TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A records of the podcast is listed below the summary.
Today’s topics consist of screening for hearing loss in older adults, aspirin and COVID, a diabetes drug for weight-loss, and saliva testing for concussion
Program notes:
0: 35 Saliva screening for concussion
1: 34 1000 Rugby players
2: 37 May be offered soon
3: 35 No lead to females
4: 01 Aspirin and COVID-19
5: 01 No differences in major bleeding
6: 01 On aspirin already don’t require to discontinue
7: 03 Diabetes medication and weight reduction
8: 01 Very first run in period 11%weight loss
9: 02 Injectable medication
9: 15 USPSTF on hearing loss evaluation
10: 16 Dramatic reduction in price of hearing aids
11: 22 If individuals do not do anything about it
12: 49 End
Records:
Elizabeth Tracey: Does aspirin have a role in the treatment of people with COVID-19?
Rick Lange, MD: Usage of a diabetic medication for weight reduction.
Elizabeth: Should we evaluate older grownups for hearing loss?
Rick: And the spitting picture of rugby gamers with concussion.
Elizabeth: That’s what we’re discussing this week on TT HealthWatch, your weekly take a look at the medical headings from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical reporter.
Rick: And I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m likewise dean of the Paul L. Foster School of Medication.
Elizabeth: And extremely clever, so obviously we’re going to need to rely on one of the BMJ‘s journals. This is having a look at can we actually evaluate concussion on the playing field with a saliva based-test?
Rick: Elizabeth, I served it up as a spitting picture of rugby players due to the fact that this is an effort to use regularly readily available body fluid– that is, saliva– to make the medical diagnosis of concussion. Certainly, that’s a distressing brain injury. When you do traditional imaging like CT or MRI imaging of the head, it looks normal, however there’s clearly have been some sort of momentary neurologic damage. We assess that by doing a head injury assessment.
It’s a medical exam. It would be good if we might in fact have some biomarker that would verify whether someone did or did not have a concussion. What these investigators said is, “Listen. If someone had some sort of neurologic injury that had a biomarker, you could not only test in the blood or urine, but possibly even the saliva also.” Here’s what they did.
They took rugby gamers– and heaven understands they usually have head injuries– over 1,000 of these rugby gamers and they checked them at baseline before a video game and after a video game. Naturally, only some of these had head injuries. About 156 of those had concussion. They took the first 15 of those and they checked the saliva and they identified 32 various distinct biomarkers– specifically non-coding micro RNAs, for our scientific geeks out there.
On the basis of that, they assessed that 14 of those together in congregate could identify those with versus those without concussion. They applied it to the remainder of the group and they discovered it was incredibly successful– about 96?fective in being predictive of whether an individual had a concussion or not.
Now, they compared it to, clearly, controls, but they likewise compared it to individuals that had musculoskeletal injuries to show that it wasn’t just from playing rugby. You had to have a knock on the noggin to get these things in your saliva.
Elizabeth: Of course, the truly exceptionally great news about this study is this is so quickly offered.
As we’ve discussed lot of times, even if we simply limit this to professional athletes, it would sure be great to be able to assess whether they’re at threat for persistent terrible encephalopathy, or CTE, as they continue play.
Rick: What you want to do is recognize those with concussion and give them a possibility to recover. By the way, these biomarkers usually had things to do with neurologic injury, their neuron degeneration, or Alzheimer’s kinds of things, or depression, so there is some biologic plausibility. Saliva was gathered an hour after a head injury and after that approximately 36 to 48 hours to reveal that it was still favorable. This needs to be proven in a larger group. It’s a proof of principle and I hope we have the ability to report on this in the future with bigger patient studies.
Elizabeth: Me too. One thing that they did determine in speaking about these outcomes was that they do not have any results in ladies. We have reported formerly that women soccer players actually experience even worse head injuries than male equivalents, so this data from ladies is going to be actually important, and also from kids.
Rick: Yeah. Once again, this study was carried out in world-class rugby players– I imply top-tier. You’re. We need to broaden the patient population as well and see whether this actually holds up in other sports.
Elizabeth: Let’s turn from here to a study that’s taking an appearance at the function of aspirin in folks with COVID-19
They consisted of just 412 clients in this analysis, and what they were looking at was the role of aspirin; 314, or 76%- plus of these did not receive aspirin, while just 98 clients, the n getting smaller, almost 24%, got aspirin within 24 hours of admission or 7 days prior to admission.
Generally, what they showed was that aspirin was able to ameliorate a few of the thrombosis that we have actually seen connected with people who have really bad COVID-19 illness and individually connected with a decreased risk of mechanical ventilation. No distinctions in significant bleeding or obvious thrombosis in between those aspirin users and the non-aspirin users.
This is, to me a minimum of, interesting since a lot like dexamethasone, a drug with which we have a ton of experience, and suggests that perhaps it would work in helping people when they present with COVID-19 and have to be hospitalized.
Now, there is biologic plausibility because the infection, as you talked about, increases the risk of apoplexy– that is, the development of an embolisms– and we know that aspirin avoids platelets from aggregating, prevents that clot from forming.
We do require to make mention, this is not a randomized regulated trial. It suggests that individuals who are on aspirin when they come into the health center with COVID, they most likely don’t need to be taken off of it.
Elizabeth: I believe it was likewise fascinating that the clients who received the aspirin had substantially higher rates of hypertension, diabetes, coronary artery disease, and renal disease. We’re already aware that these are danger elements for more serious COVID-19 disease, so I sort of hearken back to, “Chicken and the egg, which comes first?”
Rick: Yep. In the stats they tried to change for those features, however oftentimes that change is not as accurate as we ‘d like. These are the type of research studies that trigger randomized regulated trials rather than definitively answer a question.
Elizabeth: I think I’m wondering if they’re going to trigger individuals to put people on aspirin prophylactically, just based upon these results.
Rick: Yeah, and because the data does not reveal an increased risk of bleeding, one could say, “Listen, I do not have firm information, but observational data suggests it may be useful.” So it’s not unreasonable.
Elizabeth: Especially in those with all those other constellation of comorbidities.
Rick: Mentioning comorbidities, let’s go on to talk a little bit about diabetes and a medication that is utilized to treat it. It’s a medication called semaglutide and it falls into the category of medicines called a glucagon-like peptide 1 receptor agonist.
It’s a medication that’s approved for diabetes.
This is a medication that’s generally given up a once-weekly injection. If you offer it in a larger dose, you get more weight reduction. However then the concern is do you need to continue the medication or could you stop it?
They had 902 individuals that were receiving once-weekly injections of the higher dose and it took them 20 weeks to kind of work up to that high dosage due to the fact that it triggers GI distress.
With the first 20- week altercation duration, those people all lost about 11%of their body weight. For those that went on placebo after that, sadly, they tended to increase their weight, but those continued it got another 8%or 9?ditional body weight reduction up to 68 weeks. By the method, this has to do with the very same weight decrease that you get when you do gastric surgical treatment– 20%weight decrease.
Elizabeth: Very impressive.
Rick: In this specific research study, that wasn’t an issue. The significant concern there wasn’t hypoglycemia. The significant issue with this was GI distress. It only triggered about 2%or 3%of the people in the research study to stop it. They had to type of resolve it. That’s why they developed to that level, once they did, they tolerated it well.
Elizabeth: What are your thoughts about something that needs an injection? For folks with weight loss desires, they would have to keep coming back in to get this.
Rick: You do not need to keep coming in to get it– you really take it at home. It’s similar to individuals take insulin or other things.
Elizabeth: Let’s mention that study is in JAMA We’re going to remain there. We’re going to rely on a suggestion from the USPSTF, which unfortunately is an extensive take a look at the literature relative to hearing loss in older grownups and says, “Hey, think what? There’s inadequate evidence to advise that we need to be evaluating older adults.”
We were talking before we began to tape– and this is the part of it that I think is actually the important part– about the number of older grownups there are with hearing loss in the United States and how essential, potentially, it is going to be to ameliorate that hearing loss.
There is no data that informs us that attempting to rectify that situation with use of hearing aids or hearing-assist gadgets is going to make any of that not take place– dementia, anxiety, loss of happiness in activities of daily living– but we’re poised to find out, most likely, due to the fact that there was the passage of the Over-The-Counter Listening Devices Act of 2017, which is yet to be executed. But that’s going to considerably minimize the cost of these things and increase their accessibility, so we may see lots more people embracing them, particularly if they look type of cool, and in view of the reality that Apple’s going to be among those folks who’s making them I suspect that they will.
I’m finding this an interesting location, where the USPSTF is panning the benefits of screening based upon a paucity of data, however there are a horrible lot of forces that are arrayed on the other side.
Rick: The job of the USPSTF is not to back.
Now, there are 2 ways to screen. One is just to ask the simple question, “Do you have problem with your hearing?” That seemed to be like a pretty good way instead of doing what’s called tone-emitting gadget detection, where you play various decibels in hearing, and you’re really more quantitative.
That simple concern, by the method, costs nothing to ask, but the tone-emitting detection in fact costs something. If you’re going to attempt to evaluate the millions– the 60 million individuals that are over a certain age to check for their hearing, and it costs something, and then they do not do anything about it, then you haven’t received any benefit.
That’s part of the issue is, we don’t have any great studies that have actually identified those people and then they have actually all gotten hearing help to see whether they have less anxiety, and less hospitalization, and less social isolation, and less cognitive problems. We just don’t have any of that.
Elizabeth: I concur. I indicate, I think that’s a substitute step. I would likewise state that the accumulation of the information that shows that ameliorating hearing loss results in decreased rates of dementia, depression, and loss of enjoyment in everyday activities isn’t going to collect unless we get more individuals utilizing hearing aids.
Rick: But the only people that are going to utilize them are those that are motivated.
Elizabeth: Oh my God, you began on a pun and ending on one.
Rick: And I’m Rick Lange. Y’ all listen up and make healthy options.
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