Geriatric Update April 8, 2024

The CDC issued a health advisory about Avian Influenza A(H5N1) Virus. A second infection, the first case was a chicken farmer, was found in a cattle farmer who developed conjunctivitis from his infected cows, no other symptoms. His family received oseltamivir prophylaxis and did not get infected.

Signs and symptoms of Covid-19 lasted equally long, and viral rebound was the same, whether treated with Paxlovid or not. However, of the 1296 participants, age 41 (18-87), 15 were hospitalized, 5 in the Paxlovid group, 10 in placebo, none in the Paxlovid and 3 in the placebo group ended up in ICU.  Length of stay was 5 days in the Paxlovid and 18 days in the placebo group.

Universal decolonization with chlorhexidine bathing and nasal iodophor antisepsis in 35 long-term care facilities and targeted decolonization among hospital patients in contact precautions was associated with lower multi-drug resistant carriage, infections, hospitalizations, costs, and deaths.

There has been a lot of hype about artificial intelligence (AI) over the past year, but this is the first study I found actionable for us.  Stanford’s primary care and GI physicians (n=162) were offered AI generated draft responses to patient messages in the electronic inbox, and the utilization rate was 20%. There was no significant change in the mean time spent in the inbox; however, there were significant decreases in physician task load and work exhaustion scores, both by about 1/3.

Pancreatic but not hepatic visceral fat accumulation in 204 middle aged children of Alzheimer’s patients was associated with decreased cognition and brain volume in men but not women.

In a meta analysis metformin showed weight loss in overweight and obese patients without diabetes. This was more pronounced in patients with insulin resistance and NAFLD now called MASLD.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors effect on skeletal muscle pathology in patients with heart failure and reduced ejection fraction (HFrEF) was compared with patients without the med in 28 patients and 16 mice. Myofiber atrophy was ~20% less due to reduced atrophy, metabolism, and inflammation. The mechanisms were identified as:

• Tryptophan metabolism to: kynurenic acid (neuroprotective) was 24% higher and kynurenine (neurotoxic) was 32% lower.

• Pro-inflammatory cytokines reduced by 26–64%. interleukin (IL)-6-JAK/STAT3 signaling reduced by 55.6%, which also drives neurotoxic kynurenine.  

• The ubiquitin-proteasome gene was reduced by about 60%, this proteasome helps to break down proteins.

This commentary explains the mechanisms nicely in a short one-pager.

An Italian case control study showed antihypertensive drug treatment is associated with a lower risk of dementia, all the way to very old age and in frail patients.

An experimental nasal spray has improved obstructive sleep apnea (OSA) in select patients, who respond to upper airway dilator muscle stimulation. TASK 1/3 K+ channel antagonism increases upper airway dilator muscle activity and reduces pharyngeal collapsibility during nasal breathing while asleep. It improved the OSA severity to 28 apnea-hypopnea episodes vs. 36 in placebo and lowered morning BP by 10 mmHg, but made no statistically significant difference in apnea-hypopnea index. With >90 different masks available now, many patients who didn’t tolerate CPAP years ago should be referred again, but if they still don’t tolerate it, this is another, albeit less effective alternative for some. For additional suggestions and other sleep tips, watch my 20 min sleep presentation.

In patients with acute myocardial infarction (MI) who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of death from any cause or new MI than no beta-blocker use.

Sodium intake above the recommended threshold may account for 10% of total cardiovascular disease, 13% of coronary heart disease, and 30% of heart failure deaths in a low-income southern population of 72% Blacks.

Intense exercise over 6 months by patients with early Parkinson’s significantly increased dopamine transporter availability in the substantia nigra and putamen, as well as neuromelanin (NM) concentration in the substantia nigra, on NM-MRI. Normally a decline would have been expected. I look forward to a follow up study, if it improved function in the remaining dopaminergic neurons after exercise.

Exercising at least twice a week is associated with significantly fewer insomnia symptoms and better sleep duration

The 10 places with the longest life expectancy are: Monaco, age 87, Japan, Hongkong, Macau, Italy, Vatican, Singapore, Switzerland, Liechtenstein and South Korea.

The FDA warns of certain topical pain relief products that have excessively high levels of lidocaine, leading to reports of adverse events, which can be cardiac arrhythmias and seizures.

In a meta-analysis of RCTs, high-dose omega-3 fatty acids, EPA/DHA (>1.5 grams/day) were associated with the greatest improvement in the frequency of migraine days among oral pharmacologic interventions, followed by valproate and topiramate. A commentary also recommends reducing omega 6 foods and oils.

Gut microbial pathways implicated in CVD include flavonoid, γ-butyrobetaine, and cholesterol metabolism. Species from the Oscillibacter genus were associated with decreased fecal and plasma cholesterol levels. Using functional prediction and in vitro characterization of multiple representative human gut Oscillibacter isolates, this study showed cholesterol-metabolizing capabilities, including glycosylation and dehydrogenation.

In patients with inflammatory bowel disease (IBD), compared with participants with vitamin D deficiency, nondeficient participants showed a significantly reduced bowel resection risk in IBD (hazard ratio, 0.72), Crohn disease (CD; HR, 0.74), and ulcerative colitis (UC; HR, 0.73). The highest vitamin D quintile reduced resection for UC by 46%.