Anyone ever tell you that you should get your hearing tested?  And it’s more than you just choosing to ignore some annoying person 😉?  Then maybe it would pay for you to actually get your hearing tested and get a hearing aid if you need one.  “But I don’t want to wear a hearing aid”.  Then prepared to get dumber.  

Lots of studies support that as sensory inputs start to waiver – poor eyesight, hearing, even taste – the cognitive decline accelerates as you age.  Who wants that?  

If you need a hearing aide – you need to get one (or two, more likely) and WEAR IT!  It might just make you smarter.

FROM MEDPAGE TODAY / BY JUDY GEORGE

Clinically meaningful improvement in older adults at risk for mild cognitive impairment

Cognitive functioning improved 12 months after cochlear implantation for older adults with severe hearing loss and poor cognition, data from a single-center study showed.

Among 21 cochlear implant candidates whose preoperative scores indicated mild cognitive impairment, overall cognitive scores improved 12 months after cochlear implant activation from a median percentile of 5 to 12 (difference of 7, 95% CI 2-12), reported Ellen Andries, MSc, of Antwerp University Hospital in Belgium, and colleagues.

Eight participants' scores improved enough to move them out of the mild cognitive impairment category (16th percentile), Andries and co-authors reported in JAMA Otolaryngology-Head & Neck Surgery.

Speech recognition in noise improved, which was tied to a rise in cognitive abilities.

The study is one of the first to examine cochlear implants among older adults with preoperative poor cognitive functioning, the researchers noted.

"Several large studies have previously demonstrated an improvement of cognitive functioning in severely hearing-impaired older adults after cochlear implantation, but few of these studies specifically analyzed participants achieving poor cognitive outcomes preoperatively," Andries told MedPage Today.

The findings suggest cochlear implantation is not contraindicated in candidates with cognitive decline and should be considered after a multidisciplinary evaluation, she noted.

"The management of modifiable risk factors for dementia, such as hearing loss, is important as there is currently no cure for dementia and its incidence is rising rapidly," Andries added. The top modifiable risk factoropens in a new tab or window for dementia prevention is hearing loss, which accounts for 8.2% of the global dementia burden, according to a recent Lancet Commission report.

The analysis included cochlear implant candidates 55 and older with poor baseline cognitive scores among participants in Antwerp University Hospital's larger prospective cohort study from April 2015 to September 2021. Median age was 72, and 62% were men. Speech processors were activated approximately 4 weeks after cochlear implantation surgery.

All participants had a preoperative total score on the Repeatable Battery for the Assessment of Neuropsychological Status for hearing-impaired patients (RBANS-H) that indicated mild cognitive impairment -- a score at least 1 standard deviation below the mean compared with age-appropriate normative data (16th percentile or lower).

The RBANS-H evaluates five cognitive subdomains: immediate memory, attention, language, visuospatial/constructional, and delayed memory. The test battery has alternate forms A and B; both were used to assess patients 1 month preoperatively and 12 months after speech processor activation.

Speech recognition in noise was measured with the Leuven Intelligibility Sentences Test. Anxiety and depression symptoms were identified using the Hospital Anxiety and Depression Scale (HADS) preoperatively and 12 months after activation.

Most participants (16 of 21) showed improvement in the RBANS-H total percentile 12 months after cochlear implant activation. The RBANS-H percentile remained stable in one participant and decreased in four.

Speech recognition in noise improved after activation (mean score 17.16 vs 5.67 on a scale where lower is better, for a difference of −11.49, 95% CI −14.26 to −8.72). Better speech recognition in noise was associated with significantly better cognitive functioning (rs −0.48).

Other variables, including years of education, sex, RBANS-H version, and depression and anxiety symptoms, were not related to changes in RBANS-H scores.

The findings support the information degradation hypothesisopens in a new tab or window as a potential explanation for the link between hearing loss and cognition, Andries and colleagues observed. "This hypothesis states that older adults with hearing loss need to rely more on cognitive resources to compensate for impaired auditory input, resulting in more mental fatigue and a higher cognitive load, which leads to a reduction of cognitive resources available for other cognitive tasks," they noted.

The study lacked a control group for ethical reasons, the researchers pointed out, and unknown factors like infection, medications, or pain could have influenced cognitive performance.

The small sample size was also a limitation, they acknowledged. "Further longitudinal research including a larger sample of cochlear implant candidates with cognitive decline is therefore recommended," they wrote.

Source: https://www.medpagetoday.com/neurology/dem...

Healthy Eating Linked to Lower Risk of Total Mortality

The headline, of course, is the hook – Health Eating Linked to Lower Risk of Mortality.  Great – eat “what you’re supposed to” and save lives.  Only, as usual, that’s really not the whole story.  So, boatloads of people (75k women, 44k men) over lots of years (up to 36 years) showed a risk reduction of between 14 and 20 percent, which would be good, EXCEPT this compares the “best” eaters against the “worst” eaters. 

Is it worth it to get crazy about your diet? That’s not really fair – the best diet is actually not only tolerable, but good.  It’s not at all a crazy diet,  but I have a different take on all of it (Surprised??).  Before we get to that, there are some other interesting things we should note.  Certain specific categories of disease have very different results – Lung disease (to me, surprisingly) is impacted the most, with a 35-46% risk reduction (that would mean if you have lung disease – PAY ATTENTION TO YOUR DIET!).  On the other hand, Stroke is unaffected, heart disease, cardiovascular disease and cancer deaths are reduced between 6 and 18%.  

What’s my take?  The food supply is screwed up, relatively depleted of nutrition and regardless of how well you adhere to the right plan, there’s more to do.  Whether that be vitamins or other supplements, exercise, stress reduction, etc – really reducing risk of disease and death requires attention and action.   For me, that means getting some data, analyzing the results and doing “stuff” to make a difference.  

Let’s chat to see if there’s something you might want to do to change your health trajectory!

Adhering to healthy eating patterns was associated with lower risk of total and cause-specific mortality, a prospective cohort study with up to 36 years of follow-up showed.

Among 75,230 women from the Nurses' Health Study and 44,085 men from the Health Professionals Follow-up Study, those who scored in the highest quintile for healthy eating patterns recommended by the Dietary Guidelines for Americans (DGAs) had a 14% to 20% lower risk of total mortality versus those in the lowest quintile, reported Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues in JAMA Internal Medicine.

The pooled multivariable-adjusted hazard ratios of total mortality with four healthy eating patterns were (P<0.001 for trend for all):

  • Healthy Eating Index 2015 (HEI-2015): HR 0.81 (95% CI 0.79-0.84)

  • Alternate Mediterranean Diet (AMED): HR 0.82 (95% CI 0.79-0.84)

  • Healthful Plant-Based Diet Index (HPDI): HR 0.86 (95% CI 0.83-0.89)

  • Alternate Healthy Eating Index (AHEI): HR 0.80 (95% CI 0.77-0.82)

This lower risk was consistent across all racial and ethnic groups.

"This is one of the largest and longest-running studies that examine the associations of dietary scores for four healthy eating patterns recommended by the DGAs with the risk of total and cause-specific mortality in large cohort studies," Hu told MedPage Today.

"Every 5 years, the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) release an updated version of the Dietary Guidelines for Americans," he explained. "It is important to evaluate adherence to DGA-recommended eating patterns and health outcomes, especially mortality, so that timely updating of DGAs can be made."

Hu noted that these findings will be valuable for the 2025-2030 Dietary Guidelines Advisory Committee, which is being created by the USDA and HHS to evaluate the current evidence on different eating patterns and health outcomes.

Beyond total mortality, healthier diets were also significantly linked to lower risk of cause-specific mortality.

Across the four different dietary patterns, people in the highest quintile saw a 6% to 13% lower risk of death from cardiovascular disease versus those in the lowest quintile. Likewise, those in the highest quintile saw a 6% to 15% lower risk of death due to heart disease, a 7% to 18% lower risk of cancer-related death, and a 35% to 46% lower risk of respiratory disease-related death.

In addition, those with the highest scores on the AMED and AHEI also saw a modestly lower risk of death due to neurodegenerative disease (HR 0.94, 95% CI 0.90-0.99 and HR 0.93, 95% CI 0.87-0.99, respectively).

"Although previous studies have found an inverse association between healthy eating patterns and mortality, our study provides evidence that healthy eating patterns reduce the risk of cause-specific mortality including cardiovascular disease, cancer, respiratory, and neurodegenerative mortality," said Hu. "The findings on respiratory and neurodegenerative mortality are novel."

However, eating a healthy diet according to any of the four patterns did not appear to be protective against stroke-related deaths.

Hu said clinicians can recommend a "variety of healthy dietary patterns" to patients in order to reduce their risk for chronic diseases and premature death.

"These patterns such as the Mediterranean diet, DASH diet, vegetarian diet, or other versions of healthy diets can be adapted to meet individual health needs, food preferences, and cultural traditions," he noted. "These healthy dietary patterns typically include high amounts of plant foods such as fruits, vegetables, whole grains, nuts, and legumes, and lower amounts of refined grains, added sugars, sodium, and red and processed meats."

"It is also important to balance caloric intake with physical activity to maintain a healthy weight," he added.

Among the women included in the analysis, mean baseline age was 50.2 and 98% were white; for men, mean age was 53.3 and 91% were white. In total, 31,263 women and 22,900 men died during follow-up. The leading cause of death was cancer, followed by cardiovascular disease, heart disease, neurodegenerative disease, respiratory disease, and stroke.

Dietary data were taken from semiquantitative food frequency questionnaires including more than 130 items, which were completed every 2 to 4 years.

Source: https://www.medpagetoday.com/primarycare/d...

Researchers Looking For Long COVID Symptoms Find Only 7

Let's get something clear that I don't think people actually know - COVID is a disease of blood vessels.  As such, it hits everything, hence a constellation of symptoms that covers the universe (get the astronomy reference?).  Also, while the mainstream suggests that there are no clear diagnostic criteria for Long Haul, there is plenty of evidence supporting specific blood tests (that we do) that ties directly to the symptoms and mirrors patients' experience. When you can fix the labs, you can fix the people.  Unfortunately, it can take a while, but it can be done.  Defining the problem remains a problem broadly, but that's why we're not doing mainstream medicine - we need to deliver solutions first.  

FROM FIERCE HEALTHCARE / BY FRANK DIAMOND

The Centers for Disease Control and Prevention’s tally of 19 possible long COVID symptoms comes with the caveat that it's “not a comprehensive list.”

Yale Medicine counts 22 symptoms, while the Mayo Clinic lists 10. And Great Britain’s National Health Service (NHS) puts the number at 16.

These lists can be made even longer. For instance, the NHS has “high temperature, cough, headaches, sore throat and changes to sense of smell or taste” as one symptom. Mayo lists “difficulty thinking or concentrating, headache, sleep problems, dizziness when you stand, pins-and-needles feeling, loss of smell or taste and depression or anxiety” as one symptom.

A major obstacle to helping patients with long COVID is that currently there are no generally agreed-upon diagnostic or treatment guidelines. Narrowing down exactly what symptoms point to long COVID would be a start, and researchers at the University of Missouri (MU) think they’ve done just that by slimming the field of long COVID symptoms down to just seven: fast-beating heart, hair loss, fatigue, chest pain, shortness of breath, joint pain and obesity.

Their study in Open Forum Infectious Diseases said that “understanding the population and subgroup risks for long COVID associated with outcomes, including lingering and chronic never-before-experienced symptoms and new medical diagnoses such as those reported here, is important for clinicians and researchers so that clinical guidelines for treatments and symptom management can be more appropriately developed for the growing number of adults affected by COVID-19.”

Chi-Ren Shyu, Ph.D., the director of the MU Institute for Data Science and Informatics and the corresponding author of the study, tells Fierce Healthcare that “understanding the population and subgroup risks for long COVID associated with outcomes, including lingering and chronic never-before-experienced symptoms and new medical diagnoses such as those reported here, is important for clinicians and researchers, so that clinical guidelines for treatments and symptom management can be more appropriately developed for the growing number of adults affected by COVID-19.”

Shyu and co-authors examined data from 52,461 patients collected in electronic health records at 122 healthcare facilities across the U.S. They identified 47 possible symptoms of long COVID. They compared symptoms in three groups:

  • Individuals who had COVID-19 but didn’t have common viral problems associated with the disease such as influenza or pneumonia.

  • Individuals who didn’t have COVID-19 but did have a different viral respiratory infection.

  • Individuals who had neither COVID-19 nor one of the other infections.

“Previous work has briefly investigated the differences in outcomes between hospitalized COVID-19 and influenza patients,” the study states. “Our work provides additional information on this subject by analyzing a larger and more diverse patient cohort, including other common viral respiratory infections, and examining outcomes in patient cohorts not limited to patients hospitalized for the initial infection.”

The authors said they hope their findings will point out what symptoms clinicians should look for when trying to determine whether somebody has long COVID. “A better recognition of post COVID syndrome or long COVID will help us study the underlying reasons that cause these prolonged abnormalities and also help us develop screening protocols to be used when COVID-19 survivors are seen within the healthcare systems,” says Shyu. “Such recognition also helps in developing focused treatments and rehabilitation strategies to promote recovery.”

Adnan Qureshi, Ph.D., a professor of neurology at the MU School of Medicine and co-author of the study, notes in a press release that the “survivors still have symptoms that are at times disabling and preventing them from going back to work or the activities of their daily life. This is not because the COVID-19 infection is still active, but instead, the infection has caused long-term consequences, or sequelae, in the form of a post-COVID syndrome that could persist for months or even years. Our research was able to identify long-term sequelae that are distinctive to COVID-19 and separate the post-COVID syndrome from other post-viral syndromes.”

One symptom of long COVID that their study found bolsters the findings of previous studies that linked the condition to heart problems.

Source: https://www.fiercehealthcare.com/providers...