2 Minute Medicine Rewind January 8, 2023
1. Patients with type 2 diabetes randomized to using probiotic supplements were found to have significantly reduced lipoprotein-associated phospholipase A2 levels at 12-weeks follow-up.Â
2. Probiotic supplementation was also associated with improved glycemic control at follow-up.Â
Evidence Level Rating: 1 (Excellent)
Type 2 diabetes affects many adults worldwide and is increasing in prevalence in many countries. In patients experiencing type 2 diabetes, it has been hypothesized that inflammatory markers such as lipoprotein-associated phospholipase A2 increase the risk of cardiovascular events. In this double-blind randomized controlled trial based in Iraq, 68 participants with a type 2 diabetes diagnosis, aged 50-65 years were assigned to either receive a probiotic supplement or a placebo pill. The goal was to determine whether probiotic supplementation would result in reduced lipoprotein-associated phospholipase A2 levels, as well as improved glycemic-control at 12-weeks follow-up. Included in the probiotic supplement were Bacillus Coagulans, Lactobacillus plantarum, Lactobacillus acidophilus and Bifidobacterium bifdum. At follow-up, there was noted to be a statistically significant reduction in lipoprotein-associated phospholipase A2 levels in patients taking probiotics, in addition to a positive impact on HBa1c and high-density lipoprotein cholesterol levels. One of the limitations of the study was the short timeframe in which it was conducted, as diabetes complications tend to accumulate over longer timeframes. Additionally, this study could have used a food record instead of a food recall to create a more accurate response. Overall, the study findings indicate that there may be a role for probiotics in the improvement of outcomes for patients with type 2 diabetes. With further research in the area, practitioners may consider including probiotics as a counseling point for diabetes education.Â
In Utero Exposure to Alcohol and Tobacco and Electroencephalogram Power During Childhood
1. In this cohort study, children with low dose prenatal alcohol and tobacco exposure were found to have differences in electroencephalogram activity even at 11 years of age.
2. Males were particularly vulnerable to the effects of prenatal alcohol exposure compared to females.Â
Evidence Level Rating: 2 (Good)
Tobacco and alcohol consumed during pregnancy have teratogenic effects on the fetus, even when consumed in low amounts. In this cohort study, researchers sought to further characterize the effects of PAE and PTE on neurodevelopment in childhood. The study utilized data from the Safe Passage Study conducted by the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network, and involved 649 participants who had electroencephalogram (EEG) recordings obtained at 4, 5, 7, 9, or 11 years old. Maternal data of pregnant people aged 16 years or older were additionally obtained to characterize PAE and PTE. This was then correlated with EEG band powers (theta, alpha, beta, and gamma), via linear regression models. In children with PAE, the association between PAE and heightened alpha EEG power is noted (0.116 [95% CI, 0.023 to 0.209] ÎĽV2, P = 0.02), with a dose-dependent effect in continuous exposure after the first trimester (0.211 [95% CI, 0.005 to 0.417] ÎĽV2, P = 0.04). Notably, mothers included in the study had quit drinking early into their pregnancy, suggesting that even low and early doses of PAE can result in teratogenicity. Likewise, PTE was associated with decreased beta power, as well as gamma power, compared with children from non-smoking mothers. Interestingly, there appeared to be a sex-related difference where males were particularly susceptible to PTE compared to females. Study findings suggest that even minor exposures to prenatal alcohol and tobacco can result in long-lasting differences in neurodevelopment that can be objectively identified on EEG. This study exists as the first of its kind to utilize a large cohort of EEG data and quantified prenatal exposure data, though the latter did rely on self-reporting. Nonetheless, the study provides further confirmatory evidence to the teratogenicity of prenatal alcohol and tobacco exposure.
1. Families randomized to having access to a mobile application that allowed them to communicate needs with intensive care unit (ICU) physicians were found to have reduced unmet palliative care needs compared to usual care.
2. White families were observed to benefit more from the intervention than Black families as measured by the Needs at the End-of-Life Screening Tool (NEST) score.
Evidence Level Rating: 1 (Excellent)
There is a desperate need for more palliative care specialists globally as evidenced by the burden ICU patients experience. This burden is disproportionately harming black patients and their families, showing the unmet palliative care needs. In this randomized controlled trial involving 6 adult medical and surgical ICUs in North Carolina, patient-family dyads were randomly assigned access to a mobile application (ICUConnect) that allowed them to communicate palliative care needs directly to ICU attending physicians. The study focused on the change in the family-reported Needs at the End-of-Life Screening Tool (NEST) score. 111 family members and 111 patients were enrolled in the study under the supervision of 37 physicians. The primary outcome revealed a noteworthy reduction in NEST scores among intervention recipients at both day 3 (mean difference -6.6 points, P = 0.01) and day 7 (mean difference -5.4 points, P = 0.05) compared to the control group. Interestingly, white families benefited more from the intervention than Black families as can be seen by their improved NEST scores at days 3 (-18.9 to -6.1 points vs -9.3 to 8.8 points) and 7 (-16.1 to -3.0 points vs -10.7 to 7.8 points). Study findings suggest that the use of a mobile communication application may have use-cases in the improvement of palliative care outcomes in the ICU. Additionally however, they also provide further insights into the potential roles that implicit biases and race may play in the quality of care provided to palliative care patients and their families.Â
1. Despite lower prevalence of traditional cardiovascular risk factors, cancer patients were observed to have similar cardiovascular disease (CVD) events ot non-cancer counterparts.
2. Coronary artery calcium score (CACS) were well correlated with CVD risk in cancer patients suggesting a potential role as a targeted screening tool.Â
Evidence Level Rating: 2 (Good)
To date, cancer and cardiovascular disease (CVD) remain leading causes of mortality and morbidity worldwide. Recently, interaction between these two diseases have increasingly been recognized, as oncology patients face increased CVD risk even when lacking traditional risk factors. Less known however, is the efficacy of risk stratification scores such as CACS for assessing CVD risk and atherosclerosis in cancer patients. In this retrospective cohort study spanning five years, data from 10,742 patients, including 703 cancer (C) and 703 age- and sex-matched non-cancer (NC) individuals was utilized to fill this gap in literature. Patients had CACS scores, demographic data, and cardiovascular events investigated in the study. Despite lower prevalence of traditional risk factors, cancer patients exhibited comparable CVD events to non-cancer counterparts. CACS was higher in cancer patients, notably in the >400 category. Cancer patients with moderate (101–400) and extensive (>400) CACS showed increased prevalence of atherosclerotic burden, including peripheral arterial disease (PAD) and cerebrovascular accidents (CVA). Overall, the CACS scores along with the prevalence of CVD were similar when comparing cancer vs non-cancer patients involved in the cohort study. Study findings provide evidence that the use of traditional risk factors for CVD risk stratification of cancer patients. Instead, CACS may have a potential role as a targeted screening tool for cancer patients, and allow for early intervention.Â
1. In a Malaysian cohort of adults affected with COVID-19, 3.4% were found to develop post COVID-19 condition.
2. Female sex, hospital admission at initial infection, and co-existing comorbidities were identified as risk factors for the development of post COVID-19 condition.Â
Evidence Level Rating: 1 (Excellent)
Post COVID-19 condition has lasting effects on multiple organ systems and can impact anyone who has experienced SARS-CoV-2. There are a multitude of physical symptoms people have experienced, including fatigue and dyspnea, along with psychological impacts. In this prospective cohort study in Malaysia, researchers examined 44,386 COVID-positive individuals during the Omicron wave to elucidate the prevalence of post COVID-19 conditions. The inclusion criteria included having a positive test for SARS-CoV-2 between April 23rd 2022 and June 24th 2022, while also being 18 years or older. Participants were delivered a mobile application survey to help identify individuals with post COVID-19 conditions. Across all participants, 1510 (3.4%) were found to meet the criteria for a post COVID-19 condition. Cough, fatigue, and forgetfulness were the most commonly identified symptoms for those with post COVID-19 condition, affecting 84% of these individuals. Female sex, co-existing comorbidities, and admission to hospital during initial symptom onset were identified as risk factors for the development of post COVID-19 condition. Although the mechanisms by which COVID-19 infections result in long term sequelae remain poorly characterized, this data provides further insights into the demographic information of those affected be post COVID-19 condition.
Image: PD
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