TTHealthWatch is a weekly podcast from Texas Tech University. In it, Elizabeth Tracy, director of electronic media at the Johns Hopkins University School of Medicine in Baltimore, and Rick Lange, MD, director of the Texas Tech University Health Sciences Center in El Paso, discuss the week’s top medical stories .
Topics of the week include long-term COVID and variants, management of asymptomatic kidney stones, new blood markers for diabetes and cancer, and management of intracranial arteries Atherosclerosis.
0:45 Post-COVID Syndrome Associated with Variation
1:45 Systemic inflammation clusters
2:43 Treatment of asymptomatic kidney stones
3:45 Relapse after treatment 75% longer time
4:45 New technology and new equipment
5:45 Stones used by thousands of people
6:05 Two studies of intracranial atherosclerosis
7:05 Additional antiplatelet drugs were also obtained
8:05 Stroke recurrence
9:00 New risk marker r Plasma prostaglandins
10 :01 significantly associated with both diabetes and cancer
Elizabeth: We have a new blood risk of cancer and diabetes factor?
Rick: Correlate long-term COVID symptoms with different variants of the virus.
Elizabeth: Should be small asymptomatic if it has been determined that someone has kidney stones , Is it necessary to remove kidney stones?
Rick: and strategies for the treatment of atherosclerosis in cerebral vessels after stroke .
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, you check weekly from Egypt Medical headlines from the Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore medical reporter.
Rick: And I’m Rick Lange, Texas Tech, El Paso President of the University Health Sciences Center and I am also the Dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, if we turn directly to, of course in our way, the concept , “Well, what kind of post-COVID syndrome do you have if you have a different variant of the new coronavirus?” This is in medRxiv.
Rick: This is a very interesting study in the UK and they try to do several things. One was that they tried to see if there were associations between different long-term COVID symptoms and to link them to vaccinated or unvaccinated people and to various variants of the COVID virus (wild-type, alpha, and delta). – They looked at over 9,300 people for various symptoms.
They were able to identify three common patterns. There is a CNS cluster associated with the Alpha and Delta variants, which causes problems like brain fog and confusion.
There is also a second cluster. It’s called a cardiopulmonary cluster. It is often associated with more severe symptoms, such as severe shortness of breath, heart problems and lung problems mainly associated with the wild-type variant.
Then there are clusters of systemic inflammation, often with immune-related symptoms. This happened in all three different variants. These clusters were not affected by the vaccination status of individuals. It did not appear to change the characteristics or types of long-term COVID symptoms associated with these different symptoms.
Elizabeth: There is a paper we won’t discuss this week, but it was just published in in The Lancet , the paper looked at sizable cohorts and determined that 1 in 8 people will eventually develop these long-term COVID symptoms. I guess I’m still struggling with all this and the clinical impact it could have.
Rick: This is not uncommon. By clustering these things, the authors hope to try to find some common causes or causes that can help directly predict, identify, or treat. But I think we’ll talk more about this later.
Elizabeth: No doubt we will talk more about it. Let’s turn from here to The New England Journal of Medicine . This is a study on this very common condition, which is kidney stones. It looks at, when someone is being treated for symptomatic kidney stones, and if, “Gee, while you’re in treatment, should we be looking at other small stones, those smaller than 6mm but asymptomatic? Should we also try Remove those? What effect does this have on relapse?”
They conducted a multicenter randomized controlled trial. However, in that trial, they had only 38 patients in the treatment group and 35 in the control group. They studied endoscopic resection of ureteral or contralateral kidney stones. The remaining asymptomatic small stones were again removed in 38 of these patients, who were followed for an average of 4.2 years.
They were able to demonstrate that the time to relapse was 75% longer in the treatment group than in the control group. The risk of relapse in the treatment group was 82% lower than in the control group. They also looked at the financial aspects of this and determined that continuing to treat these asymptomatic stones was actually cheaper than having the person continue treatment and then develop symptoms later.
The editorial thought it was “well, it might be a good idea to keep doing this”, although they did note that only a quarter of patients were prescribed in both groups Preventive medications are prescribed to try to help reduce this risk of recurrence.
Rick: Elizabeth, as you said, this is an interesting study , because if you have kidney stones and have been treated, your chance of having them recur in the next 4 to 5 years is about 50%. As you said, these people are ready for kidney stone treatment. In fact, the treatment has gotten better. Urologists have newer technology and newer equipment. Overall, this is a very safe process.
Now, the real question is, “Well, what about people who don’t have asymptomatic kidney stones? Should we do something about their asymptomatic stones?” But, If a person is being treated for symptomatic kidney stones, the urologist should at least consider removing smaller, asymptomatic kidney stones in the same patient.
Elizabeth: Yes. However, I also wonder if screening is appropriate for someone who already has a problem in this extremely common problem. Finally, the editorial authors state that, aside from preemptive surgical intervention, there is a way to figure out how to allow small stones to fall off and pass on their own.
Rick: You are right. The choice is a drug that reduces the formation or shedding of new stones. The second is trying to expel them and keep them asymptomatic. This sounds like a rather lofty but difficult goal. Or the third is to remove them at the time of surgery. Millions of people already have symptomatic kidney stones, and it only takes about 25 minutes to remove the additional stones.
Elizabeth: How about the idea of this screening? What do you think?
Rick: If we’re going to do this, I’ll just screen and do something. Do you treat their stones? This is really a question that a study should address. In this case, if it proves to be beneficial, then screening should be done.
Elizabeth: Let’s move on to your next one. That’s in JAMA, there are actually quite a few.
Rick: Elizabeth, we’re going to discuss two studies together. Both approaches are treatment strategies for people whose intracranial atherosclerosis blocks the blood vessels in the brain that lead to stroke. About 12% of white patients with a history of acute ischemic stroke or so-called transient ischemic attack have some form of intracranial atherosclerosis. If you really look at people under the age of 55, about a third of them have intracranial atherosclerosis.
When you have a stroke, how can you best treat to minimize neurological dysfunction and reduce the risk of stroke recurrence? Removing the blood clot or clot that causes the stroke is one of the most effective treatments.
Can we combine other treatments to make it more effective? One of these is the use of more intensive antiplatelet drugs, which may reduce the risk of recurrent stroke.
In one of the studies, they did. The patient underwent thrombectomy. They removed the clot. They received aspirin and then an intravenous injection of a very potent antiplatelet drug called tirofiban within 20 hours of surgery.
Unfortunately, it doesn’t really improve neurological deficits, but it does increase the risk of intracerebral hemorrhage. The second study looked at, “Okay, so after you’ve done a thrombectomy, either have balloon angioplasty, or have a blocked stent in there?”
They took 358 stroke patients. They did a thrombectomy. They then waited 3 weeks to 12 months before randomizing them to placement of a stent and balloon or continued drug therapy. They found that this was not the case. Adding stents or balloon angioplasty did not reduce this risk at all. In fact, it initially increased it slightly, and even over the course of many years, survival didn’t improve.
Now, Elizabeth, that’s part of the reason, because our medical treatments are so good right now. They were on intensive statin therapy and aspirin, and we lowered their blood pressure. In this setting, the risk of recurrent stroke was very low, about 7% at one year, compared with an overall 1.3% mortality rate at 3 years in the medical group.
Elizabeth: Yeah, I’m not going to say I don’t think we need to go even further Far from it, let’s prevent any from starting with these events and not have to formulate all of them by paying very careful attention to everything – blood pressure, sodium, etc. – so that we can avoid the whole problem for most people.
Rick: Elizabeth, we know the risk factors: diabetes, smoking and untreated high blood pressure. There is also a genetic component. The average age of these people was only 56. You’re right, preventing strokes is really much more effective than treating them.
Elizabeth: Now that we’re talking about — you’ve mentioned a risk factor — diabetes , then let’s turn to Diabetologia. This is the study of a novel risk marker for diabetes and cancer mortality. This is called plasma prostaglandins. I haven’t heard of this before. do you have?
Rick: No, this is news to me.
Elizabeth: This is a study conducted in the Malmö Diet and Cancer Study Cardiovascular Cohort study; that was in Sweden. In this particular study, they had more than 4,600 participants, and they excluded some of them because they didn’t have enough data for them all.
What they were looking at was this blood marker, prostaglandins, blood sugar levels and other covariates. Interestingly, this marker is associated with epithelial sodium channels. There is a relationship between these sodium channels that is ultimately linked to diabetes and this cancer risk.
They tracked them for a long time – more or less 22 years. During this period, some of them developed diabetes and also died of cancer. They were able to show that prostaglandins were significantly associated with the incidence of diabetes and cancer, especially in individuals with impaired baseline fasting glucose levels. They suggested this might be a marker we could start paying attention to.
Rick: I find research like this interesting, but I’m going to talk limitation. One prostaglandin measurement was performed in these individuals. You want to follow this for a long time. For example, we don’t even know if prostaglandin levels fluctuate in the normal population.
When you see this, you ask yourself, “Is there an association? Second, is it causal or not? Is it a marker or not? Is it a By-products? Does it matter?” These are all things that need to be determined. An interesting hypothesis, but there is still a lot of work to be done.
Elizabeth: I’ll note at the end, however, we’ve talked a lot – and I There seems to be a lot of talk – about this relationship between diabetes and different kinds of cancer. I think finding hard evidence here is something I’m very interested in.
Rick: Yes, this is possible for many of our listeners Unknown association. There is no doubt that diabetes is associated with an increased risk of cancer.
Elizabeth: More. no doubt. Here are the top medical headlines this week at Texas Tech. My name is Elizabeth Tracey.
Rick: This is Rick Lange. You all listen and make healthy choices.