Geriatric Update Mar 17, 2025

The CDC reported 301 confirmed measles cases in 15 states: Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New Mexico, New York City, New York State, Pennsylvania, Rhode Island, Texas, Vermont, and Washington. 

Only 93% of kindergartners were inoculated because of relaxed state laws: in 13 states, a personal objection is all you need to opt out of a school vaccine requirement, only 5 states do not allow any type of non-medical exemption: California, Connecticut, West Virginia, Maine, New York.

During the 2023 to 2024 season, the 30-day risk of hospitalization was similar for COVID-19 (16.2%) and influenza (16.3%) but lower for RSV at 14.3% (risk of death (RD) for COVID-19 vs RSV, 1.9% [95% CI, 0.9%-2.9%]; RD for influenza vs RSV, 2.0% [95% CI, 0.8%-3.3%]) among the 123,090 (87%) male veterans, avg age 66 years. Mortality was higher for veterans without COVID-19 vaccination in the previous year compared to veterans without seasonal influenza vaccination. In contrast, among groups vaccinated against their respective infections, there were no mortality differences at any time point between COVID-19 and influenza. 

Probiotics have the potential to suppress chronic inflammation by reducing C-reactive protein levels and proinflammatory cytokines, such as IL-6, in the blood, and leading to improved glycemic control, such as HbA1c levels in metabolic disorders.

Denosumab is a monoclonal antibody against the receptor activator of nuclear factor-κB ligand (RANKL), which stimulates osteoclastic bone loss. Given 60 mg subcutaneously every 6 months, it reduced the activity of osteoclasts at the bone surface, reducing fractures. After stopping, fracture rate quickly rose almost sixfold from 1.2 to 7.1 per 100 participant-years, especially multiple fractures at a rate of 4.2 per 100 participant-years compared to 0.4 while on denosumab and 3.2 in the placebo group.

Zoledronic acid following denosumab treatment cessation preserved bone in those who received <2 years of denosumab, but in those >3 years treatment, caused bone loss in the spine and several fractures.  In other locations, zoledronate maintained bone density and prevented fractures.

Alpha-gal syndrome is a tick-borne allergy to the galactose-α-1,3-galactose (alpha-gal) carbohydrate, transmitted by the lone star tick and affecting about 450,000 individuals in the US, mostly in the Southeast.

Symptoms are: angioedema, urticaria, gastrointestinal distress, and delayed anaphylaxis, present 2-8 hours after eating red meat. A key difference from typical food allergies is the delayed reaction, making diagnosis more challenging. Diagnosis took >5 years 20 years ago and is now about 28 months. But a big difference by education groups: 1.4 years for those with graduate degrees compared with 4.4 years for high school diploma holders.

High adherence to the Mediterranean diet was associated with a 6% lower risk of obesity-related cancers compared with low adherence. Furthermore, this inverse association was not mediated by body mass index and waist to hip ratio.

Almost half of intracranial hemorrhage (ICH), 46.4%, was associated with previous ICH and features of cerebral amyloid angiopathy, and were adjacent to previous ICH.

Among individuals with high baseline amyloid (Aβ), female sex was associated with faster tau accumulation localized to inferior temporal, temporal fusiform, and lateral occipital regions compared with male sex, and was faster among APOEε4 carriers. This is based on a review of 6 studies with 1376 participants, mean age at first tau scan, 72 years.

Among 3608 hospitalized patients with bloodstream infection, age 70, antibiotic treatment for 7 days was noninferior to treatment for 14 days.

Blood leukocytes showed transcriptome alterations during the aging process, and ten genes (CD248, PHGDH, SFXN2, MXRA8, NOG, TTC24, PHYKPL, CACHD1, BPGM, and TWF1) were identified as potential aging markers and used to construct an aging clock. Infection accelerates aging via increased inflammation and oxidative stress in infectious disease patients. We have seen infections causing delirium and accelerating dementia, now we have another reason to vaccinate and avoid infections when possible.

A recombinant Newcastle disease virus with pork α1,3GT gene (NDV-GT) for various cancers (liver, ovarian, cervical, lung, esophageal, rectal, breast and melanoma), triggered hyperacute rejection to the cancer. Of 23 patients with relapsed/refractory metastatic showed a 90% of disease control and durable responses over 7 weeks, without serious adverse events and clinically functional neutralizing antibodies.

Patients with clinically node-negative, staged as T1 or T2 (tumor size, ≤5 cm) invasive breast cancer (90% with clinical T1 cancer and 79% with pathological T1 cancer), omission of surgical axillary dissection/staging was noninferior to sentinel-lymph-node biopsy after a median follow-up of 6 years.

Artificial intelligence (AI) hallucinations are misinterpretations that arise due to overfitting, bias, inaccuracies in the training data, or model complexity that can be compared with how humans perceive shapes in clouds or faces on the moon. Chatbots hallucinate between 3% and 27% of the time in simple tasks like summarizing news, with variation depending on the model and developer, and AI incorrectly flags benign nodules as malignant in 12% of cases.