COVID News and More 7/15/23
Covid hospitalizations, emergency room visits are very low now, but wastewater levels are starting to increase slightly. Even when virus levels are low, you can still get COVID. Beloved Dr. Bob Wachter of UCSF always wears masks in clinic and on airplanes, but he thinks that he contracted COVID while eating indoors at a restaurant. His COVID course was complicated by him passing out in the shower which led to a small subdural hematoma and a non-displaced fracture of his cervical spine. He is doing better now. Former CDC director Dr. Tom Frieden recommends that people over age 60 and people who are medically vulnerable get a bivalent booster now if it has been more than 5 to 6 months since their last dose. We do not know when the fall XBB booster will come out, but I expect it will be sometime in September.
Immunocompromised people
A national study in Singapore shows that booster vaccines protected people with cancer and cancer survivors against severe COVID infection for at least five months after the last booster. A recent study in Science shows that in immunocompromised adults, each additional mRNA booster helped to boost T cell immunity against Omicron infection. T cells respond to new variants, even after immunologic imprinting from the original mRNA vaccine.
A study of a large US health insurance plan population showed that immunocompromised populations in general were found to be at substantial risk of hospitalization which led to increased costs and healthcare resource utilization. People with advanced kidney disease had the highest risk of severe Covid infection. They concluded that vaccinations, medications like Paxlovid, and other measures to prevent Covid transmission (masks) are especially important for immunocompromised people.
Immunology and some really interesting molecular mechanism diagrams:
The first line of defense against viruses such as SARS-CoV-2 are Interferons (IFNs) which make up our innate immune immunity. Interferon has been given for acute Covid infections, but has different outcomes depending on whether it is given early or late in the infection. Please see the article for a diagram of how the interferon pathways interact with the SARS-CoV-2 virus. A diagram of how SARS-CoV-2 induces innate immune activation and interferons and the role of the JAK-STAT pathway can be found here.
A group in Saudi Arabia looked at the proteome in the nasopharynx and showed that there is a pathophysiologic molecular signature for severe COVID-19 disease (depletion in stat one mediated type one interferon response, retinal, metabolism, and an RF two antioxidant system), and for COVID infection deaths (dysregulation of glucocorticoid, signaling, and the renin-angiotensin- aldosterone system) A helpful summary diagram of these pathways can be found on page 49 here.
Autoimmunity can happen when a part of a virus is similar to human antigens (molecular mimicry). A new study shows that some SARS-CoV-2 viral proteins are cross-reactive with some human gut antigens. This can result in autoantibodies and cross-reactive T cells that attack “self” tissues and can lead to diseases such as inflammatory bowel disease, celiac disease, autoimmune hepatitis and primary biliary cholangitis.
Regarding the effects of SARS-CoV-2 on the brain, plasmalogen deficiency was found to be a shared biologic hallmark of Long Covid and ME/CFS. Plasmalogen levels decrease when there is chronic neuroinflammation. The authors suggest future trials of plasmalogen replacement therapy against neuroinflammation in Long Covid and ME/CFS. The summary diagram on plasmalogen deficiency and Long COVID was compelling.
Usually, the SARS-CoV-2 virus enters human cells via the ACE2 receptor. However, there is another ACE2-independent way for the virus to infect our cells using TMEM106B, a lysosomal transmembrane protein. TMEM106B works with heparan sulfate receptors to serve as a way for SARS2 to infect ACE2-negative cells. TMEM106B was found to promote spike-mediated syncytium formation, suggesting a role of TMEM106B in viral fusion of human cells.
A new study shows that transcutaneous vagus nerve stimulation (tVNS) on the tragus part of the ear in people with acute COVID infection caused a decrease in CRP levels, IL-6 levels and depression scores. Other groups are using tVNS to stimulate the cymba concha part of the ear for Long COVID because it better stimulates the auricular branch of the vagus nerve.
Children
Younger children, those living in poverty and ethnic minority kids have a higher risk of being hospitalized for Covid infection. Most (60%) of the children hospitalized for Covid in this study had no underlying health conditions.
A study in Nature magazine last week showed that there is immunological imprinting of antibody immunity in children for SARS-CoV-2. A first Omicron infection in children elicited only a weak antibody response. However, antibodies were much higher after a booster vaccine or another COVID infection. Omicron reinfections were quite high in children and within three months of a BA.1 infection, 54% of children in this study were reinfected with the BA.4/5 variants. Immunologic imprinting affected antibody production in kids, but cellular immunity helped to protect against severe infection.
People often have questions regarding home rapid antigen Covid tests. A new study shows that if someone is exposed to Covid but they do not have symptoms, they should do a rapid antigen test three times at 48 hour intervals (i.e. day 1, 3, 5) in order to rule out a COVID infection. But, if someone has Covid symptoms after an exposure, they should do a rapid antigen home test two times separated by 48 hours (i.e. day 1 and day 3) in order to rule out being infected.
Paxlovid given to younger vaccinated people age 18 to 50 reduced hospitalizations, emergency room visits and deaths if the person was at higher risk because of cancer or a cardiovascular problem. Surprisingly, in this study if a younger person had asthma or COPD, taking Paxlovid did not make a difference in ER visits and hospitalizations. Still, since Paxlovid decreases the risk of Long COVID by about 24%, Paxlovid may be worth taking.
Long Covid
A new pre-print from Barcelona, Spain, researchers, followed people with Covid infections prospectively for two years. They concluded "Recovery [from Long COVID] is extremely rare during the first 2 years, posing a major challenge to healthcare systems." In their study, 17.3% recovered from Long COVID within 2 years in Cluster A (LC symptom of fatigue, male, prior hospitalization and ICU care, few allergies), <1% recovered in Cluster B (LC symptoms of fatigue plus dyspnea, neurocognitive complaints, headache, myalgia, arthralgia, chest pain and tachycardia) and 2% of people recovered from Long COVID within 2 years in Cluster C (LC symptoms of cluster B plus skin and smell alterations, dysphagia, diarrhea, and neurosensitivity.) Of note, this study followed people infected before vaccination was available.
A group from South Korea also followed people who got Long COVID after being infected in 2020 before vaccines were available. They found that Long COVID symptoms, particularly neuropsychiatric symptoms, persisted over 2 years in 71% of people and that COVID-19 vaccination after contracting Long COVID did not significantly affect the incidence of Long COVID. In an Australian study, 79% of people with Long COVID were found to have POTS (Postural orthostatic tachycardia syndrome) which led to a poorer health-related quality of life and to higher usage of healthcare services. The researchers recommended that “autonomic testing should be routinely undertaken in those with Long COVID to aid diagnosis and direct appropriate management to improve health outcomes.”
Long COVID and the Brain
In Nature magazine, Dr. Hashimoto reviewed the detrimental effects of SARS-CoV-2 on the brain and how EBV reactivation and/or changes in the microbiome of the gut, nasal, oral, or lung could trigger Long COVID. Another group reviewed possible mechanisms of how SARS-CoV-2 can invade the human brain and the molecular basis of SARS-CoV-2 infection interfering with human brain and memory. I also posted above an article showing that plasmalogen deficiency causing neuroinflammation may be a shared biologic hallmark of Long Covid and ME/CFS.
Dr. Eric Topol recommends a five star review on the Immunology of Long COVID by Drs. Danny Altman and Rosemary Boyton. The review takes a very comprehensive look at molecular mechanisms that may cause Long COVID, proposed endothelial dysfunction and immunothrombosis in Long COVID, autoantibodies which may cause specific symptoms and a review of global clinical trials of medications to treat Long COVID. It is a very thorough review that is worth a read.
In other medical news, maternal deaths in the United States have more than doubled and the highest death rate was noted for Black women and for American native populations. A blood test for preeclampsia was approved by the FDA. In a prospective study with a 22 year follow up, Black women with a history of hypertensive disorders of pregnancy (preeclampsia and chronic hypertension) had a 66% increased long-term risk of stroke.
Parkinson’s disease can be predicted up to 7 years before clinical diagnosis using a wrist accelerometer and AI. Pirtobrutinib was effective in people with CLL or SLL who had received a covalent BTK inhibitor. There is a continued national shortage of Bicillin L-A and it should be used only for treatment of syphilis in pregnant people and infants. The FDA approved Leqembi which slows progression by 27% for patients in the earliest stages of Alzheimer's, but it should be used with caution because of dangerous side effects including brain swelling and bleeding. Finally, the FDA approved an over-the-counter progestin-only birth control pill called Opill.
Artificial intelligence (A.I.) can now pick up heart ejection fraction, valvular heart disease and Type II diabetes from a simple chest x-ray. Eric Topol reviews A.I. in medicine here and here.
Have a good rest of your weekend,
Ruth Ann Crystal MD
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Ruth Ann Crystal MD
COVID news:
US Variant tracker: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
CDC COVID Hospitalizations (blue) and Emergency Room (orange) visits tracker: https://covid.cdc.gov/covid-data-tracker/index.html#trends_weeklyhospitaladmissions_7dayeddiagnosed_00
US Wastewater Monitoring:
CDC Wastewater Monitor https://covid.cdc.gov/covid-data-tracker/#wastewater-surveillance
Biobot: https://biobot.io/data/
Over the last 6 months. There may be an uptick starting.
In the last 6 weeks:
Sewer Coronavirus Alert Network (SCAN) project by Stanford University:
7/13/23 JAMA (Singapore): COVID-19 Severity and Waning Immunity After up to 4 mRNA Vaccine Doses in Patients With Cancer https://buff.ly/3ru5x8B
Each booster COVID-19 vaccine dose was associated with significant clinical protection against severe disease in patients with cancer, lasting at least 5 months in actively treated patients with cancer and cancer survivors, underscoring the benefit of boosters.
7/12/23 Lancet preprint (Barcelona): Determinants of the Onset and Prognosis of the Post-COVID-19 Condition (PCC, Long COVID): A 2-Year Prospective Cohort Study https://buff.ly/3pJ7eyp
"Recovery [from Long COVID] is extremely rare [7.6% overall] during the first 2 years, posing a major challenge to healthcare systems."
Recovery from Long COVID at 2 years in unvaccinated people:
17.3% recovered in Cluster A (LC symptom of fatigue, male, prior hospitalization and ICU care, few allergies)
<1% recovered in Cluster B (LC symptoms of fatigue plus dyspnea, neurocognitive complaints, headache, myalgia, arthralgia, chest pain and tachycardia)
2% recovered in Cluster C (LC symptoms of cluster B plus skin and smell alterations, dysphagia, diarrhea, and neurosensitivity.)
7/12/23 Science: Additive effects of booster mRNA vaccination and SARS-CoV-2 Omicron infection on T cell immunity across immunocompromised states https://buff.ly/3JQP192
Regardless of underlying immunodeficiency, T cells can respond to new viral variants, even after repeated antigen exposure and a robust immunological imprint from ancestral SARS-CoV-2 mRNA vaccination.
7/12/23 Dr. Bob Wachter of UCSF finally got COVID. Taking a shower while being sick and dehydrated was a bad combination (but he’s better now).
7/11/23 Nature (South Korea): Long COVID prevalence and impact on quality of life 2 years after acute COVID-19 https://buff.ly/43lIIkI
Study of 132 people with Long COVID 24 months after a COVID infection in 2020.
Symptoms of long COVID, particularly neuropsychiatric symptoms, persisted over time, and COVID-19 vaccination or the number of vaccinations received did not significantly affect the incidence of long COVID.
At 2 years:
71% had some LC symptoms
35% had fatigue
30% amnesia
24% had concentration difficulties
21% insomnia
20% depression
33% had neuropsychiatric symptoms that affected their quality of life.
Eric Topol: “A new 5★ review on #LongCovid immunology”
7/11/23 Nature Reviews Immunology (Danny Altman, Rosemary Boyton): Review of the Immunology of long COVID https://buff.ly/3Okx8SJ
See Table 2: Autoantibodies in acute COVID and Long COVID
Figure 2: Proposed mechanisms of endothelial dysfunction and immunothrombosis in Long COVID
Table 3: Clinical trials on Long COVID
7/11/23 Immunity: Innate immunity and Interferon in SARS-CoV-2 infection outcome https://buff.ly/3Od2rP7
Innate immunity and the actions of type I and III interferons (IFNs) which are essential for protection from SARS-CoV-2 are reviewed here.
Therapeutic IFN has been used for acute COVID infections but has different outcomes when given early or late in infection.
7/11/23 Current Medical Research and Opinion: Assessing the risk and costs of COVID-19 in Immunocompromised populations in a large United States commercial insurance health plan: the EPOCH-US Study https://buff.ly/44HUczS
> 16 Million patients studied. 2.7% were immunocompromised.
Immunocompromised populations appear to be at substantial risk of hospitalization and severe COVID-19 outcomes, leading to increased costs and healthcare resource utilization (HCRU).
COVID-19 can cause severe health issues in immunocompromised people (highest in people with advanced kidney disease, lower in hematologic and solid tumor cancers) and use of vaccinations, medications, and other measures to prevent COVID-19 are especially important.
7/10/23 BioRxiv (Saudi Arabia): Proteome profiling of nasopharynx reveals pathophysiological signature of COVID-19 disease severity https://buff.ly/43lUkEf
COVID severity is related to depletion in STAT1-mediated type I interferon response, retinol metabolism and NRF2 antioxidant system.
COVID fatality was related to dysregulation of glucocorticoid signaling and renin-angiotensin-aldosterone system (RAAS).
Hyperactivation of the host innate immune system was observed in severe patients, marked by elevated proteins involved in neutrophil degranulation and platelet aggregation.
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Data from FRED: https://fred.stlouisfed.org/series/LNU00074597
7/7/23 Biomedicines: SARS-CoV-2 Gut-Targeted Epitopes: Sequence Similarity and Cross-Reactivity Join Together for Molecular Mimicry https://buff.ly/3OaTENA
Antibodies made against SARS-CoV-2 viral proteins that were cross-reactive with human gut antigens are involved in several essential cellular functions.
Autoantibodies and cross reactive T cells that attack tissues.
7/7/23 Brain Research Bulletin: Chronic inflammation, neuroglia dysfunction, and plasmalogen deficiency as a new pathobiological hypothesis addressing the overlap between post-COVID-19 symptoms (PASC, Long COVID) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) https://buff.ly/43quejv
Authors’ summary:
Plasmalogens (Pls) are lipids containing a vinyl-ether bond in their glycerol backbone.
Pls have antioxidant properties and are important for curved membrane assemblies.
Post-COVID-19 (Long COVID) symptoms are highly prevalent and share several features with ME/CFS.
Pls depletion is a shared biological hallmark of ME/CFS and acute COVID-19 syndrome.
Plasmalogen replacement therapy (PRT) is a promising tool against neuroinflammation in these two conditions.
In 2019 the FDA granted PPI-1040 orphan drug designation for the treatment of rhizomelic chondrodysplasia punctata type 1 (RCDP).
7/7/23 Cell: TMEM106B is a receptor mediating ACE2-independent SARS-CoV-2 cell entry https://buff.ly/3XG3OJi
TMEM106B, a lysosomal transmembrane protein, can serve as an alternative receptor for SARS2 entry into ACE2-negative cells.
This ACE2-independent SARS-CoV-2 infection mechanism involves cooperative interactions with the receptors heparan sulfate and TMEM106B.
TMEM106B promotes spike-mediated syncytium formation, suggesting a role of TMEM106B in viral fusion of human cells.
7/5/23 Conversation and BMJ: COVID in kids: Younger children, those living in poverty and ethnic minority children have higher risk of being hospitalized for COVID– new research https://buff.ly/3pPjbCw
60% of children hospitalized for COVID had no underlying health conditions.
7/4/23 Molecular Psychiatry: Detrimental effects of COVID-19 in the brain and therapeutic options for long COVID: The role of Epstein–Barr virus and the gut–brain axis https://buff.ly/3CXETr9
h/t John Chi (thanks)
Effects of COVID-19 on the brain, and the biological mechanisms (e.g., EBV reactivation, and changes in the gut, nasal, oral, or lung microbiomes) underlying long COVID.
Potential therapeutic approaches based on the gut–brain axis, including plant-based diet, probiotics and prebiotics, fecal microbiota transplantation, and vagus nerve stimulation, and sigma-1 receptor agonist fluvoxamine.
7/4/23 Annals of Internal Medicine: Performance of Rapid Antigen Tests to Detect Symptomatic and Asymptomatic SARS-CoV-2 Infection: A Prospective Cohort Study https://buff.ly/3NIrPL4
5353 participants completed Rapid Ag Test and PCR tests for SARS-CoV-2 every 48 hours for 15 days. In total, 154 participants had at least 1 positive RT-PCR result.
If someone is exposed to COVID, they should do a Rapid Antigen test every 48 hours x3 to make sure that they are not asymptomatically positive for SARS-CoV-2.
If someone has COVID symptoms, they should do a Rapid Antigen test every 48 hours x2.
An initial negative Rapid Antigen Test does not mean that someone is negative for SARS-CoV-2. They need to test several times to make sure that they don’t get a COVID infection.
7/4/23 MedRxiV (Finland): Genome-wide Association Study of Long COVID https://buff.ly/46DjOj4
6400+ LC, 1+ million controls
FOXP4 gene variants are associated with Long COVID with fatigue and pulmonary and cognitive dysfunction.
FOXP4 gene variants are also associated with COVID-19 severity, lung function, and cancers. This suggests a broader role for lung function in the pathophysiology of Long COVID.
7/3/23 Nature: COVID-19 digital contact tracing worked — heed the lessons for future pandemics https://buff.ly/3XFzEWI
These privacy-preserving tools saved thousands of lives during the pandemic.
6/30/23 Clin Infectious Disease (J. Faust): Oral Nirmatrelvir and Ritonavir (Paxlovid) for Covid-19 in Vaccinated, Non-Hospitalized Adults, Ages 18-50 Years https://buff.ly/3JQFIG7
NMV-r (Paxlovid) use in vaccinated adults aged 18-50, especially with serious comorbidities (cancer and cardiovascular disease), was associated with reduced all-cause hospital visits, hospitalization, and mortality in the first 30 days of Covid-19 illness.
However, NMR-r Paxlovid in patients without significant comorbidities or with only asthma/COPD had no benefit.
6/29/23 Medscape by Lisa McCorkell: 3 Years Into Long COVID: Where Do We Go From Here? https://buff.ly/44dKdT2
Ms. McCorkell recommends:
A Ryan White Care Program for Long COVID: education and training centers
More clinical trials and therapeutics: accessible to people with severe long COVID
Action by the FDA: quality of life endpoints and use of existing biomarkers, expanded access, fast-track designation and breakthrough therapy designation as drugs are developed and repurposed.
Sustainable, transparent and coordinated research: via the NIH
Communication campaigns: massive public and provider education campaigns on LC
6/29/23 Am J Med (Australia): High incidence of autonomic dysfunction and postural orthostatic tachycardia syndrome in patients with Long COVID: Implications for management and healthcare planning https://buff.ly/3JGmRgz
79% of those with PASC (Long COVID) met the internationally established criteria for POTS, leading to poor health-related quality of life (HrQoL).
6/29/23 Nature/Cell Death Discovery: Long-term effects of SARS-CoV-2 infection on human brain and memory https://buff.ly/44i1s5Z
Review of how SARS-CoV-2 can invade the human brain and the molecular basis of SARS-CoV-2 infection interfering with human brain and memory, which are associated with the immune dysfunction, syncytia-induced cell death, the persistence of SARS-CoV-2 infection, microclots and biopsychosocial aspects.
6/29/23 Nature: Immunological imprinting of humoral immunity to SARS-CoV-2 in children https://buff.ly/3NIz3Pl
A first Omicron infection in children elicited a weak antibody response in children which was boosted after reinfection or vaccination.
Cellular responses were robust and broadly equivalent in all groups, providing protection against severe disease irrespective of SARS-CoV-2 variant.
Within 3 months of a BA.1 infection, 54% of children were reinfected with BA.4/5 subvariants.
6/29/23 Wash U Medicine nephrologist and epidemiologist Dr. Al-Aly has risen to prominence, uncovering society’s biggest health issues https://buff.ly/44qMQRf
COVID’s lasting impact including heart attacks, stroke, diabetes and Long COVID
6/22/23 Didier Raoult : 30 years of unregulated experiments on human https://buff.ly/46Fhvw2
Marseille, France professor Didier Raoult conducted "research" with hydroxychloroquine on more than 30,000 patients during the Covid pandemic, even after other research showed that it didn't work. The French Medicines Agency (ANSM) has now taken the matter to court.
This is shedding light on the fact that he has been collecting blood samples on homeless people without their consent for 30 years.
6/16/23 Virology: Acute and post-acute sequelae of SARS-CoV-2 infection (PASC, or Long COVID): a review of risk factors and social determinants https://buff.ly/3D0xdnX
Review of genetics, sex differences, age, reactivation of chronic viruses such as EBV, gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients’ diet, alcohol use, smoking, exercise, and sleep patterns.
Social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients’ access to health services.
PASC Risk Factors:
10/19/22 MDPI: Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) Improves Inflammation but Does Not Interfere with Cardiac Modulation and Clinical Symptoms of Individuals with acute COVID-19: A Randomized Clinical Trial https://buff.ly/3POlHna
52 people hospitalized with acute COVID-19
active (a-taVNS) on Tragus of the ear or sham taVNS (s-taVNS) for 90 min twice a day for seven consecutive days.
Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) decreased CRP by 24%, IL-6 by 38%, and depression levels in hospitalized COVID patients.
taVNS caused no changes in IL-10, cortisol levels, or in heart rate variability.
Photo credit: Dr C J Falconer, UCL
Non-COVID news:
7/3/23 Nature: Wearable movement-tracking data identify Parkinson’s disease up to 7 years before clinical diagnosis https://buff.ly/3O1eIWI
Predicting Parkinson's disease with a wrist accelerometer and AI.
7/3/23 JAMA: Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States https://buff.ly/43dC4wN
The number of women in the United States who died within a year of pregnancy more than doubled between 1999 and 2019. The highest deaths were noted among Black women.
Maternal deaths per 100,000 live births:
In US overall: maternal deaths rose from 12.7 to 32.2 per 100,000 live births
Native Americans, Alaskans: 14.0 to 49.2 maternal deaths per 100,000 live births
Blacks: 26.7 to 55.4 maternal deaths per 100,000 live births
Asians: 9.6 to 20.9 maternal deaths per 100,000 live births
Hispanics: 9.6 to 19.1 maternal deaths per 100,000 live births
Whites: 9.4 to 26.3 maternal deaths per 100,000 live births
While maternal mortality remains unacceptably high among all racial and ethnic groups in the US, American Indian and Alaska Native and Black individuals are at increased risk, particularly in several states.
7/3/23 NY Times: A Blood Test Predicts Pre-eclampsia in Pregnant Women https://buff.ly/43fmEIe
FDA approved a blood test for preeclampsia.
"The new blood test, made by Thermo Fisher Scientific, has been available in Europe for several years. It is intended for pregnant women who are hospitalized for a blood pressure disorder in the 23rd to 35th weeks of gestation.
The test can tell, with up to 96% accuracy, who will not develop preeclampsia within the next two weeks and so can safely be discharged from the hospital.
Two-thirds of the women who get a positive result, on the other hand, will progress to severe pre-eclampsia in that time, and their babies may need to be delivered early. "
7/5/23 AP: Study says drinking water from nearly half of US faucets contains potentially harmful chemicals https://buff.ly/3pzPbKQ
“Forever chemicals” PFAS may cause cancer and other health problems.
7/6/23 NEJM: Pirtobrutinib after a Covalent BTK Inhibitor in Chronic Lymphocytic Leukemia https://buff.ly/43f5JFF
Pirtobrutinib showed efficacy in patients with heavily pretreated CLL or SLL who had received a covalent BTK inhibitor.
7/6/23 NEJM: Hypertensive Disorders of Pregnancy (HDOP) and Risk of Stroke in U.S. Black Women https://buff.ly/3rwRFu0
In a prospective study of Black women with 22 year follow up, a history of HDOP was associated with an estimated 66% increased long-term risk of stroke.
7/7/23 Reuters: US FDA grants standard approval of Eisai/Biogen Alzheimer's drug https://buff.ly/3PNVzJd
Leqembi slows progression of the brain-wasting disease by 27% for patients in the earliest stages of Alzheimer's.
Leqembi can cause dangerous brain swelling and bleeding and the risk is higher in patients with two copies of APOE4 and in patients on anticoagulation.
CDPH Health Advisory: Bicillin® L-A (Benzathine Penicillin G) Shortage https://buff.ly/44EpebM
7/10/23 From Sara Cody MD, Santa Clara County
Save Bicillin L-A for syphilis in pregnant people and infants.
Acceptable alternative treatments for non-pregnant adults include:
Primary, Secondary, Early Latent syphilis or exposure to syphilis: Doxycycline 100mg PO BID x 14 days
Late Latent/ Unknown Duration syphilis: Doxycycline 100mg PO BID x 28 days
Bicillin C-R is not an acceptable alternative for the treatment of syphilis.
7/10/23 NY Times: Who Employs Your Doctor? Increasingly, a Private Equity Firm. https://buff.ly/3O5OVN7
Private equity acquisitions of physician practices are contributing to higher medical prices, especially if they own more than 30% of the market.
A.I. and Deep Learning can pick up cardiac functions and Type 2 diabetes from a chest x-ray with EMR data.
7/6/23 Lancet: Artificial intelligence-based model to classify cardiac functions from chest x-rays https://buff.ly/3ND4lqR
Heart ejection fraction and valvular disease detected on chest x-ray.
7/7/23 Nature: Opportunistic detection of type 2 diabetes using deep learning from frontal chest radiographs https://buff.ly/3rmUoX8
Explainable AI techniques revealed correlations between specific adiposity measures and high predictivity, suggesting CXRs’ potential for enhanced T2D screening.
7/13/23 FDA Approves First Nonprescription Daily Oral Progestin-Only Contraceptive https://buff.ly/43nVleP
Opill (norgestrel) tablet for nonprescription use to prevent pregnancy.
7/12/23 Eric Topol MD: Medical A.I. is on a tear
(Part One) Review of 3 new deep learning cardiopulmonary imaging studies, one transformer model (aka generative A.I., or large language model, LLM), some progress in virtual scribes and tomorrow (Part Two) a slew of new papers that are coming out.
7/14/23 Eric Topol MD: Medical AI is on a tear, Part Two
Review of This week’s Science Magazine is dedicated to A.I., much of it medical applications.