How common is stroke in people critically ill with COVID-19?

covid

A large, year-long study has found that among people with COVID-19 who were hospitalized in an intensive care unit (ICU), 2% experienced a stroke after they were admitted to the ICU. The preliminary study released today, April 15, 2021, will be presented at the American Academy of Neurology’s 73rd Annual Meeting being held virtually April 17 to 22, 2021. The study also found that hemorrhagic stroke, a bleeding stroke, was associated with a higher risk of death among people in the ICU, but ischemic stroke, a stroke caused by a blood clot blocking an artery, was not.

“Stroke has been a known serious complication of COVID-19 with some studies reporting a higher-than-expected occurrence, especially in young people,” said study author Jonathon Fanning, M.B.B.S., Ph.D., of the University of Queensland in Brisbane, Australia, and a member of the American Academy of Neurology. “However, among the sickest of patients, those admitted to an ICU, our research found that stroke was not a common complication and that a stroke from a blood clot did not increase the risk of death.”

Researchers used an international database of COVID-19 patients in 52 countries admitted to an ICU between January 1 and December 21, 2020. They identified 2,699 people who were admitted to an ICU for management of severe COVID-19 infection. Of those, 59 had a stroke. The people had an average age of 53.

Researchers evaluated the patient data at 370 hospital ICUs and found 59 people, or 2.2%, experienced a stroke during their stay in the ICU. Of those, 19 people, or 32%, had a stroke from a clot, 27 people, or 46%, had a bleeding stroke, and 13 people, or 22%, had an unspecified stroke.

Researchers determined that people who had a bleeding stroke had up to five times greater risk of death than people without stroke. However, people who had a stroke from a clot had no increased risk of death.

Of the people with bleeding stroke, 72% died, but of those, only 15% died of stroke. Instead, multiorgan failure was the leading cause of death.

“For people with COVID-19 in intensive care, our large study found that stroke was not common, and it was infrequently the cause of death,” said Fanning. “Still, COVID-19 is a new disease and mutations have resulted in new variants, so it’s important to continue to study stroke in people with the disease. More importantly, while the proportion of those with a stroke may not be as high as we initially thought, the severity of the pandemic means the overall absolute number of patients around the world who will suffer a stroke and the ongoing implications of that for years to come, could create a major public health crisis.”

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Mediterranean diet with lean beef may lower risk factors for heart disease

lean beef

Eating red meat may have a bad reputation for being bad for the heart, but new research found that lean beef may have a place in healthy diets, after all.

In a randomized controlled study, researchers found that a Mediterranean diet combined with small portions of lean beef helped lower risk factors for developing heart disease, such as LDL cholesterol.

Jennifer Fleming, assistant teaching professor of nutrition at Penn State, said the study suggests that healthy diets can include a wide variety of foods, such as red meat, and still be heart friendly.

“When you create a healthy diet built on fruits, vegetables, and other plant-based foods, it leaves room for moderate amounts of other foods like lean beef,” Fleming said. “There are still important nutrients in beef that you can benefit from by eating lean cuts like the loin or round, or 93% lean ground beef.”

David J. Baer, research leader at the United States Department of Agriculture—Agricultural Research Service, and study co-principal investigator, added, “This study highlights the importance of including lean beef in a Mediterranean dietary pattern that can yield heart-healthy benefits.”

According to the researchers, red meat such as beef has been associated with an increased risk for cardiovascular disease in previous studies. But it has remained unclear whether red meat actually causes these effects or if they actually are caused by other diet and lifestyle choices that people engage in alongside red meat consumption.

Additionally, the researchers said many studies have combined both fresh and processed meats together when evaluating red meat consumption and health. Processed red meats have a very different nutrient profile than fresh meat—for example, processed meat products are much higher in sodium—that could explain the red meat research that has been reported.

“The Mediterranean diet is traditionally low in red meat,” Fleming said. “But, knowing that many Americans enjoy red meat, we wanted to examine how combining lean beef with the Mediterranean diet would affect cardiovascular risk markers.”

The study included 59 participants. Every participant consumed each diet for four weeks each, with a one week break between each diet period, and blood samples were drawn at the beginning of the study as well as after each diet period.

Three of the four diet periods contained different amounts of beef to a Mediterranean diet plan, which provided 41% calories from fat, 42% from carbohydrates and 17% from protein. In addition to the control average American diet, one diet provided 0.5 ounces of beef a day, which is the amount recommended in the Mediterranean diet pyramid. A second diet provided 2.5 ounces a day, which represents the amount an average American eats in a day, and the third experimental diet included 5.5 ounces a day, which previous research connected with certain heart health benefits.

All three Mediterranean diet periods included olive oil as the predominant fat source, three to six servings of fruits, and six or more servings of vegetables a day. The beef included in these diet periods was either lean or extra-lean.

Fleming said they were able to use a special technology called nuclear magnetic resonance—or NMR technology—to measure the number and size of lipoprotein particles. She said this study was one of the first randomized controlled trials of the Mediterranean diet to use the technique.

“This is important because there is growing evidence to suggest that LDL particle number is more strongly associated with cardiovascular disease risk than total blood LDL concentrations alone,” Fleming said. “Moreover, we were able to identify changes in apolipoproteins, specifically apoB, which are also associated with increased CVD risk.”

After the data were analyzed, the researchers found that participants all had lower LDL cholesterol following the Mediterranean diet periods compared to the average American diet. But while the total numbers of LDL particles were reduced following all three Mediterranean diet periods, they were only significantly decreased when following those periods that included 0.5 or 2.5 ounces of beef a day compared to the average American diet.

Additionally, non-HDL cholesterol and apoB—a protein involved in lipid metabolism and a marker of CVD risk—were lower following all three Mediterranean diet periods compared to the average American diet.

Fleming said the study—recently published in the American Journal of Clinical Nutrition—underscores the importance of consuming healthy, well-balanced diets.

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E-cigarettes with a cigarette-like level of nicotine are effective in reducing smoking

e-cigarette

E-cigarettes that deliver a cigarette-like amount of nicotine are associated with reduced smoking and reduced exposure to the major tobacco-related pulmonary carcinogen, NNAL, even with concurrent smoking, according to a new study led by researchers at Virginia Commonwealth University and Penn State College of Medicine in Hershey, Pennsylvania.

The study, which will be published in The Lancet Respiratory Medicine journal, provides new and important information for smokers who may be trying to use e-cigarettes as a means to cut down on their smoking habit and lower their exposure to harmful toxicants.

“[We found] e-cigarettes with nicotine delivery like a combustible cigarette were effective in helping reduce smoking and exposure to a tobacco-related carcinogen,” said lead author Caroline O. Cobb, Ph.D., an associate professor in the VCU Department of Psychology in the College of Humanities and Sciences. “But it doesn’t just happen by accident. It requires the smoker to be actively trying to reduce their smoking by replacing it with e-cigarette use.”

The researchers conducted a randomized controlled trial of 520 participants who smoked more than nine cigarettes a day, were not currently using an e-cigarette device, and were interested in reducing smoking but not quitting.

Over 24 weeks, participants used an e-cigarette device filled with either 0, 8 or 36 milligrams per milliliter of liquid nicotine or a plastic tube (shaped like a cigarette) that delivered no nicotine or aerosol. The e-cigarette conditions were chosen to reflect a range of nicotine delivery, either none, low (8 mg/ml) or cigarette-like (36 mg/ml). The participants were also provided with smoking reduction instructions.

At weeks 0, 4, 12 and 24, the researchers sampled participants’ urine, testing for the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, also known as NNAL. They found that participants using e-cigarettes filled with the cigarette-like level of liquid nicotine had significantly lower levels of NNAL at week 24 compared to baseline and compared to levels observed in the non-e-cigarette control condition.

The findings represent an important addition to the scientific literature because it suggests that when e-cigarettes deliver nicotine effectively, smokers have greater success in reducing their smoking and tobacco-related toxicant exposure. This study is important for two reasons, Cobb said.

“First, many e-cigarettes have poor nicotine delivery profiles, and our results suggest that those products may be less effective in helping smokers change their behavior and associated toxicant exposure,” she said.

“Second, previous randomized controlled trials examining if e-cigarettes help smokers change their smoking behavior/toxicant exposure have used e-cigarettes with low or unknown nicotine delivery profiles,” she said. “Our study highlights the importance of characterizing the e-cigarette nicotine delivery profile before conducting a randomized controlled trial. This work also has other important strengths over previous studies including the sample size, length of intervention, multiple toxicant exposure measures and control conditions.”

The question of whether an e-cigarette’s nicotine delivery profile is predictive of its ability to reduce harm and promote behavior change among smokers remains highly relevant to policymakers, public health advocates, health care providers and smoking populations. That knowledge will lead to better designed studies of the potential harms and benefits of e-cigarettes and ultimately inform tobacco regulatory policy, Cobb said.

The study contributes to the ongoing question of what role e-cigarettes play in changing smoking behavior.

Jonathan Foulds, Ph.D., professor of public health sciences at Penn State (one of the two study sites), commented, “This study shows that when smokers interested in reduction are provided with an e-cigarette with cigarette-like nicotine delivery, they are more likely to achieve significant decreases in tobacco-related toxicants, such as lower exhaled carbon monoxide levels.”

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Predicting mutated gene associated with melanoma

melanoma

Although risk for melanoma, the most serious type of skin cancer, is often associated with ultraviolet light exposure, genetic factors are also at play, with some families being more prone to the disease than others.

Moreover, mutations in the gene CDKN2A are also associated with increased risks for other cancers such as pancreatic cancer, making it especially important to identify carriers among melanoma patients. With population-based melanoma incidence rates varying according to geography, clinicians could benefit from a universal, cost-effective tool for assessing mutational status among melanoma patients from the same family. Such a tool could aid in directing patients toward risk counseling and away from expensive and inappropriate genetic testing.

In a study published in the Journal of the American Academy of Dermatology, a research team led by Nicholas Taylor, assistant professor in the Epidemiology and Biostatistics Department at the Texas A&M University School of Public Health, used data collected by the international GenoMEL Consortium of melanoma researchers to develop a statistical model for the prediction of germline CDKN2A mutations in a global population of familial melanoma cases. This algorithm (GenoMELPREDICT) gives clinicians a helpful tool for determining the appropriateness of genetic testing and likelihood of the presence of deleterious CDKN2A mutations. It has recently received international recognition and endorsement from the Australian government. The GenoMELPREDICT algorithm has been deployed on the GenoMEL Consortium website in an easy-to-use point-and-click interface.

In this study, Taylor and colleagues began by first testing a well-established prediction model known as MELPREDICT, which has shown good performance predicting the gene mutations among affected members of melanoma-prone families of Northern European descent. The original algorithm performed fairly well in predicting mutational status when applied to the GenoMEL population.

The researchers tested changes in model performance after adding personal or family history of pancreatic cancer, tendency to sunburn and tan, facial freckling, skin type and eye color. Significant prediction improvement was noted with the addition of any history of pancreatic cancer to the model.

Taylor and colleagues found that the GenoMELPREDICT model could be generalized to the more diverse population of melanoma-prone families found in the GenoMEL dataset. They observed that the model performed better with some populations than others, like among patients in Australia. It performed the poorest for those living in southern Europe or South America. The authors state that this may be due to the larger proportion of Australian subjects in the sample and the classification for melanoma-prone families being too strict for populations with lower overall incidences of melanoma, respectively.

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Mena Suvari Gives Birth, Welcomes 1st Child With Husband Michael Hope

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    Mena Suvari is a mom! The actress gave birth to her and husband Michael Hope’s first child.

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    Suvari, 42, welcomed a baby boy named Christopher Alexander, earlier this month, People reports.

    Us Weekly confirmed in October 2020 that the American Beauty star was pregnant.

    “The greatest, most precious gift has come our way,” the Rhode Island native captioned her baby bump debut via Instagram at the time. “Through all the trauma, through all the struggle, through all the doubt, our little angel has chosen us. I will never have enough words to describe my love for this beautiful soul coming into our lives, but I won’t ever stop trying to give him the best life possible.”

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    The model went on to address her baby-to-be, writing, “You’re all I’ve ever wanted and the most important thing that will ever matter. We love you, #BabyHope. We welcome, honor, and cherish you.”

    In the social media upload, the then-pregnant star cradled her budding belly while wearing a sweater dress.

    Suvari revealed in October 2018 that she and Hope had tied the knot, exclusively telling Us that their marriage was “great.”

    “I’m really happy,” the American Horror Story alum added at the time. “We’re happy. Third time’s a charm. … It was [a] very beautiful [ceremony]. I had my closest friends with me. It was very meaningful. After all these years, sort of having ups and downs, it’s very nice just being settled, especially at this point in my life.”

    The American Pie star went on to call the Canadian native “a really great guy,” explaining, “Old school, really considerate, old-fashioned. I’m like, ‘Who are you?’”

    As far as “maybe” starting a family with him, Suvari told Us, “I have a few years left. We’ll see.”

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    She and Hope met on the set of Hallmark’s I’ll Be Home for Christmas. Suvari starred in the film while the set decorator worked in the art department.

    Ahead of dating Hope in 2016, Suvari was previously married to cinematographer Robert Brinkmann from 2000 to 2005 and concert promoter Simone Sestito from 2012 to 2012.

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