Geriatric Update June 17, 2024

Following a Covid vaccine, the more symptoms, heart rate and temperature response, the more long-term neutralizing antibodies are produced.

 SARS-CoV-2 virus loses 90% of its ability to infect people within 20 minutes — with most of the loss occurring within the first five minutes. Metabolizing and growing virus in droplets drives up the pH to alkaline levels, causing them to die. Carbon dioxide (CO2) plays a critical role in determining how long viruses can stay alive in the air by neutralizing the alkaline environment. Of course, a crowded indoor environment in winter, also in summer when air conditioning is needed in hot climes, increases CO2 but also increases the amount of virus exhaled.

 This study confirmed that patients infected with SARS-CoV-2 had a 65% increased risk (HR 1.65; 95% CI 1.62–1.68) of developing new-onset diabetes relative to noninfected individuals. Vaccines lowered risk of developing new-onset diabetes 21% in comparison with unvaccinated COVID-19 survivors (HR 0.79; 95% CI 0.73–0.86) with more doses reducing risk more.

 The National Academies of Sciences, Engineering, and Medicine suggested a new, more inclusive definition for long COVID in a 187 page report: Long COVID (LC) is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems. LC manifests in multiple ways. A complete enumeration of possible signs, symptoms, and diagnosable conditions of LC would have hundreds of entries. Any organ system can be involved.

 An electronic health record review over five flu seasons showed that for adults of any age, influenza hospitalization odds ratios ranged from 1.8 (95% CI, 1.7–2.0) for 1 risk factor to 6.4 (95% CI, 5.8–7.0) for ≥4 risk factors: sex, geographic region (Northeast, Midwest, South, West, unknown), baseline health care resource use, specific high-risk comorbidities (Carlson), body mass index (≥30), and smoking status. Although age ≥65 years, is considered a risk factor by the CDC, it was not a risk factor in this analysis. Vaccination status and race/ethnicity are risk factors but were not reliably documented and therefore not included. 

 Whooping cough is up 3 fold so far this year compared to all of 2023, 4,864 vs. 1,746 cases. Mostly due to lagging vaccinations.  This bacterial infection can be treated with antibiotics, but needs to be identified early and does not affect the long duration of the cough, in Chinese the disease is called the 100 day cough.

 195 Italians born before 1924 were evaluated, including the short physical performance battery (SPPB) and the minimum data set. Long-term survivors to age 95 had lower levels of disability, but higher body mass index (BMI), SPPB scores and gait speed. 

 The experimental LM11A-31 was given to 242 Europeans age 50-85 with Alzheimer’s dementia (AD) as oral capsule twice daily over 26 weeks, in a phase 2 study.  LM11A-31 modulates the p75 neurotrophin receptor (p75NTR), a member of the tumor necrosis factor family, modifying neuronal dysfunction and degeneration in AD. Side effects were nasopharyngitis, diarrhea, headache and eosinophilia with only 2 participants withdrawing due to diarrhea. MRI findings showed no amyloid-related imaging abnormalities (ARIAs), and no difference in brain volume. CSF analysis showed slowed progression of amyloid and slowed progression of presynaptic and postsynaptic loss. No differences in cognitive loss were found on testing between treatment and placebo.

 Irisin levels in cerebrospinal fluid (CSF) are significantly lower among patients with Alzheimer’s disease, and levels positively correlate with amyloid beta 1-42 (Abeta42). Irisin is a hormone released by muscles during physical exercise, is negatively correlated with Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) in female patients, pointing to a sex-specific disease phenomenon.

 I have reported before that hearing loss contributes to dementia, the mechanism seems to be that hearing loss can accelerate the decline in brain metabolism that occurs in people suffering from mild cognitive impairment, as evidenced by multiple FDG-PET brain scans in 31 participants over 2 years. This acceleration may be largely mitigated through the use of hearing aids.

 Participants, age >70, with glaucoma had a more than 35% increased risk for Alzheimer’s disease, about 65% greater risk for vascular dementia and about 55% greater risk for all-cause dementia, regardless of sex. No increased risk in <60 yo.

 Jinlida (JLD) granules, a Chinese herb of 17 different components, 9 g 3 times/d, decreased risk of developing diabetes by 41% compared to placebo over a mean observation period of 2.2 years in 889 participants with impaired glucose tolerance. Adverse events were no different from placebo.

 Over 52 weeks, loop diuretic dose decreased by 17% in the semaglutide 2.4 mg weekly group vs. a 2.4% increase in the placebo group (P<0.0001) in 1145 participants with heart failure (HFpEF) and body mass index ≥30 kg/m2. 

 Thankyou, Joe for sending: Sodium-glucose cotransporter-2 inhibitors (SGLT2) reduced heart failure death (HR, 0.68 [95% CI, 0.46–1.02] and sudden cardiac death (HR, 0.86 [95% CI, 0.78–0.95]) and was more effective in those with albuminuria, without a significant effect on myocardial infarction or stroke.  

 In 323 patients with acute stroke, blood‐based biomarkers at cutoff concentrations of plasma glial fibrillary acidic protein (213 pg/mL) and d‐dimer (600 ng/mL) in combination with the field assessment stroke triage scale for emergency destination yielded the best performance for large vessel occlusion detection, with specificity of 94% and sensitivity of 71%. Performance was higher in patients presenting <6 hours from symptom onset, with 93% specificity and 81% sensitivity, and ruled out all patients with hemorrhage.

 Use of statins improved disease-free-survival in 8,010 postmenopausal women with early-stage, hormone receptor–positive invasive breast cancer enrolled in 1998 – 2003, by 21-26%.  The mechanism may by depriving tumor cells of the cholesterol needed for cell membrane synthesis, but also lower estrogen production.

 This pharmacist led multi component intervention in the VA reduced proton pump inhibitor (PPI) use by 7.3% without adverse or beneficial effects. With the decreased absorption of magnesium calcium and vitamin B12 in conjunction with PPI use, it is important that we use these meds judiciously.

 This presentation at a National Conference summarizes the evidence behind advantages and disadvantages of appendectomy. The appendix seems to protect us from diarrhea diseases by harboring and repopulating the colon with beneficial bacteria. It is also a training camp for the immune system and appears to play a beneficial role in ulcerative colitis, irritable bowel syndrome (IBS) and lupus. But the evidence is mixed for colorectal cancer to Parkinson's disease. Antibiotics could be an alternative to surgery for some.

 Skin biopsy for phosphorylated α-synuclein detected Parkinson disease [92.7%], dementia with Lewy bodies [96%], multiple system atrophy [98.2%], and pure autonomic failure [100%], in 343 symptomatic participants age 69.5, while 3.3% (4 of 120) of controls had cutaneous phosphorylated α-synuclein detected.

 After adjustment for confounders, tattooed participants had a 21% higher risk for overall lymphoma than non-tattooed participants (incidence rate ratio = 1.21; 95% CI, 0.99-1.48). A larger tattooed area did not increase the risk.

This Cardi-OH episode is about Obesity and (pharmacological) weight loss management by Drs. Bernheisel, Farrell and Holliday.

OMDA’s weekly call this Thursday at 8 am will be: Urine PCR, by Leslie Eber, MD