TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, 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.
This week’s topics include outcomes for babies in women infected with COVID during pregnancy, new cardiovascular health guidelines, targeting difference pathways in Alzheimer’s, and a monkeypox update.
Program notes:
0:40 Neurological outcomes for babies whose moms had COVID
1:40 Adjusted for other factors still had twice the risk
2:40 One year of follow-up
3:00 Targeting noradrenergic pathways in Alzheimer’s
4:00 Large positive effect on apathy
5:00 Have more global effects
6:49 Direct contact spread
7:50 Administration of vaccines?
8:00 Cardiovascular health calculator
9:00 Very rare for people to meet them
10:00 Red, yellow, or green and an overall score
11:36 End
Transcript:
Elizabeth Tracey: Adding sleep to the calculus for your risk of cardiovascular disease.
Rick Lange, MD: The neurodevelopment of kids born to mothers with COVID.
Elizabeth: Can we target a different pathway in managing some of the symptoms of Alzheimer’s disease?
Rick: And human monkeypox virus in individuals in the United Kingdom.
Elizabeth: That’s what we’re talking about this week on TT HealthWatch — your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I’m also dean of the Paul L. Foster School of Medicine.
Elizabeth: Let’s turn right to JAMA Network Open and take a look at, gosh, what happens to kids who are born to moms who had COVID while they were pregnant?
Rick: This is a really important study because we have talked before about vaccinating women who are pregnant to avoid COVID. But what about women who actually have COVID and are there sequela in terms of neurodevelopment in their kids?
We know that other maternal inflammations can affect neurodevelopment in kids. Things like influenza, flu, has been associated with autism spectrum disorder, schizophrenia, and cerebral palsy. How do you address this?
This is a retrospective cohort study that examined live offspring of all mothers who delivered between March and September 2020. They looked at 7,772 live births, 222 of those births were to COVID-positive mothers, and they examined if children reported to have neurodevelopmental disorders over the subsequent year after they were born. If mothers had COVID, they were more likely to have a preterm delivery, about twice as likely to do that.
When they adjusted for everything they can adjust for — age, race, ethnicity, insurance status, offspring, sex, maternal age, and preterm status — the kids who were born to mothers with COVID were twice as likely to have neurodevelopmental disorders. By the way, third-term trimester infection was associated with the largest magnitude. It was about a two and a half fold increased risk. It does look like maternal COVID infection is associated with neurodevelopmental sequelae in at least some of the offspring.
Elizabeth: We have certainly seen that with lots of other things — Zika virus in particular — and what a great model for that. Here is what I’m wondering. We, of course, note that from the 7,000+ women, we dropped down to only 200+ who had COVID during pregnancy, so our N has dropped a lot. What was the vaccination status of these women?
Rick: Elizabeth, that we don’t know. Is it related to the severity of infection? We don’t have that information. Even though I suggested that the third trimester was associated with the largest increase, again, the numbers are small enough that I can’t make that a definitive conclusion. Although, again, it’s not surprising that this viral infection like other viral infections is associated with some neurodevelopmental issues. Now, by the way, this is at 1 year of age. Does that persist later?
Elizabeth: Lots and lots of work still to do. We do know, of course, that COVID-19 infection in pregnant women can have really dire outcomes.
Rick: More reason to get vaccinated.
Elizabeth: Since we are talking about things that affect the CNS, the central nervous system, let’s turn to the BMJ‘s Journal of Neurology, Neurosurgery, and Psychiatry.
This study is a meta-analysis taking a look at whether the noradrenergic system and management of that system with different drugs that we already have in place could help with some of the symptoms of Alzheimer’s disease. The authors say something right at the beginning that dysfunction of the locus coeruleus noradrenergic system occurs early in Alzheimer’s disease. To me, this seems bizarre that recognition of that fact would not have had people already looking to target this particular pathway.
In this meta-analysis of 19 randomized controlled trials, they used 10 of those that showed a significant, small positive effect of noradrenergic drugs on global cognition. This was measured using the Mini-Mental State Examination or the Alzheimer’s Disease Assessment Scale. They also used eight of those trials and 425 patients to show that there was a large positive effect of noradrenergic drugs on apathy.
They found methylphenidate interestingly was one of the drugs that seemed to be really helpful in this and, of course, we have abundant experience with it. I think it’s great if we can improve global cognition and apathy for folks who have Alzheimer’s disease. They do admit — and I think this is a serious limitation of this study — that there are significant interactions between other meds and even other medical conditions that people might have if these drugs start to be employed on a wider scale.
Rick: They studied this decades ago in small studies. They really didn’t show a benefit. When you look at the larger picture, there was no benefit on attention, verbal memory, visual memory, executive function, somatic memory, and visual spatial abilities. It makes one wonder, does it really change apathy and cognition? Or is it just if you throw enough stuff against the wall something sticks?
By the way, some of these drugs have more than just adrenergic effects. They have cholinergic effects and dopaminergic effects as well. It’s kind of an interesting hypothesis generating, but I certainly wouldn’t hang my hat on this peg.
Elizabeth: Clinically, though, for people who are managing loved ones with Alzheimer’s disease, it probably might be worth trying some of these things because we do have abundant experience with these meds.
Rick: But, as you’re aware, they increase heart rate and they increase blood pressure. These patients are oftentimes older. In the absence of a well-designed study, I’d be loath to tell any of our listeners, gosh, let’s put senior citizens with Alzheimer’s on medications that could make things worse. I would agree with you, it does need further study.
Elizabeth: I think that’s because, as you know, we’ve had very, very disappointing results with almost every other candidate that’s come over the transom with regard to managing Alzheimer’s.
Then let’s turn to The Lancet and maybe we’re going to agree about what’s going on with monkeypox in the U.K.
Rick: People have been hearing about this increase in monkeypox, really throughout the world. It’s unusual because it’s endemically circulating primarily in West and Central Africa. Now, fast-forward to June 8, 2022, there has been a cumulative total of over 1,285 laboratory-confirmed monkeypox virus cases have been reported in 23 different countries. These were people that were seen in sexual health clinics in London between May 14 and May 25.
What they discovered is they confirmed 54 individuals who developed monkeypox. All of these were men who had sex with men and the median age was about 41 years. About a fifth of these individuals had no prodromal symptoms. Almost all of them had some type of skin eruption. About a third had rash. About two thirds had some fatigue. Most of the pustules were in the anogenital region, which leads the authors to suspect that this is direct contact and that’s how the monkeypox is spread.
There was a small handful that were hospitalized, but not related to monkeypox, just that they developed an underlying cellulitis. They really can’t figure out exactly how it got to the United Kingdom, but it appears it’s been direct-contact male-to-male sex.
Elizabeth: We are certainly seeing an awful lot of emerging information about that. I would specifically cite these sewage studies that are demonstrating it’s turning up all over the place, including here domestically. Some of the characteristics of this infection are different than what we see in the endemic version that is circulating in Africa.
We also know from abundant experience with COVID for the last 2 and a half years that viruses undergo all kinds of evolution. I guess what I’m wondering is how big of a public health concern is this?
Rick: Time will tell. We first of all have to have an awareness as healthcare providers in the community knowing that it may manifest a little bit differently than what we are used to and have a high index of suspicion in individuals that have unusual skin lesions.
Elizabeth: What are your thoughts about prophylactic administration of vaccines?
Rick: I think that’s something we will need to consider. I think everybody is watching this very closely.
Elizabeth: Finally, let’s turn to Circulation, the journal of the American Heart Association. This is an update of their, what should we call it, formula for calculating one’s cardiovascular health. This one is entitled “Life’s Essential 8.”
In 2010, the American Heart Association created this formula, this paradigm, that said we don’t want to just focus on disease treatment, we really want to take a look at what can we do to live in its entirely and most healthful way so that we avoid cardiovascular disease.
They looked at this, again, and now they have Life’s Essential 8. What are these essential 8s? Healthy diet, participation in physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure.
It turns out that this ideal cardiovascular health is unbelievably low — less than 1% for all age groups studied, including among individuals as young as 12 years of age. The prevalence of having greater than or equal to five of these metrics at ideal levels is only 45% among U.S. adolescents, 32% among those 20 to 39 years of age, 11% in adults 40 to 59, and 4% among adults greater than or equal to 60 years of age.
They give a very lengthy description of how a calculation can be made and somebody can be given a score. They also make recommendations regarding policy-level decisions that would help to promote all of this. I think that the inclusion of sleep is a really good one. I know I get that 7 to 9 and I know you don’t. Let’s talk about what your thoughts are on this modification.
Rick: Elizabeth, as you said, there are four health behaviors — diet, physical activity, nicotine exposure, and sleep — and four health factors: body weight, blood lipids, blood glucose, and blood pressure. They kind of give them a red, yellow, green score and then they sum them all up to give you an average score. We can look at colors, we can look at a score, and it helps us.
Overall, except for sleep, I think I do pretty well. It’s interesting, because in the past sleep wasn’t even a part of the Healthy 8. I do like the idea of providing an overall score to individuals so they can decide, gosh, I need to get my butt in gear if I’m going to be healthy. I agree with you. It’s not just how many people do all eight, but even the number of individuals that do five or more is less than 5%.
Elizabeth: I think the other thing I applaud here is that they have also included psychological health and social determinants of health in their calculus, and obviously talk about how psychological well-being, mindfulness, gratitude, optimism, and a sense of purpose positively impact, of course, on the things that are used in this calculation.
Rick: The things that you discussed actually affect our health behaviors and our health factors. The foundation of having cardiovascular health means that you’re motivated, you have access, you’re willing, and you’re able to do these things. The psychological factors you mentioned and socioeconomic status does affect that.
Elizabeth: I’m just going to toss this out to our listeners, I would just be so interested in having people do this calculation and reveal what their scores are.
On that note then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.
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