TTHealthWatch is a weekly podcast from Texas Tech. In this paper, Elizabeth Tracey, director of electronic media at Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Health Science Center at Texas Tech University in El Paso, take a look at the week’s more sensible medical stories.
This week’s topics include the threat of thrombosis in hospitalized patients with COVID, thresholds for gestational diabetes, clinical rules for monkeypox and remote ischemic conditioning, and stroke outcomes.
Program Notes:
0:40 Thromboembolism in other people hospitalized with COVID instead of influenza
1:40 60% to one hundred percent increased threat of deep vein thrombosis or pulmonary embolism
2:40 Continue after hospitalization?
3:44 Effect of remote ischemic conditioning stroke
4:45 Results advanced to 5%
five:4cinco It is mandatory to try from one hundred to five
6:48 Biological plausibility?
7:10 Clinically ape smallpox
8:10 Lack of clinical decision-making of the consultant
8:43 Gestational Diabetes Treatment
9:45 Several hundred in the arm
10:45 Perhaps it would help lower glucose levels?
11:56 End
Transcription:
Elizabeth: Do we still know when to treat gestational diabetes?
Rick: Do other people hospitalized with COVID have an increased risk of clotting in the venous and arterial system?
Elizabeth: Can what’s called remote ischemic conditioning be able to other people who have had a stroke?
Rick: And what do we know about the quality of clinical control guidelines for monkeypox?
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at medical headlines at Texas Tech University Health Science Center in El Paso. I’m Elizabeth Tracey, a medical journalist in Baltimore.
Rick: And I’m Rick Lange, president of the Health Science Center at Texas Tech University in El Paso, where I’m dean of the Paul L School of Medicine. Foster.
Elizabeth: Rick, of course, let’s move on to the COVID curtains that are in JAMA.
Rick: The authors here looked at the occurrence of clots, or what’s called thromboembolism, either in the arterial formula, in the arteries, and in the veins of other people with COVID-19, because the threat of this remains uncertain. Second, it remains literally unclear whether vaccination has replaced that.
Thus, a retrospective cohort of more than 41,000 patients hospitalized before vaccine availability and another 44,000 hospitalized patients after COVID-19 vaccine availability.
They reported it to other people hospitalized for influenza and measured arterial thromboembolism, that is, the risk of acute central attack or stroke, and then the risk of having a clot or thromboembolism in the vein that manifests as deep vein thrombosis or pulmonary embolism. within 90 days of hospitalization.
There was an increased risk of venous thromboembolism, an increase of about 60% and up to 100% for expanding deep vein thrombosis or increased pulmonary embolism. Compared to influenza, the risk of arterial embolism was not higher.
Now, has the vaccine replaced the threat of venous clots?The answer is no. Actually, that wasn’t the case. Compared to patients with influenza, the threat of venous thrombosis was particularly greater in patients before the vaccine, with an accumulation of about 60%, and then the availability of the vaccine, with an accumulation of about 90%. %
Elizabeth: This highlights a challenge that was identified very early in COVID hospitalization, the progression of blood clots, and do you recommend that we give some kind of anticoagulation to those hospitalized people?
Rick: Elizabeth, I think it really brings 2 things. One is to be aware of this and seek it. By the way, this happens not only in hospitalization, but in the first 90 days after that. Then, a hospital stay, we have tactics to save you deep vein thrombosis, blood thinners to save you this, and in other high-risk people, as you said, the question is whether we then continue with an antiplatelet agent or a low-dose anticoagulant?I think either of the two possibilities.
Elizabeth: Are you convinced enough through the knowledge you would offer as a recommendation to other people after discharge from the hospital?
Rick: The threat of thromboembolism about 5% in patients with influenza compared to about 9% with COVID-19. That before the vaccine was available. Then, after that, the numbers were about 10. 9% [with] a vaccine.
Elizabeth: Okay, and to me, it might seem like other people are hospitalized, whether it’s for the flu or COVID, we deserve this factor after hospitalization.
Rick: Okay, but again, I would restrict it to other high-threat people. The explanation of why is that he does not need to treat another hundred people, 90% of whom he puts under threat of remedy, and there is some threat related to him, without getting any advantage from it. But I agree with you. I think we deserve to at least be aware of that and tell other people. In other high-threat people, who would they be?Well, other people who have already had a clot, or maybe other sedentary people or other obese people.
Elizabeth: Since we’re talking about clotting issues, let’s stay on JAMA and go back to this effect of remote ischemic conditioning as opposed to the same previous care in the neurological service as in patients who have had a moderate acute ischemic stroke, therefore a stroke due to clotting. .
This is a study that was conducted in China, and with all due respect I would say that it would never have worked in the United States. It included 1893 participants who suffered moderate acute ischemic stroke. Patients were randomly assigned within 48 hours of symptom onset to obtain remedy using remote ischemic conditioning. This involved the use of a pneumatic electronic device on either of the upper extremities with a cuff inflation cycle for five minutes and deflation for five minutes for 10 to 14 days, or the same previous care.
All of this was discovered in animal models and also in previous studies that showed that this concept of remote ischemic conditioning (interrupting the blood source and then letting it return) is favorable in such circumstances. In fact, when they looked at its effects, they found that the number of other people who came out of this episode with the correct functional effects at 90 days was 67. 4% in the ischemic conditioning organization and 62% in the organization. There were slightly more adverse occasions in the organization that underwent remote control ischemic conditioning. A lot of them were things like pain or anything in the place of the bracelet.
Authors and editorialists have pointed out that there are limitations to this study. One of them, of course, is that there is no way to blind this, but to raise it definitively as a prospective to be able to help the results in those people. .
Rick: For those who aren’t familiar with what we call remote ischemic conditioning, this causes brief but reversible episodes of ischemia, which is a minimum in BloodArray and then repairs the blood in the vascular beds that were not affected by the initial attack. I want to treat another hundred people so that five of them get a non-disabling result with this specific therapy.
The most productive therapy, obviously, is to identify the blood in the brain, and we do that by using drugs to dissolve the clot or by using catheters, devices to remove the clot, which are called thrombectomies, and they are much, much more effective in preventing disabling strokes.
These other people in China didn’t have any available. What I would say is that this is a very modest effect and there is some controversy because it has been tried in other people who have had a stroke and it has not been beneficial, so you want to replicate. The merit is that you can do it anywhere.
Elizabeth: I just notice that the columnist is talking about a consensus organization called STAIR, the Academic Stroke Treatment Industry Roundtable. These other people highlighted several pleiotropic interventions with other mechanisms of action rather than targeting an unmarried injury trail. That’s one of the reasons I think it was compelling. For the 5% of other people who were most successful in it, it was very important to them.
Rick: Right, are you saying there is biological plausibility?Ischemia and reperfusion would possibly supply certain proteins or protective factors. At this specific stage, there are hypotheses, but we don’t know how it is beneficial, if at all. it will have to be reproduced.
Elizabeth: Let’s move on to the British Medical Journal and here’s a look at what we know lately about the clinical remedy of monkeypox.
Rick: Elizabeth, this is a systematic review that looked at the availability, scope, and quality of so-called monkeypox clinical control guidelines.
Most cases of monkeypox were reported in West and Central Africa. It was first reported in 1970 and several outbreaks in 2008. This means that we have had decades to arrive at what are considered clinical control guidelines.
They did a systematic review, either in 6 routinely used databases, but they also did a correct search in the literature, something unofficial. These are in foreign languages. They are in PDF. They are not the typical databases.
Here’s what they discovered. They found that only 14 rules were included. Unfortunately, most of them were considered to be of poor quality and did a very bad job of offering evidence-based clinical rules.
They noted that estimates of early outbreaks in Africa show that the case fatality rate is between 1% and 11%, but, overall, they knew that evidence-based clinical monitoring was lacking to advise patients diagnosed with monkeypox in clinical decision-making.
Elizabeth: This obviously indicates a challenge as we see more and more cases of ape smallpox.
Rick: Cierto. Es a chance. The CDC is again looking to provide guidance on identifying apepox, then the most effective remedies available, isolating people, receiving antiviral agents, and then administering vaccines to others who have been exposed and are considered high-risk.
Elizabeth: More to come in this case, no doubt. Finally, let’s move on to the New England Journal of Medicine. I said, “Oh my God, do we still know when we deserve to start treating gestational diabetes?”
This is a test that was carried out in New Zealand. A total of 4061 women were randomized on this to look at their fasting blood sugar level, an oral glucose test and then what it looks like, their sugar control, for hours after taking it. ?
The question is when we say, “Oh, you have gestational diabetes and now we want to start treating it or managing it more closely. “One last measure of outcomes that is vital here is the birth of a very giant baby, macrosomia.
They had two degrees of glycemic criteria organizations. The higher one allowed higher blood sugar levels than the lower one. There were 310 women in the organization of low glycemic criteria and 124 in the organization of higher glycemic criteria who were diagnosed with gestational diabetes.
What happened to your children? Practically macrosomia numbers – large babies for gestational age. Other types of things surrounding induction of labor, use of fitness services, use of pharmacological agents, and neonatal hypoglycemia were not unusual in this organization of lower glycemic outcomes.
Basically, I must say that the lowest does not seem to have given the result they were looking for, but it resulted in many other things that had to be done for those women. I don’t think we know the answer yet.
Rick: We’ve looked at studies that say, “Does early diagnosis help the mother or the child?Because currently, moms are screened between the 24th and 28th weeks of pregnancy. Early detection tests were not beneficial.
This study said, “What if we lowered the set point, i. e. a lower sugar level?Maybe it will improve outcomes for both mother and child. “But this study shows that this is not the case. Twice as many women have been diagnosed. They followed the same old remedies, but the decrease in the criteria for access to glucose to make a diagnosis literally did not help at all. I think this is actually very helpful in avoiding diagnosis and remedy in women who in a way that doesn’t help them or their babies.
Elizabeth: I would also respectfully recommend that this be carried out in New Zealand, where the population is largely white, and since we know that the incidence of diabetes and gestational diabetes is much higher in other ethnicities, I wonder how applicable those effects are. to other women.
Rick: Elizabeth, that’s a smart point. In fact, in all of our studies, we have to take a look at the populations that have been studied and say, “Are they representative of the population as a whole?”As you said, this would possibly apply to Caucasians, but it also wants to be replicated in other populations. That’s a smart point.
Elizabeth: In that sense, here are this week’s headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. You pay attention and make healthy choices.