Geriatric Update Jan 29, 2024
I have written about prolonged infections with virus mutations in immune compromised patients before. This study of 156 immune compromised patients with COVID showed similar within-host evolutionary rates across patients, and individuals with infections lasting longer than 56 days accumulated spike mutations, which were distinct from those seen globally. However, prolonged replication-competent omicron SARS-CoV-2 infections were uncommon.
Long COVID is uncommon, but not rare in children. Of 1.1 million children, 0.3% met the criteria for probable long COVID. Of those with known infection, 0.8% developed diagnosed long COVID and 4.5% had probable long COVID. Vaccines were moderately effective in preventing long COVID and the level of protection depended on the definition used for long COVID, the age of the child, and the length of time from vaccination, as summarized nicely in this commentary and copied below.
Overall vaccine effectiveness (VE) was 35% for probable long COVID.
VE was higher for older (12–17 years) children at 50%.
VE was lower for younger (5–11 years) children at 24%.
Overall VE was 42% for diagnosed long-COVID.
VE was higher for older (12–17 years) children at 56%.
VE was lower for younger (5–11 years) children with the confidence interval crossing zero.
VE declined from 61% at 6 months after vaccination to 11% at 18 months after vaccination.
168,000 adults aged 18 years and older, 42.2% reported receiving an influenza and 18.3% an updated COVID-19 vaccine. Of the 62,816 adults aged 60 years and older, 17.0% reported receiving the respiratory syncytial virus vaccine. Among those who had not been vaccinated, the majority indicated an openness to vaccination, 53% in those >60 yo.
>3 months after SARS-CoV-2 infection. About 1/3 of 4684 individuals responded to a questionnaire, of whom 988 (21.1%) were treated with Paxlovid and 3696 (78.9%) were untreated, median age 55 years. At 5.4 ± 1.3 months after infection, treatment was not associated with subsequent long COVID symptoms (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.80–1.64; p = 0.45), and rebound symptoms or test positivity were not associated with long COVID symptoms (OR: 1.34; 95% CI: 0.74–2.41; p = 0.33).
Unvaccinated mothers were shown to have had greater incidence of severe or critical COVID disease, at a rate of 16% compared to those who were vaccinated, at 4%.
In geriatric and other news,
In 412 emergency room health care workers, avg. age 37, reuse of N95, led to fit failure in 38.7% of masks after 1 shift. Trifold N95s had higher incidence of fit failure 61% compared with dome 28% N95s. This is important to consider, especially for those of us who can only be fitted for duckbill masks.
3721 (7.6%) UK participants identified as healthy aging completed a food questionnaire in 1984 when aged <60. Protein intake at middle age was significantly associated with higher odds of healthy aging. The ORs (95% confidence intervals) per 3%-energy increment with healthy aging were 1.05 (1.01, 1.10) for total protein, 1.07 (1.02, 1.11) for animal protein, 1.14 (1.06, 1.23) for dairy protein, and 1.38 (1.24, 1.54) for plant protein. Plant protein was also associated with higher odds of absence of physical function limitations and good mental status. In substitution analyses, the authors observed significant positive associations for the isocaloric replacement of animal or dairy protein, carbohydrate, or fat with plant protein (ORs for healthy aging: 1.22–1.58 for 3% energy replacement with plant protein).
Excellent 2 min video on the myth of 10,000 steps a day. In summary: even smaller amounts are beneficial, but more is better, even beyond 10,000 steps.
Freezing of Gait in Parkinson’s patients can be averted using a soft robotic device — a machine that uses pulleys to apply physical assistance to movement with minimal restriction, a fundamentally different approach to rigid exoskeleton.
This study of 1523 dialysis-dependent patients initiating denosumab and 1281 initiating oral bisphosphonates, the incidence of severe hypocalcemia (ie, <7.5 mg/dL [1.88 mmol/L] or emergent care) at 12 weeks was 41.1% with denosumab, 60 mg, vs 2.0% with oral bisphosphonates (weighted risk difference, 39.1% [95% CI, 36.3%-41.9%]). This is not surprising, considering that denosumab is more potent, given twice a year IV vs. bisphosphonates once a week orally. It is not clear if patients were instructed to take calcium supplements, which all participants in the approval studies for osteoporosis meds were taking. A fairer comparison would have been annual zoledronic acid infusion with denosumab, however, all bisphosphonates are not approved for CreatCl of <30.
A blood test for the detection of glial malignancies (GLI-M) based on the identification of circulating glial cells (CGCs). The test is highly specific for GLI-M and can detect multiple grades (II–IV) and subtypes including gliomas, astrocytomas, oligodendrogliomas, oligoastrocytomas and glioblastomas, irrespective of gender and age. The test differentiated GLI-M from non-malignant brain tumors (NBT), brain metastases from primary epithelial malignancies and healthy individual donors, with 99.35% sensitivity (95% confidence interval [CI]: 96.44%–99.98%) and 100% specificity (95% CI: 99.37%–100%).
Individuals who lack the LCT-rs4988235 gene are susceptible to become lactose intolerant in adulthood. But it is in these individual that higher milk intake is associated with reduced the risk of developing diabetes through alterations in gut microbiota (for example, enriched Bifidobacterium and reduced Prevotella) and circulating metabolites. No difference was found in individuals who have the gene and are not at risk of lactose intolerance.
Six children with autosomal recessive deafness were treated with gene therapy with an adeno-associated virus (AAV) carrying a human OTOF transgene (AAV1-hOTOF).
After 26 weeks, 5 of the 6 children showed hearing recovery as well as “dramatic improvements in speech perception and the restored ability to conduct normal conversation.”
On Feb 1st at 2-3 pm Eastern time, the CDC has a webinar on Diagnostic Testing and Treatment Guidelines for COVID-19 and Influenza, and recording available a few hours later.
"If we are to have peace on earth, our loyalties must become ecumenical rather than sectional. Our loyalties must transcend our race, our tribe, our class, and our nation; and this means we must develop a world perspective."
Martin Luther King, Jr. Christmas sermon, Atlanta, Georgia, 1967.