TTHealthWatch is a weekly podcast from Texas Tech.
Today’s topics include workout for knee osteoarthritis, tocilizumab for COVID-19, gut flora and their function in health and illness, and heparin and COVID infection.
Program notes:
0: 41 Tocilizumab and COVID
1: 46 All needed oxygen
2: 48 How pricey?
3: 18 Workout and knee osteoarthritis
4: 18 High or low intensity strength training
5: 18 Very thorough research study
6: 18 Keeping people in the research study for 18 months
6: 38 Heparin for decreasing embolism in COVID
7: 40 Subcutaneous injection
8: 41 Research study coming quickly
9: 10 Human gut microbiome and health
10: 10 Driven by healthy and plant-based foods
11: 10 Less of one bug in the gut might be connected with heart disease
12: 10 Is it a cause or an effect?
13: 15 End
Transcript:
Elizabeth Tracey: Is exercise of any benefit whatsoever in knee osteoarthritis?
Rick Lange: Do individuals with COVID take advantage of a blood thinner?
Elizabeth: An actually exhaustive appearance– up until now– at the human gut microbiome and how it may be related to disease.
Rick: And a various anti-inflammatory medication for people with COVID and respiratory problems.
Elizabeth: That’s what we’re talking about today on TT HealthWatch, your weekly take a look at the medical headings from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical reporter.
Rick: And I’m Rick Lange, president of the Texas Tech University Health Sciences Center in El Paso, where I’m likewise the dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, we’re still leading of mind with COVID, so I’m going to let you choose among yours to start with.
Rick: Elizabeth, let’s talk about this anti-inflammatory agent, and I called it new– it’s really not brand-new.
We know that there are various treatments. Early on, there’s monoclonal antibodies prior to people enter into the health center; once they get in and they’re mildly impacted, remdesivir; however those that are most severely impacted– those on a ventilator or about to– gain from high-dose steroids.
What that mentions is the truth that our body immune system is accountable for some of the lung damage, the swelling. There is a monoclonal antibody called tocilizumab, which has actually been utilized for rheumatoid arthritis due to the fact that it’s also an inflammatory condition. Specifically, it hinders what’s called interleukin 6.
They took over 4,000 adults that had actually COVID that had evidence of swelling– elevated C-reactive protein– and they all had some requirements for oxygen– some were on a ventilator– and they randomized them to the typical care or a single infusion of tocilizumab. Sometimes, if they wished to, they could offer a second dosage the next day, and the easy outcome was, how did they do with regard to mortality?
What they discovered was that the addition of tocilizumab to usual care, 29%of the individuals that got tocilizumab passed away within 28 days versus 33%of the patients who did not get it. Overall, that was a 14%reduction in death.
Elizabeth: Let’s simply advise everyone that this is published on the preprint server medRxiv and that this belongs to the HEALING trial, that giganto and, in my mind, an exceptionally well-designed research study that’s happening in the U.K. that’s looking very rigorously at a lot of these things. We can say that our dexamethasone outcomes were really an outcome of the HEALING trial.
Let’s go back, though, to “toci”– that’s how I’ve heard people abbreviate it when they’re talking about it– how costly is this?
Rick: Elizabeth, it doesn’t state in this particular post so I can’t resolve that, but the paper does allude to the reality that we require to do a cost-benefit analysis.
Elizabeth: We like those repurposed things because, of course, we already have abundant experience with them and that’s a terrific thing.
In point of reality, as we know, osteoarthritis is the # 1 kind of arthritis and a leading cause of impairment among adults worldwide and the knee, of course, a very typical joint to be impacted. In this research study, they said, “Hey, if we put people on various types of exercise routines or typical care, will we be able to ameliorate the pain and the special needs that go with knee osteoarthritis?”
They had 377 community-dwelling grownups– I wish to have actually seen more people, frankly– and they likewise had varying BMIs, so ranging from 20 to45 They didn’t stratify this. This is one criticism I have of this study since we know that those increasing BMIs truly do worsen this condition, however in any case, they had among 3 groups, a high-intensity strength training group, a low-intensity strength training group, or what they called an “attention control group” where they had this mindfulness type of based technique for assisting them discover to sort of pertained to terms with their discomfort, if you will.
They did have a truly long follow-up and that was 18 months.
Rick: Elizabeth, as you said, it affects millions of people– particularly over 250 million individuals worldwide. Now, one of the things I liked about this specific study is it was done extremely well.
Eighteen months, really no advantage. On the one hand, it wasn’t countless people. On the other hand, it was so well done I think it really lays to rest the fact that high-strength intensity training would be advantageous for knee osteoarthritis.
Elizabeth: I know, but it’s simply so frustrating.
Rick: No.
Elizabeth: Well, as for me– and I believe maybe even for thee– I’m going to promote for doing all of this strength training previous to developing knee osteoarthritis so that we could possibly ameliorate some of that.
Rick: And controlling our BMI too, at the exact same time.
Elizabeth: You got it. Back to COVID. Let’s rely on the British Medical Journal
Rick: We talked a minute ago about hypoxic respiratory arrest. The other problem that’s really been afflicting with individuals with COVID is they appear to have actually an increased occurrence of developing clots, and those embolisms can add to death. We see this even in younger individuals.
It’s been approximated that about 30%of hospitalized COVID patients will develop some evidence of venous thromboembolism– venous embolisms– so there many individuals have been promoting about utilizing anticoagulants, not complete dose, however low dose, as kind of prophylaxis to avoid that.
There is a randomized controlled trial going on, but even previous to that, these authors tried to answer the question– Would preliminary prophylactic use of anticoagulation improve mortality?– by looking at the largest incorporated health care system in the United States, which is the VA Health System.
They looked at over 4,000– in reality, almost 4,300– clients confessed to the hospital with COVID-19
What they found was that it reduced death from about 18.7%to 14.3%, about a 34%reduction in death in general, and you state, “Well, gosh, that need to have increased the risk of bleeding since it was low dose.” It did not do that. It does recommend, till the randomized trials are readily available, that prophylactic anticoagulation might be beneficial in COVID-hospitalized clients.
Elizabeth: I would hearken back to what you said about the first– the toci research study, which is that we’ve got a lot of experience medically with heparin.
Rick: Definitely. It’s medication that we have around. It’s for an use that we’re used to, that is prophylactic prevention of clots. The real question will remain in the randomized controlled trial.
Elizabeth: Which ought to be happening really pretty quickly, I believe.
Rick: It is, Elizabeth. I believe you and I have actually already gotten some wind that the outcomes might be favorable, however we have not reported on it due to the fact that before we report on late-breaking news we want to be able to look at the study to assess it in excellent detail.
Elizabeth: One other thing that I think it’s incumbent upon us to discuss about COVID before we leave it is this just-released information relative to the variants that are emerging and increased mortality with them, so a little word of warning. It’s great that we’re getting our arms around a lot more of these scientific elements.
Rick: Right.
Elizabeth: Enough of the gloom and doom relative to COVID, at least for a minute, and let’s turn to something that I think tickled my fancy in Nature Medication
Of course, we have actually got them all over else too.
They did this metagenomic sequencing of over 1,200 gut microbiomes from these 1,100 folks in this Customized Reactions to Dietary Structure Trial or PREDICT-1 research study.
They have had lots of historic trouble trying to identify the microbiome due to the fact that we understand that much of these bugs that live in our gut are either anaerobic or facultative anaerobes, and it is difficult to culture those things when you get out there, but what they’re really relying on is this entire genomic kind of analysis.
In the very first research study, the one that’s having a look examining the microbiomes, they identify one organism, Prevotella copri, and then another bacterial species as indications of favorable postprandial glucose metabolism, so let me change to the second constant, since we’re changing them both together. Their title is The Gut Microbiome Modulates the Protective Association between a Mediterranean Diet and Cardiometabolic Illness Risk, which they analyzed with different aspects.
They likewise identify this organism, Prevotella copri, with an increased rate of cardiovascular illness danger when they had less of this particular bug in their gut, so we believe this is fascinating.
Rick: You’re right. It was nerdish. This was a really difficult research study since of the quantity of material– the raw data– that they had. Once again, these were, in the larger research study, over 1,100 individuals that they had a longitudinal follow-up, so they had detailed long-term diet details, numerous fasting and postprandial cardio-metabolic blood markers and in addition to the microbiome as well.
As you recommended, there seems to be a relationship between microbiome, diet, and also a relationship in between what are called cardio-protective factors such as lipids, postprandial sugar, that is postprandial glycemic control. Now, I ‘d call it an association, however I don’t believe we can show causation.
Elizabeth: I believe it’s extremely provocative. We’ve been talking about this for years and the other concern I would contribute to yours is, “OK, then how about if we spike someone’s gut with Prevotella copri or among these other bugs that have been determined as being helpful? What takes place then?” I don’t believe we know anything about that.
Rick: You’re right, and this moves from a research study that is detailed to one that it really is perhaps therapeutic. That’s truly the thing that I think people discover most intriguing.
Elizabeth: No doubt we’re going to be hearing more about this. On that note then, that’s a take a look at this week’s medical headings from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’ all listen up and make healthy options.
Last Updated February 19, 2021
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