COVID Antibody Treatment Is Safe, Effective in Transplant Patients
FRIDAY, June 11, 2021 (HealthDay News) — Antibody treatments are safe and effective for transplant patients with mild to moderate COVID-19, a new study shows.
Monoclonal antibodies help prevent the SARS-CoV-2 virus from attaching to cells, which helps block the spread of infection.
The findings are important, researchers said, because transplant patients with COVID are more likely to be severely ill or die.
“Monoclonal antibody therapy is really important for the transplant population because they are less likely to develop their own immunity,” said senior author Dr. Raymund Razonable, an infectious diseases specialist at the Mayo Clinic in Rochester, Minn. “Providing them with these antibodies helps them recover from COVID-19.”
The study included the first 73 solid organ transplant patients at the Mayo Clinic who received monoclonal antibody infusions for treatment of mild to moderate COVID-19.
Eleven patients had an emergency department visit and nine were hospitalized. None required mechanical ventilation, died or developed organ rejection, according to findings published June 10 in the journal Open Forum Infectious Diseases.
“While we expected monoclonal antibody therapy would be beneficial for patients, we were pleasantly surprised by the results,” Razonable said in a Mayo news release. “Only one patient required care in the ICU for non-COVID-19 indication, and, most importantly, there were no deaths.”
Last fall, the U.S. Food and Drug Administration authorized emergency use of the monoclonal antibody therapies bamlanivimab and casirivimab-imdevimab to treat mild to moderate COVID in patients at high risk for serious illness.
But many health care institutions hesitated to use them because their safety and effectiveness for transplant patients was unknown due to limited clinical data, Razonable said.
“It is important that these patients have early access to monoclonal antibody treatment,” Razonable said. “Our data show the outcomes for patients are better if they get infused earlier.”
More information
The American Society of Transplantation has more on COVID-19.
Middle Ages Misery: Medieval Shoe Trend Brought Bunions
FRIDAY, June 11, 2021 (HealthDay News) — Suffering for fashion is nothing new. Researchers in the United Kingdom have unearthed new evidence that stylish pointed shoes caused a “plague” of bunions in the late medieval period.
Investigators from the University of Cambridge analyzed 177 skeletons from cemeteries in and around the city of Cambridge. Included were a charitable hospital, the grounds of a former Augustinian friary where clergy and wealth benefactors were buried, a local parish graveyard that held the working poor and a rural burial site by a village.
Researchers inspected foot bones for the bump by the big toe that is the hallmark of hallux valgus, known to millions of sufferers as bunions.
They found that those buried in the town center, particularly in plots for wealthier citizens and clergy, were much more likely to have had bunions.
Only 3% of the rural cemetery showed signs of bunions, 10% of the parish graveyard, 23% of those on the hospital site and 43% of those at the friary.
While just 6% of individuals buried between the 11th and 13th centuries had evidence of bunions, 27% of those from the 14th and 15th centuries were hobbled by the affliction.
That’s likely because shoe style changed significantly during the 14th century, when it shifted from a functional rounded toe box to a lengthy pointed tip.
“The 14th century brought an abundance of new styles of dress and footwear in a wide range of fabrics and colors. Among these fashion trends were pointed long-toed shoes called poulaines,” said study co-author Piers Mitchell, from Cambridge’s archaeology department.
“We investigated the changes that occurred between the high and late medieval periods and realized that the increase in hallux valgus over time must have been due to the introduction of these new footwear styles,” Mitchell said in a university news release.
Hallux valgus is a minor deformity in which the largest toe becomes angled towards the second toe and a bony protrusion forms at its base, on the inside of the foot. Though genetics and muscle imbalance can predispose a person to bunions, the most common contemporary cause is restrictive boots and shoes.
In the 13th and 14th centuries, it was increasingly common for those in clerical orders in Britain to wear stylish clothes — a cause for concern among high-ranking church officials, Mitchell noted.
Across late medieval society, the pointiness of shoes became so extreme that in 1463 King Edward IV passed a law limiting toe-point length to less than 2 inches within London.
The majority of remains with signs of bunions in the study, 20 of 31, were male.
Lead author Jenna Dittmar, who conducted the work while at Cambridge, also found that skeletal remains with hallux valgus were more likely to show signs of fractures that usually result from a fall.
“Modern clinical research on patients with hallux valgus has shown that the deformity makes it harder to balance, and increases the risk of falls in older people,” Dittmar said in the release. “This would explain the higher number of healed broken bones we found in medieval skeletons with this condition.”
The paper appears in the June 10 issue of the International Journal of Paleopathology.
More information
The American College of Foot & Ankle Surgeons has more on bunions.
SOURCE: University of Cambridge, news release, June 10, 2021
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Old Age No Bar to Successful Heart Transplant, Study Finds
FRIDAY, June 11, 2021 (HealthDay News) — People over 70 are far less likely to be considered for or to receive a new heart — even though new research suggests their survival rates after transplant are similar to those of younger patients.
For the study, the researchers analyzed data on more than 57,000 adults (aged 18 and older) listed as heart transplant surgery candidates in the United States between January 2000 and August 2018, and they found that only one in 50 was aged 70 or older.
The rate was the same among the more than 37,000 patients who actually had a heart transplant during the study period. However, the researchers did find that the number of older patients receiving a heart transplant each year rose from 30 in 2000 to 132 in 2017.
There was no significant difference between age groups in death rates in the first year after heart transplant, even though older patients were more likely to receive hearts from older donors with chronic diseases, like diabetes and high blood pressure.
The difference in death rates between older and younger patients within five years after heart transplant disappeared when the researchers accounted for factors like patients’ body mass index (or BMI, which is an estimate of body fat based on weight and height) and the time patients spent on the transplant waiting list.
Older patients were more likely to have a stroke after a heart transplant, but the risk was still very low (3.5%). Most strokes in older patients occurred in the third year after their transplant, according to study author Dr. Abhishek Jaiswal, of the Hartford Hospital in Connecticut, and colleagues.
The study, published online June 8 in the Journal of the American Geriatrics Society, shows that older age alone should not prevent people from being considered for heart transplants, the researchers said.
In addition, people 70 and older with heart failure should consider asking their cardiologist if they could be a candidate for a heart transplant, the study authors suggested in a journal news release.
The researchers noted that most of the older patients in the study who received heart transplants were white, not frail, and didn’t have other chronic diseases, and that this group of patients doesn’t represent most older adults who have heart failure.
More information
The U.S. National Heart, Lung, and Blood Institute has more on heart transplantation.
SOURCE: Journal of the American Geriatrics Society, news release, June 9, 2021
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Smokers, Obese People Need Major Heart Interventions Earlier in Life
FRIDAY, June 11, 2021 (HealthDay News) — In a finding that confirms healthy habits make for healthy hearts, new research shows that smokers and obese people must have their clogged arteries cleared at much younger ages than nonsmokers or people who are a normal weight.
It found that angioplasty and/or stenting to widen coronary arteries and restore blood flow had to be performed in smokers nearly a decade sooner than in nonsmokers, and that obese patients who had these procedures were four years younger than patients who weren’t obese.
Women also typically had their first procedure to clear blocked arteries at a later age than men, according to the researchers.
The study included more than 108,000 patients without a history of heart attack who were treated at hospitals across Michigan participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Nearly all of the patients had at least one risk factor for heart trouble — including smoking, obesity, high blood pressure, high cholesterol and diabetes — and most of them had three or more risk factors.
Over the past decade, rates of obesity and diabetes have increased among patients undergoing their first angioplasty or stent procedure, while rates of smoking and high cholesterol have decreased, according to the researchers.
“Smoking is a completely preventable risk factor,” said senior study author Dr. Devraj Sukul, an interventional cardiologist and a clinical lecturer at the University of Michigan Health Frankel Cardiovascular Center.
“If we direct additional efforts at preventing smoking and obesity, we could significantly delay the onset of heart disease and the need for angioplasty and stenting,” Sukul said in a university news release.
“In Michigan, we will work to help every smoker quit at the time of cardiac care because it is an unmatched teachable moment for patients,” said Dr. Michael Englesbe, a surgeon and professor at Michigan Medicine.
The findings were published June 9 in the journal PLOS ONE.
More information
The U.S. National Library of Medicine has more on angioplasty and stent placement.
SOURCE: Michigan Medicine-University of Michigan, news release, June 9, 2021
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Houston Methodist Suspends Nearly 200 Workers Who Refuse COVID-19 Vaccines
THURSDAY, June 10, 2021 (HealthDay News) — Nearly 200 employees of the Houston Methodist hospital system in Texas have been suspended without pay for refusing to get COVID-19 vaccines.
Nearly 25,000 workers met Monday’s deadline to be fully immunized, but 178 failed to do so and were suspended, including 27 who had received one dose of a two-dose vaccine, CBS News reported. The hospital system previously warned that unvaccinated employees would be fired as of June 21.
The policy has triggered a court challenge by a group of unvaccinated workers who claimed they are being used as “human guinea pigs,” CBS News reported. But Houston Methodist said in a statement that, “It is legal for health care institutions to mandate vaccines, as we have done with the flu vaccine since 2009.”
“As the first hospital system to mandate COVID-19 vaccines, we were prepared for this,” Marc Boom, M.D., the chief executive officer of Houston Methodist, said in a statement. “As of today, several other major health care centers have followed our lead and have announced their own vaccine mandates, with many more to follow soon.”
That includes the University of Pennsylvania Health System (UPHS), which is requiring all employees be vaccinated by Sept. 1, 2021, CBS News reported. More than 33,000 of approximately 44,000 workers are fully vaccinated, UPHS said in announcing its mandate in late May.
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Arsenic Levels Trigger Recall of Beech-Nut Infant Cereal
THURSDAY, June 10, 2021 (HealthDay News) — Excessive levels of arsenic in some samples of Single Grain Rice infant cereal sold across the United States have prompted Beech-Nut Nutrition to recall the product.
“We are issuing this voluntary recall because we learned through routine sampling by the State of Alaska that a limited quantity of Beech-Nut Single Grain Rice Cereal products had levels of naturally occurring inorganic arsenic above the FDA guidance level, even though the rice flour used to produce these products tested below the FDA guidance level for inorganic arsenic,” Jason Jacobs, Beech-Nut’s vice president of food safety and quality, said in a statement.
No illnesses related to the recalled products have been reported, according to Beech-Nut.
Testing showed that levels of naturally occurring inorganic arsenic were higher than the guidance level set by the U.S. Food and Drug Administration last year.
The recall is for Beech-Nut Single Grain Rice infant cereal with the UPC Code number 52200034705, an expiration date of May 1, 2022, and product codes 103470XXXX and 093470XXXX. Consumers should discard the recalled product and can get more information on exchanges or refunds by going to the company’s website or by calling (866) 272-9417, Monday through Friday from 8 a.m. to 8 p.m.
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U.S. to Send 500 Million COVID-19 Vaccine Doses to Countries Desperate for Shots
THURSDAY, June 10, 2021 (HealthDay News) — The United States plans to purchase 500 million doses of Pfizer’s coronavirus vaccine that it will then donate to countries in need around the world.
The first 200 million doses will be sent out this year, with 300 million more shared in the first half of next year, three people familiar with the plan told The Washington Post on Wednesday.
COVAX, the World Health Organization-backed initiative to share COVID-19 doses across the globe, will distribute the doses to low- and middle-income countries. Pfizer is selling the doses to the United States at a “not-for-profit” price, sources told The Post on the condition of anonymity so they could share details that are not yet public.
Biden plans to announce the massive effort on Thursday at the start of the Group of Seven (G-7) meeting in Britain, The Post reported.
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$5.1 Billion Effort to Eradicate Polio Announced
THURSDAY, June 10, 2021 (HealthDay News) — A $5.1 billion plan to eradicate polio worldwide by 2026 was announced this week by the Global Polio Eradication Initiative, a public-private partnership led by national governments and health groups.
For decades, the initiative has been trying to rid the world of polio by immunizing every child against the polio virus, but the COVID-19 pandemic interrupted that effort, leading to an increase in cases, The New York Times reported. There were 1,226 cases of polio worldwide in 2020, compared with 138 in 2018.
“Now is the time to double down and really make sure that we stop transmission and that we’re able to deliver a polio-free world,” said John Vertefeuille, chief of the polio eradication branch at the U.S. Centers for Disease Control and Prevention, one of the partners in the global initiative, The Times reported.
Progress is being made. Last August, African countries were declared free of wild poliovirus, which means that Afghanistan and Pakistan are the only two countries where polio remains endemic. Late last year, the World Health Organization gave emergency authorization to a new vaccine that could minimize polio outbreaks, The Times reported.
Global Polio Eradication Initiative
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UnitedHealthcare Delays New Policy on Emergency Department Visits
THURSDAY, June 10, 2021 (HealthDay News) — Under intense pressure, UnitedHealthcare says it will wait until the COVID-19 pandemic is over before implementing a new policy to stop paying for emergency department visits that it considers nonurgent.
It had announced a few days ago that the new policy would take effect next month, but faced significant backlash from several major hospital and doctor groups, The New York Times reported.
“Plain and simple, this is a very misguided policy that could have a chilling effect for people going to the emergency room,” Rick Pollack, the chief executive of the American Hospital Association, said earlier this week.
In a letter to UnitedHealthcare’s chief executive, he urged the giant insurer to reverse the new policy and said the COVID-19 pandemic highlighted the risks of discouraging patients from seeking care.
“This is dangerous for patients’ health at any time, but is particularly unsafe in the midst of a public health emergency,” Pollack said, The Times reported.
“Based on feedback from our provider partners and discussions with medical societies, we have decided to delay the implementation of our emergency department policy until at least the end of the national public health emergency period,” UnitedHealthcare said in a statement issued Thursday.
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America Is Losing the War Against Diabetes
THURSDAY, June 10, 2021 (HealthDay News) — After years of improvement, Americans with diabetes may be losing some ground in controlling the condition, a new government-funded study shows.
Researchers found that between 1999 and the early 2010s, U.S. adults with diabetes made substantial gains: A growing percentage had their blood sugar, blood pressure and cholesterol down to recommended levels.
Since then, the picture has changed: Progress on cholesterol has stalled, and fewer patients have their blood sugar and blood pressure under control than a decade ago.
The findings are concerning, the researchers said, since the trends could put more Americans at risk of heart disease, stroke and other diabetes complications.
“This is very sobering,” said senior researcher Elizabeth Selvin, a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “It’s not just that rates [of control] are plateauing, they’re worsening.”
Selvin and her colleagues published the findings in the June 10 issue of the New England Journal of Medicine.
As of 2018, over 34 million Americans had diabetes, according to American Diabetes Association. The vast majority had type 2 diabetes, where the body can no longer properly use insulin, a hormone that regulates blood sugar.
As a result, blood sugar levels soar. Over time, uncontrolled blood sugar can damage the blood vessels and nerves, contributing to complications such as heart disease, stroke, kidney failure and eye disease.
On top of that, people with diabetes often have other chronic conditions, like high blood pressure and elevated cholesterol, which can also feed those complications.
So, why would control of those conditions be worsening?
It’s not clear from the study, but Selvin pointed to some possibilities. In 2008 and 2009, three clinical trials were published that questioned the value of “intensive” blood sugar control: Diabetes patients assigned to that regimen showed no further reduction in their risk of heart trouble or stroke — but they did have a greater risk of potentially dangerous drops in blood sugar.
Those trials tested the effects of especially tight control of patients’ A1C levels. That’s a measure of a person’s average blood sugar levels over the past three months.
The trials aimed to get patients’ A1C to below 6.5% or 6% — versus the standard 7%.
After the results were published, some doctors began backing off from tight blood sugar control.
“I think what we’re seeing now is something of an overcorrection,” Selvin said.
That’s because fewer Americans are now achieving even the standard A1C goal of below 7%.
Selvin’s team found that between 1999 and the early 2010s, the proportion of diabetes patients meeting that target rose from 44% to 57%. By 2018, that had declined to 50%.
The trends for blood pressure control were similar. Over the earlier time period, the percentage of diabetes patients meeting blood pressure goals improved from 64% to 74%. That figure dipped thereafter, to 70%. (Control was defined as below 140/90 mm Hg.)
The reasons are not clear, but Selvin noted the pattern matches that of the U.S. population as a whole.
Dr. Joanna Mitri is an endocrinologist and research associate at Joslin Diabetes Center in Boston. She had no role in the study.
Mitri said that after the trials of intensive glucose (blood sugar) lowering came out, treatment guidelines shifted away from being “glucose-centric” toward a broader focus on controlling other cardiovascular risk factors as well.
For some patients, she said, a relatively higher A1C may be appropriate — for example, an older adult at risk of low blood sugar episodes. For other patients, keeping A1C below 7% may be the right goal.
The point is, the treatment plan should be individualized, Mitri said. She encouraged diabetes patients to ask their doctor what their A1C goal is, why that’s the target, and how best to achieve it.
But don’t forget the bigger picture. “We need to improve all three things — blood glucose, blood pressure and cholesterol — in addition to weight management, diet and exercise,” Mitri said.
According to Selvin, it’s possible that lifestyle-related factors, including trends in obesity, contributed to declines in blood sugar and blood pressure control in recent years.
“Complementing medication with lifestyle changes is very important,” she said. “Preventing further weight gain is very important.”
Selvin also noted that since the 2008/2009 trials, new diabetes medications have become available that can lower blood sugar with less risk of dangerous lows.
Like Mitri, she suggested patients talk to their doctors about their treatment goals and ask whether they are on “optimal” management.
The study was funded by the U.S. National Heart, Lung, and Blood Institute.
More information
The American Diabetes Association has more on managing diabetes.
SOURCES: Elizabeth Selvin, PhD, MPH, professor, epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Joanna Mitri, MD, endocrinologist, research associate, Joslin Diabetes Center, Boston; New England Journal of Medicine, June 10, 2021
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