Did HIV Drug Help in COVID-19?

The 24-hour news cycle is just as important to medicine as it is to politics, finance, or sports. At MedPage Today, new information is posted daily, but keeping up can be a challenge. As an aid for our readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include COVID-19 treatment, surgery for chronic pain, and cannabinoids. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.

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Morning Break: Gender Segregation in Medicine; Microbial DNA & Cancer; Docs Who Write Poetry

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A gynecologic surgeon, who's seen the ob/gyn specialty become dominated by women, ties the wage gap between male and female physicians to growing "gender segregation." (STAT)

President Trump said the nation would ban most travel from Europe for 30 days (with many exceptions, such as travel from the U.K.) in light of the growing coronavirus pandemic. For more COVID-19 coronavirus news, check out our daily feature summarizing late-breaking developments.

Finding microbial DNA in patient's blood can help diagnose cancer, according to a study in Nature.

Whistleblower Chelsea Manning attempted suicide while in jail and is recovering in a hospital. (BoingBoing)

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Avalanche of Alzheimer's Cases: Are We Ready?

Nearly nine in 10 primary care physicians expect to see more patients with dementia in the next 5 years, and half say the medical profession is not prepared to meet this demand, new data from the Alzheimer's Association showed.

While 82% of primary care physicians said they're on the front lines of providing dementia care, not all are confident about caring for these patients, a survey commissioned by the association reported. Nearly 40% said they were never or sometimes comfortable making an Alzheimer's or dementia diagnosis and 27% said they were never or sometimes comfortable answering patients' questions about the disorders.

The survey findings were included as part of the annual facts and figures report published in Alzheimer's & Dementia, the journal of the Alzheimer's Association.

"Importantly, 50% of primary care physicians told us that the medical community as a whole is not ready to deal with the increase they're expected to see in people with dementia between now and 2050," said Keith Fargo, PhD, Alzheimer's Association director of scientific programs.

These perspectives raise an alarm about current and future dementia care, Fargo told MedPage Today. Currently, an estimated 5.8 million Americans age 65 or older have Alzheimer's dementia; 80% of these people are 75 and older. "The baby boom generation has already begun to reach age 65 and beyond; in fact, the oldest members of the baby boom generation turn age 74 in 2020," Fargo said.

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Screening Metrics Updated to Improve Care for Dementia Patients

(MedPage Today) -- Study Authors: Susan K. Schultz, Maria D. Llorente, et al.Target Audience and Goal Statement: Geriatricians, neurologists, psychiatrists, nurses, primary care physiciansThe goal of this update was to provide clinicians with...
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Just How Bad Is Missing a Few Preeclampsia Prophylaxis Doses?

Greater aspirin adherence was associated with better preeclampsia prevention in high-risk pregnancies, according to an observational cohort study.

Inadequate adherence, seen in 63 of 145 women prescribed prophylactic aspirin in the study from Australia, was linked to a higher incidence of:

Early-onset preeclampsia (17% vs 2% with adequate adherence, OR 1.9, 95% CI 1.1-8.7)Late-onset preeclampsia (41% vs 5%, OR 4.2, 95% CI 1.4-19.8)Intrauterine growth restriction (29% vs 5%, OR 5.8, 95% CI 1.2-8.3)Preterm delivery (27% vs 10%, OR 5.2, 95% CI 1.5-8.7)Increase in antihypertensive use antenatally (60% vs 10%, OR 4.6, 95% CI 1.2-10.5)

Good aspirin compliance was linked to lower odds of premature delivery -- the only treatment for preeclampsia -- on Kaplan-Meier analysis (HR 0.3, 95% CI 0.2-0.5), a study team led by Renuka Shanmugalingam, MBBS, of Liverpool Hospital in Australia, reported online in the Hypertension journal.

With an absolute risk reduction of 51% and number needed to treat of just two when adherence is ≥90%, the authors concluded that aspirin is "an effective prophylactic agent" for the prevention of preeclampsia.

"Therefore, suggesting adequate adherence with aspirin is essential and that nonadherence with aspirin among high-risk pregnant women may result in preventable obstetric complications," they urged.

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Drug Use for Emergency Back Pain Shifts Over Time

NATIONAL HARBOR, Md. -- Emergency department (ED) use of tramadol for back pain doubled from 2007 to 2016 in the U.S. despite an overall decrease in opioid use in that period, an analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data showed.

Tramadol -- either administered in the ED or prescribed -- was used in 8.4% of back pain visits in 2016, up from 4.1% in 2007 (P=0.001), reported Peter Mullins, MD, MA, MPH, of Brigham and Women's Hospital in Boston, and colleagues, at the annual meeting of the American Academy of Pain Medicine here.

Back pain is the most common pain complaint worldwide and accounted for about 9% of all U.S. ED visits in the study period, Mullins noted.

"Our research demonstrates that the use of opioid medications given and prescribed during these visits decreased by 7%, an important finding in light of the current opioid epidemic," he told MedPage Today.

EDs saw 10.5 million visits for back pain in 2016, an increase over the 8.1 million seen in 2007, Mullins added. Besides the increase in tramadol use, the study also showed that "diagnostic resources used in these visits continued to increase, in particular with the use of advanced imaging," he said.

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Weekend Warriors Be Warned: Irregular Sleep Patterns Linked to CV Risk

The more variable a person's sleep schedule, the greater his or her risk of cardiovascular disease (CVD), data from the Multi-Ethnic Study of Atherosclerosis (MESA) showed.

A larger range in individual sleep duration and sleep timing across 7 days of wrist actigraphy was associated with significantly more CVD events over a median 4.9 years of follow-up (P=0.002 for both trends).

For example, CVD risk was more than doubled for those whose standard deviation (SD) in sleep duration was greater than 120 minutes (vs ≤60 min) and for those whose time at sleep onset varied with a SD of more than 90 minutes (vs ≤30 minutes).

Every 1-hour increase in sleep duration SD was associated with 36% higher CVD risk (P=0.02). For ever 1-hour increase in sleep timing SD, there was an 18% increase in risk (P=0.002).

Results persisted even when shift workers were excluded, a team led by Tianyi Huang, ScD, MSC, of Brigham and Women's Hospital in Boston, reported in the Journal of the American College of Cardiology.

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Brief Cognitive Therapy Shows Promise for Chronic Pain

NATIONAL HARBOR, Md. -- A brief cognitive behavioral therapy (CBT) program showed promise in treating chronic pain among Veteran Affairs (VA) patients, a clinical demonstration project showed.

By mid-treatment, chronic pain patients showed significant improvements in pain interference and pain self-efficacy, reported Gregory Beehler, PhD, MA, of the VA Center for Integrated Health Care in Buffalo, New York, and colleagues, at the American Academy of Pain Medicine annual meeting.

The program also was well received by primary care behavioral health providers. "They were very receptive to it," Beehler said. "They found the materials easy to use and said they'd be happy to use it following our project."

CBT can be effective in managing pain, but often involves lengthy treatment delivered in specialized clinics, Beehler noted. "Our goal was to see whether we could get a brief version of cognitive behavioral therapy for chronic pain up and running and working in primary care," he said in a interview with MedPage Today.

Brief psychological pain treatment is the future, observed Beth Darnall, PhD, of Stanford University in California, who was not part of the VA project.

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Hopes for Novel Stroke Drug Dashed in Trial

LOS ANGELES -- A putative neuroprotective agent failed to improve stroke patients' outcomes when given in conjunction with endovascular thrombectomy in the ESCAPE-NA1 trial, although those not given a thrombolytic did appear to benefit.

Nerinetide led to "good functional outcome," defined as a modified Rankin Scale (mRS) score of 0 to 2 at 90 days, in 64.1% of patients compared to 59.2% of patients getting placebo infusion (adjusted RR 1.04, 95% CI 0.96-1.14, P=0.35).

Nor were there benefits for mortality (12.2% vs 14.4%, adjusted RR 0.84, 0.63–1.13) or any other secondary outcomes or safety outcomes, Michael Hill, MD, of the University of Calgary, Alberta, reported here at the International Stroke Conference and online in The Lancet.

"Once again, the favourable effects of a neuroprotective drug reported consistently in preclinical models of brain ischaemia did not translate to clinical efficacy in humans with brain ischaemia," Graeme Hankey, MD, of the University of Western Australia in Perth, wrote in an accompanying editorial.

Nerinetide is a peptide drug believed to interrupt a pathway tied to excitotoxic neuron death in stroke. The agent had shown strongly positive effects in animal models including macaques with middle cerebral artery occlusion.

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Lower LDL Longer Is Better for Stroke Prevention

LOS ANGELES -- Longer time at a lower low-density lipoprotein (LDL) target appeared to improve secondary prevention in stroke survivors, an analysis of the Treat Stroke to Target trial showed.

Targeting 70 mg/dL reduced composite risk of ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes of 9.6% compared with 12.9% for patients randomized to a 90-110 mg/dL target (P=0.019).

That hazard ratio of 0.74 at a median 5.3 years of follow-up was just slightly better than the 0.78 seen at median 3.5 years (8.5% vs 10.9%, P=0.04) as had been reported at the American Heart Association meeting in November.

As there was no significant increase in intracranial hemorrhage (13 vs 11 cases, HR 1.17, 95% CI 0.53-2.62), the number needed to treat was 30 for both the primary composite endpoint and the net benefit pooling the two together, reported Pierre Amarenco, MD, of Bichat Hospital in Paris, here at the International Stroke Conference and online in Stroke.

There had been some "hand-wringing" about hemorrhage risk based on the 2006 SPARCL trial's finding of a small increase in those events with statin use after a recent stroke or transient ischemic attack, commented Jeremy Payne, MD, PhD, director of the Stroke Center at Banner-University Medicine Neuroscience Institute in Phoenix.

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Out of the Basement: Early Results Promising for Portable MRI

LOS ANGELES -- An investigational low-power MRI scanner appeared safe and feasible for use at the bedside in a standard neuroscience ICU, researchers reported.

The 64-mT portable machine under development by Hyperfine Research required no shielding, no special power supply, no changes to the equipment used in the patient's room, and no precautions for ferrous metal, Bradley Cahn, BS, of Yale University School of Medicine in New Haven, Connecticut, and colleagues reported here at the International Stroke Conference.

Among 96 stroke patients scanned non-acutely (minimum 9 hours post-onset, mean 87 hours), there were no "significant" adverse events. Overall, 87% of participants completed the full exam: six participants experienced claustrophobia, and five didn't fit head and shoulders comfortably into the 30-cm opening.

Acquisition times were about 7.5 minutes for T2-weighted scans, 9.5 for FLAIR, 9.8 for diffusion-weighted imaging, and just shy of 29 minutes for a full exam.

Portable CT machines are already in clinical use for stroke, notably in mobile stroke units, noted Ralph Sacco, MD, chairman of neurology at the University of Miami and past president of the American Heart Association.

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Higher Neuropathy, Dementia Drug Costs Lead to Lower Adherence

Higher out-of-pocket costs were linked with lower medication adherence among patients with peripheral neuropathy or dementia, an analysis of private insurance claims showed.

Among neuropathy patients, a $50 increase in out-of-pocket costs for gabapentinoids was associated with a 9% decrease in adherence, reported Brian Callaghan, MD, MS, of the University of Michigan in Ann Arbor, and colleagues.

Similarly, a $50 increase in out-of-pocket costs was tied to a 12% drop in medication adherence of cholinesterase inhibitors for dementia, they reported in Neurology.

"Out-of-pocket costs can lead to a predictable drop in taking medications prescribed by physicians," Callaghan said. While previous studies focused on very expensive drugs like disease-modifying therapies for multiple sclerosis, "we were able to show that even small changes in out-pocket-costs affect medication adherence," Callaghan told MedPage Today.

Not only are out-of-pocket drug costs rising, but high-deductible health plans are more prevalent, he added.

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'Treat Them Like Human Beings': What We Heard This Week

"I think we should close the camps, and if we can't do that, at least do the absolute minimum for people who are imprisoned in these camps, and that is treat them like human beings who deserve medical care." -- Zack Berger, MD, discussing the immigrant detainees at the Mexican border.

"We're not evangelists claiming to offer a cure for smoking." -- Jerry Loftin, an executive for a company that makes e-cigarette products, during a House hearing on teen vaping.

"The bottom line is: Show me the data." -- Derek Chu, MD, PhD, of McMaster University in Ontario, Canada, on the many unanswered questions regarding the newly approved oral immunotherapy for peanut allergy.

"For some neurological disorders, we found a four to fives times higher suicide rate when compared with the general population." -- Annette Erlangsen, PhD, of the Danish Research Institute for Suicide Prevention/Mental Health Centre Copenhagen, on the elevated risk of suicide among neurology patients.

"We were always correct that this is not a safe drug." -- Steven Nissen, MD, of the Cleveland Clinic, on a new meta-analysis of rosiglitazone (Avandia).

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EHR Vendor Pays $145M to Settle Opioid Kickback Charges

An electronic health record (EHR) system developer agreed to pay $145 million to settle charges that it was involved in a kickback scheme to increase opioid prescriptions, the U.S. Department of Justice (DOJ) said in a press release.

Practice Fusion, a cloud-based EHR vendor based in San Francisco, admitted that it received a nearly $1-million payment from a "major opioid company" to develop software that encouraged doctors to prescribe more opioids.

That money came out of the unnamed drugmaker's marketing budget, DOJ said.

The startup implemented clinical decision support (CDS) alerts -- a key function of health information technology platforms -- that marketed extended-release opioids to healthcare providers, according to DOJ.

It will pay $26 million in criminal fines and $118.6 million in civil settlements. This is the first time criminal action has been taken against an EHR vendor, according to DOJ.

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When Pregnant Moms Are Distressed, Fetal Brains May Suffer

Psychological distress -- a term encompassing anxiety, stress, and depression -- was more prevalent than expected in a sample of healthy, well-educated pregnant women and was associated with impaired fetal brain development, a prospective study suggested.

Among 119 pregnant women with uncomplicated pregnancies, 27% scored high on a perceived stress questionnaire, 26% had high scores for anxiety, and 11% had elevated symptoms of depression, according to Catherine Limperopoulos, PhD, of the Center for the Developing Brain at Children's National Hospital in Washington, D.C., and colleagues.

Increases in trait anxiety scores were associated with reductions in left hemisphere fetal brain volume, and elevated maternal stress and anxiety levels were tied to increased fetal gyrification (cortical folding) in frontal and temporal lobes, they reported in JAMA Network Open. Elevated maternal depression scores also were associated with reductions in fetal creatine and choline levels.

The study involved a group of well-resourced, well-educated women, and while the research is preliminary, "it points to prenatal psychological distress being alarmingly prevalent and clinically under-recognized," Limperopoulos said.

"We did not expect these findings among women expecting normal babies. These women had no indication of any mental health disorder, which leads us to worry that many women with similar maternal distress are slipping below the radar during routine clinical encounters," she told MedPage Today.

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More Flavonol, Less Alzheimer's

Higher flavonol intake was linked to lower risk of Alzheimer's dementia in a prospective cohort study of older adults.

After adjusting for genetic, demographic, and lifestyle factors, people who consumed the highest dietary intake of flavonols were 48% less like to develop Alzheimer's dementia than people with the least intake, reported Thomas Holland, MD, of Rush University in Chicago, and colleagues, in Neurology.

"This research lends a further understanding of the contents of the foods we eat," Holland said. "The bioactives in foods -- which from our research would be specifically flavonols found in kale, spinach, tomatoes, tea, olive oil, apples, pears, and over 20 other foods -- have antioxidant and anti-inflammatory properties that have the potential to protect against cellular damage due to oxidative stress and sustained inflammation," he told MedPage Today.

Flavonols are a type of flavonoid, a group of phytochemicals found in plant pigments. "Technically speaking, we knew little regarding flavonols, specifically, and Alzheimer's dementia," Holland said. Earlier research has looked at antioxidants and Alzheimer's risk, but no studies have researched whether dietary intake of flavonoid subclasses is associated with Alzheimer's dementia, he added.

This work complements other studies that show fruit and vegetables support brain health, observed Robert Friedland, MD, of the University of Louisville, who wasn't involved with the study.

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Heart Disease Risks Fall for Most Survivors of Childhood Cancer

(MedPage Today) -- Study Authors: Daniel A. Mulrooney, Geehong Hyun, et al.; Mike Hawkins, Alex Brownsdon, Raoul ReulenTarget Audience and Goal Statement: Oncologists, cardiologists, pediatricians, family physicians, primary care physicians...
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Magic Mushrooms Ease Cancer Anxiety; Olanzapine/Samidorphan NDA Accepted

Just one dose of synthetic psilocybin -- the compound in magic mushrooms -- alleviated anxiety and depression in cancer patients for up to five years. (Journal of Psychopharmacology)

Based on the ENLIGHTEN program, the FDA accepted Alkermes' application for its schizophrenia and bipolar disorder treatment ALKS 3831 (olanzapine/samidorphan) with an expected action date of November.

Although it was FDA approved in March 2019, esketamine nasal spray (Spravato) was not recommended for inclusion as a reimbursable drug in the U.K. by the National Institute for Health and Care Excellence (NICE) due to the safety profile. (BBC)

A Rhode Island cohort study found that girls received an autism diagnosis roughly 1.5 years later on average than boys. (Autism Research)

Antidepressant-related sexual dysfunction may continue long after stopping treatment. "Some likely comfort themselves with the thought that once they stop treatment, they will get back to normal, when in fact they may be even less able to function," stated David Healy, MD, of Bangor University, writing in a commentary in the Journal of the Royal Society of Medicine.

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Repurposed Mucolytic Shows Promise for Neuroprotection in Parkinson's Disease

(MedPage Today) -- Study Authors: Stephen Mullin, Laura Smith, et al.Target Audience and Goal Statement: Neurologists, radiologists, neuropsychologists, pulmonologists, family physiciansThe goal of this study was to assess the safety, tolerability...
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Brilinta Shines in Stroke Prevention; Leadless Pacing Expands; Triglyceride Drug Clears Hurdle

Adding ticagrelor (Brilinta) to aspirin reduced risk of stroke and death among people at high risk due to a recent minor acute ischemic stroke or high-risk transient ischemic attack in topline results from the THALES trial, AstraZeneca announced.

FDA approved a new version of Medtronic's leadless pacemaker, Micra AV, that has atrial sensing, allowing the large population with atrioventricular block to avoid a dual-chamber pacemaker. (MassDevice)

FDA also cleared the SoundBite Crossing System for peripheral chronic total occlusions, SoundBite Medical Solutions announced. (Cath Lab Digest)

Another phase II trial came up positive for an antisense drug: APOCIII-LRx reduced triglycerides in patients with hypertriglyceridemia with or at risk for cardiovascular disease, Akcea Therapeutics announced in topline results, following publication of phase II results with its APO(a)-LRx agent against lipoprotein(a).

Visit-to-visit systolic blood pressure variability may flag young adults at higher risk of developing cardiovascular disease, a study showed in JAMA Cardiology.

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