Pulse Oximeters Didn’t Add Value to Daily Monitoring for COVID-19 Patients at Home
Pulse oximeters gained popularity during the pandemic for their ability to alert people quarantined at home to dropping oxygen levels.
A study out of the Perelman School of Medicine at the University of Pennsylvania suggests the devices added no value over simply monitoring people for daily symptoms.
The investigators looked at people taking part in Penn Medicine’s COVID Watch program. The program uses twice daily automated text messages to keep up with how COVID-19 patients are doing. Those who indicate they are having more trouble breathing receive a call from a nurse who either directs the patient to the ER, arranges a telehealth visit or suggests continued monitoring at home.
The program, which has enrolled more than 28,500 patients since March of 2020, is credited with a 68% reduction in mortality.
However, when comparing more than 2,000 patients who were randomized to receive a pulse oximeter in addition to COVID Watch or COVID Watch alone, the researchers found no difference in outcomes. Race did not affect the results.
“Overall, these findings suggest that a low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices,” said study author Krisda Chaiyachati, MD. However, she emphasizes that there are other conditions where a high-tech device like a pulse oximeter might make a difference.
The study was published by The New England Journal of Medicine. Read More
A Quit Smoking App for All
A study conducted in conjunction with the Washington State Department of Health has found that the 2Morrow stop smoking app can reach a wide range of people, including women, people in the LGBTQ+ community, and those with low household incomes, poor mental health, and Medicaid insurance.
The app also draws in people in rural communities, those aged 35-54, and college graduates.
These findings come from an observational study of 1,280 adults in Washington who registered to activate the app between 2018 and 2020.
“When comparing app and state data, we found that we were able to reach a diverse group of tobacco users and a large percent of some underserved populations relative to their prevalence in the state,” said Dr. Susan Zbikowski, chief science officer at 2Morrow and coauthor of the study. “This first of its kind research study is novel in that it examines real-world use of a publicly available evidence-based app for smokers.”
The 2Morrow app grew out of a collaboration between the company and researchers at the Fred Hutchinson Cancer Research Center. The app incorporates Acceptance and Commitment Therapy, or “ACT.”
The study was published by JMIR Public Health and Surveillance. Read More
INOMax May Benefit COVID-19 Patients with ARDS
According to a study by Mallinckrodt, the maker of INOmax, the inhaled nitric oxide therapy approved to improve oxygenation in preterm infants may also be effective in COVID-19 patients with acute respiratory distress syndrome (ARDS).
The study was conducted among 37 patients who received INOmax during hospitalization for at least 24 hours continuously. When INOmax was initiated, they also had a partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F ratio) >100 and ≤300mmHg. The patients were followed up to 30 days after being discharged from the hospital.
Results showed –
- When response was defined as an increase in P/F ratio by >20 percent at any time after INOmax initiation, about two-thirds of patients achieved response to INOmax.
- Additionally, the mean P/F ratio increased from 136.7 (34.4) at baseline to 140.3 (53.2) at 48 hours and 151.8 (50.0) at 72 hours after INOmax initiation.
- The median time for response was three days after initiation of INOmax.
- Furthermore, in a sensitivity analysis, when response was defined as a ˃10 percent increase in P/F ratio, 70.3% of the patients were categorized as responders.
- Among the 27 patients receiving invasive mechanical ventilation at the time of INOmax initiation, four were transitioned to noninvasive ventilation.
- After initiating INOmax, no patient required extracorporeal membrane oxygenation (ECMO).
- Data on select adverse events of interest (methemoglobinemia, airway injury, and worsening pulmonary edema) showed none were attributed to INOmax treatment.
- According to Clinical Global Impression-Improvement scores, 54% of the patients improved or remained stable at discharge.
The study was published by Drugs in Context. Read More
Why Most Smokers Never Get Lung Cancer
While we understand that smoking causes the majority of lung cancers, that doesn’t mean the majority of people who smoke will get it. In fact, only a small minority of smokers ever develop the disease.
Scientists have speculated that genetic mutations are to blame for lung cancer in smokers, and now Albert Einstein College of Medicine researchers have evidence that this is the case.
Using a new genetic sequencing technique called single-cell multiple displacement amplification (SCMDA), they compared normal lung epithelial cells from 14 never smokers aged 11 to 86 with those from 19 smokers aged 44 to 81 who had smoked a maximum of 116 pack years. The cells used in the study came from bronchoscopy samples collected for other diagnoses.
Mutations increased with age, and significantly more mutations were found in the cells of the smokers than the never-smokers. “This experimentally confirms that smoking increases lung cancer risk by increasing the frequency of mutations, as previously hypothesized,” said Simon Spivack, MS, MPH. “This is likely one reason why so few nonsmokers get lung cancer, while 10% to 20% of lifelong smokers do.”
Interestingly, the number of pack-years wasn’t as influential in causing mutations as the researchers would have thought. In fact, after 23 pack-years of exposure, they basically stopped occurring.
“The heaviest smokers did not have the highest mutation burden,” continued Dr. Spivack. “Our data suggest that these individuals may have survived for so long in spite of their heavy smoking because they managed to suppress further mutation accumulation. This leveling off of mutations could stem from these people having very proficient systems for repairing DNA damage or detoxifying cigarette smoke.”
The authors believe these findings suggest a new direction for lung cancer research. They now want to develop new assays that can measure an individual’s capacity for DNA repair or detoxification.
The study appeared in Nature Genetics. Read More
Infants, Toddlers with Trachs Risk Middle Ear Effusion
Researchers from UT Southwestern have found that infants and toddlers who need a tracheostomy are at greater risk of developing fluid behind their eardrums when on a mechanical ventilator.
The build-up of fluid could be putting these children at risk of developing ear infections or hearing loss, along with delays in speech and language development.
The investigators reached this conclusion after following 94 children who received a trach before age two. All underwent regular hearing tests to determine the presence of middle ear effusion (MEE). During two years of follow-up, 74% of the children who required mechanical ventilation developed at least one MEE vs. just 31% of those who did not require mechanical ventilation.
Especially troubling was that 80% of MEEs in children with trachs persisted for several months.
Since placing ear tubes to drain the fluid requires anesthesia and kids with trachs are not good candidates for anesthesia, the researchers believe more vigilant screening is necessary for children with tracheostomies to guard against adverse effects on speech and language. In addition, they feel more study is needed to determine the best way to proceed.
The study was published by the International Journal of Pediatric Otorhinolaryngology. Read More
Nanoparticle Treatment Holds Promise for Pulmonary Fibrosis
Using nanoparticles coated in a type of sugar called mannose, scientists at the University of Illinois Chicago have developed a new treatment that may one day have a role in the treatment of pulmonary fibrosis (PF).
The coated nanoparticle treatment stops fibrosis by binding to a subset of macrophages with a receptor for mannose called CD206, which has been shown to be hyper-expressed in people with PF. When the sugar-coated nanoparticle binds to the cell’s receptor, it delivers a nucleotide that was loaded into the nanoparticle. Once in the cell, this nucleotide blocks the macrophage’s ability to make excessive amounts of proteins, such as collagen, known to be involved in the scar formation that is the hallmark of PF.
The current study published by the Proceedings of the National Academy of Sciences was conducted in animals. However, investigators have now launched a new project along with colleagues at the University of California San Francisco to test the treatment in human lung samples. Read More
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