2 Minute Medicine Rewind November 1, 2021

COVID-19 mortality risk correlates inversely with Vitamin D3 status

1. There is a negative correlation between Vitamin D3 levels and mortality from COVID19.

Evidence Rating Level: 3

As the COVID-19 pandemic continues to impose a significant burden on healthcare systems worldwide, ongoing research is conducted to evaluate different correlates of disease severity and clinical outcomes. One recent area of interest includes the investigation of how blood calcidiol levels correlate with SARS-CoV-2 infection severity. Prior studies have found low D3 levels to be associated with more severe infection, possibly owing to the negative effects a deficiency may have on immune function. In this systematic review, researchers sought to further investigate this area. Researchers conglomerated results from retrospective cohort and clinical studies, and a population study published between November 2019 to March 2021 to delineate any possible correlation between vitamin D3 levels and COVID-19 mortality risk. Researchers found a moderately negative Pearson’s value (95% CI: −0.805–−0.08) between blood calcidiol levels and COVID-19 mortality risk. The observed median (IQR) vitamin D3 value collected from all eight of the studies was 23.2 ng/mL. A). Interesting, extrapolation of data via regression analysis additionally suggested that at a blood level of 50 ng/mL 25(OH)D3, the COVID-19 mortality risk value could theoretically be zero. Using mathematical regressions, this study also suggests that healthy vitamin D3 levels begin at around 125 nmol/L or 50 ng/mL 25(OH)D3. Study findings show that prior to vaccine availability, people with higher levels of Vitamin D3 were less likely to suffer severe COVID-19 infections and were at a lower risk of dying from the disease compared to those with low or deficient calcidiol levels. This further reinforces the role of adequate calcidiol consumption, and potentially suggests a role for its supplementation as an additional prophylactic means of preventing severe infection.

Anemia among children living with HIV/AIDS on HAART in Mekelle Hospital

1. In the Tigray region of Northern Ethiopia, a relatively low but significant proportion of children with HIV/AIDS on HAART therapy were found to be anemic.

Evidence Rating Level: 2

Children with HIV/AIDS often have anemia, and is unfortunately especially prevalent in Ethiopia, as prior studies have found over a 22% prevalence of anemia among children living with HIV/AIDS on HAART. Currently, there is a lack evidence on this topic in children on HAART in Tigray in Northern Ethiopia. This institution-based cross-sectional study attempted to address this gap in literature. Specifically, researchers sought to further investigate the prevalence of anemia amongst 241 children that are on HAART at the Mekelle Hospital between November 2018 to January 2019. Data on socio-demographic factors were additionally included and controlled for via questionnaires and patient interviews. Hemoglobin levels were measured in participants in order to analyze anemia status. This study found that 7% of patients included in this study were anemic. 56% of them had mild anemia, 19% had moderate anemia, and 25% had severe anemia. Amongst them, normocytic-normochromic anemia was the most common type of anemia found among the participants. Compared to the rest of the nation, Tigray demonstrated a lower rate of anemia amongst its pediatric patients with HIV/AIDS on HARRT. Despite this, this relatively low number still constitutes a large volume of patients, and a large proportion of affected patients were affected with severe anemia. These findings further support how anemia may be an under-addressed issue amongst these patients, and reinforce the importance of early detection and intervention to optimize clinical outcomes and quality of life.

Phototherapy and childhood cancer

1. In a large cohort, phototherapy for neonatal hyperbilirubinemia is not associated with any childhood cancer.

Evidence Rating Level: 2

Phototherapy for the treatment of hyperbilirubinemia is ubiquitous in pediatric practices worldwide. Its simplistic application allows practitioners to address a common neonatal outcome that can potentially have severe implications, such as kernicterus. Although this therapy is thought to be safe, there have been concerns in the past that it could potentially be correlated with an increased incidence of cancers. In this multi-centre cohort study, researchers included 139,100 children born in Kaiser Permanente Northern California hospitals between 1995 to 2017 and who had a bilirubin level that qualified for the American Academy of Pediatrics phototherapy threshold. The participants were followed through March 16^th, 2019 as means of tracking cancer incidence. The participants were identified as exposed to inpatient phototherapy or not, and the outcome observed was the incidence of childhood cancer of any type observed during the follow-up period. Using Cox proportional hazard models, researchers  found that phototherapy did not have any association with any childhood cancer over a mean follow up period of 8.2 years. There was a slight increase in hazard ratio of no statistical significance for any cancer (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 0.83–1.54), hematopoietic cancer (HR: 1.17, 95% CI: 0.74–1.83), or solid tumors (HR: 1.01, 95% CI: 0.65–1.58). Study findings further reinforce the safety of phototherapy as a therapy for hyperbilirubinemia, and may be used to inform practitioners when having informed discussions with parents prior to therapy initiation.

Prenatal antibiotic exposure and childhood asthma

1. In a population-based cohort study in Manitoba, maternal exposure to antibiotics prior to, during, and following pregnancy was associated with a dose-dependent increase in asthma among infants

Evidence Rating Level: 2

One of the challenges faced by physicians is to weigh the risks and benefits of certain treatments during the prenatal and postpartum period, as different exposures can have long-term effects on exposed offspring. One of the ongoing areas of study currently is the association between antibiotic exposure and childhood development of asthma, as exposure can have deleterious effects on immune development and gut microbiota. In this population-based cohort study, researchers used records from the general population in Manitoba, Canada. Participants included 213,661 mother-child couples born between 1996 and 2012. Prescription records determined prenatal antibiotic use, the exposure in this study. Hospital records, billing claims, and prescriptions determined asthma diagnosis status, the outcome in this study. Results showed that prenatal antibiotic use was associated with an increased risk of childhood asthma using Cox regression (Hazard ration is 1.29 with a 95% Confidence Interval of 1.26–1.33. These results also accounted for maternal asthma diagnosis status. It is worth noting that maternal antibiotic use in the nine months before pregnancy (adjusted HR 1.28, 1.24–1.31) and the nine months after pregnancy (adjusted HR 1.32, 1.29–1.36) were also found to have similar associations with childhood asthma. Study findings suggest that both prenatal, and postpartum exposure to antibiotics appear to be associated with an increased risk of development of childhood asthma. Results should be used to further inform practitioners during prescription, and further studies may be warranted to delineate which classes of antibiotics are more or less associated with asthma development.

Risk factors for diabetic peripheral neuropathy in adolescents and young adults with type 2 Diabetes

1. Amongst young adults with Type 2 Diabetes, male sex, older age, greater BMI, and poor glycemic control was associated with increased risk of developing diabetic peripheral neuropathy.

Evidence Rating Level: 2

Diabetes mellitus is associated with many macro and microvascular comorbidities in affected individuals, especially when poorly controlled. Amongst them, diabetic peripheral neuropathy (DPN) can have significant impact on patient quality of life. Currently, the data on DPN in youth currently is limited. This study aims to study the prevalence of DPN in youth with type 2 diabetes. This study used the Michigan Neuropathy Screening Instrument (MNSI) and a 10-g monofilament exam annually over about 10 years to assess DPN in participants enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. The study included 674 participants, of which 35% were male. The mean age of the participants was 14 years old. Patient demographic, nonmetabolic, and metabolic characteristics such as BMI and glycated hemogloblin (HbA1c) levels were additionally collected and used in further analysis. Through Cox proportional hazard regression models, male participants had greater DPN incidence values than female participants (38.5% vs. 27.2% via MNSI-exam, P = 0.002; 14.0% vs. 5.1% via monofilament exam, P = 0.01). As expected, participants with high BMI values and poor glycemic control as measured by higher HbA1c also showed higher DPN incidence. Furthermore, race/ethnicity did not show any significant difference in DPN incidence, though advanced age was additionally associated with greater severity of DPN. Study findings not only further reinforce the importance of early and optimal glycemic control for the minimalization of diabetic neuropathy, but also highlights how DPN can affect youth and adults alike. Further investigation into the mechanisms by which males were at greater risk of developing severe DPN compared to females is additionally warranted.

Image: PD

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