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An Unambiguous Warning

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Published May 4, 2024

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

A band of resourceful clinicians may have answered Barbie’s existential question, “What was I made for?” They suggest she may serve as the ideal model for virtual musculoskeletal exams. Struggling to convey a Faber/Patrick’s test over a laptop? No sweat for Barbie. What she lacks in anatomical accuracy, she makes up for in hypermobility. In a small randomized controlled trial, researchers found that employing Barbie as a visual aid in telehealth visits enhanced patients’ ease and efficiency in performing 12 musculoskeletal exam maneuvers. Participants’ ages ranged from 4 to 17 years, but this tactic may also benefit older patients. Let’s hope the next study includes a wider age range, and maybe even Ken, who—once again—was completely overlooked. Sometimes a popliteal angle test needs a little Kenergy.

Rethinking Beta-Blockers Post-MI

CARDIO CORNER

In the 1980s, studies conclusively showed the benefit of taking beta-blockers (BBs) after a myocardial infarction (MI), establishing an enduring post-discharge protocol. But when research dates back to an era that also championed tanning with baby oil, it may be time for an evidence refresh.

REDUCE-AMI

The REDUCE-AMI study offers the first large randomized controlled trial to evaluate the use of post-MI BBs since the treatment landscape expanded to include reperfusion, percutaneous coronary intervention, and a slew of effective secondary medications. Investigators randomly assigned >5,000 patients with an acute MI and a left ventricular ejection fraction of ≥50% to either a BB (metoprolol or bisoprolol) or no BB, with a follow-up of three and a half years.

Beta-block buster

The findings, published in The New England Journal of Medicine, revealed that initiating post-MI BBs did not confer an advantage in these patients. Researchers found no discernible daylight between hazard ratio lines for (1) all-cause mortality or new MI, (2) all-cause mortality, or (3) new MI. Furthermore, BBs failed to improve atrial fibrillation hospitalization rates. While investigators acknowledge that their study’s unblinded design could invite bias, they argue that bias wouldn’t likely manifest in an MI or death.

Key takeaways

Has the practice of routinely prescribing BBs after an MI reached its expiration date? Study authors say, “Likely yes,” at least for some. Lead author Dr. Troels Yndigegn summarizes, “We believe that the evidence still supports beta blockers for patients with a large myocardial infarction that experience heart failure, but for patients with no signs of heart failure and a normal ejection fraction, this trial establishes that there’s no indication that routine use of beta blockers is beneficial.” Eliminating just one pill from the post-MI regimen? That could translate into thousands of patients dodging side effects, saving money, and upping their compliance.

Guideline Update

USPSTF finalizes breast cancer screening guideline

Study Syncs Afib Rhythm with Gum Health

CARDIO CORNER

In oral hygiene news, four out of five dentists recommend reading this next summary detailing the link between treatment for gum disease and a lower risk of atrial fibrillation (AF) recurrence.

In a single-center, nonrandomized prospective study in Japan, investigators enrolled nearly 300 adults slated for radiofrequency catheter ablation for AF. Each participant visited the dentist and received a periodontal inflamed surface area (PISA) rating (and a shiny new toothbrush, of course). Appropriate patients were then invited to undergo periodontal treatment within three months of ablation; nearly 100 patients RSVP’d “yes.” Researchers tracked all participants for one to two years, recording AF recurrences. They drilled down to the following observations:

24% experienced an AF recurrence.
Among the patients eligible for periodontal treatment, those who accepted saw a 61% reduction in AF recurrence in comparison with those who bypassed the dental chair.
The worse the gum disease, the greater the risk of AF recurrence—put simply, the PISA score may be a crystal ball for AF recurrence.

Key takeaways

While the American Heart Association has not yet officially branded periodontitis a modifiable risk factor for AF, this study, supported by mounting evidence, indicates that such recognition may be imminent. First, we need large, randomized trials to fortify these findings (and convince that elusive fifth dentist). In the meantime, the reasonable clinical pearl here is to keep pearly whites pearly, especially post-ablation. To that end, here are five lesser-known brushing pearls:

Socially distance your toothbrushes (at least 7 inches apart).
Don’t rinse your mouth after brushing; simply spit out the toothpaste.
Keep toothbrushes away from toilets (toilet bowl droplets have a way of finding them).
Air-dry toothbrushes (don’t store in containers).
Wait >30 minutes after brushing before eating.

FDA Approves …

A Viral Infection Prevention Right Under Our Noses?

EMERGING TRENDS

What if the next breakthrough in respiratory viral infection prevention came from a $7 tube already in your patients’ medicine cabinets? Researchers have reimagined the ointment-next-door Neosporin as a potential shield against viruses, essentially removing the antibiotic’s proverbial oversized glasses and ponytail to reveal a whole new side.

Neosporin’s all that?

Researchers theorize that smearing a dollop of Neosporin in the nostrils—the gateway to the respiratory system—may initiate an immune reaction capable of warding off respiratory viruses like COVID-19 and influenza. Adding weight to this theory, a mice study showed that Neosporin protected against COVID-19 and influenza, and a hamster study demonstrated reduced SARS-CoV-2 transmission. Further up the research food chain, investigators have now shown a preliminary benefit in humans. A dozen healthy participants applied Neosporin inside their nostrils twice daily for a week, while seven used Vaseline as a comparison. After nasal swabs and PCR tests, investigators verified that Neosporin’s active ingredient neomycin sulfate stimulates receptors in the nose, activating the body’s defensive barrier against viruses.

Key takeaways

These results indicate that neomycin sulfate may hold promise as a host-directed antiviral approach for preventing respiratory viral infections. Patients may soon be asking whether the familiar clear ointment smelling of childhood adventure should be used for more than just cuts and scrapes. If you consult Neosporin’s website, you’ll see an unambiguous warning to avoid intranasal use, and that’s probably sound advice for now. That is, until larger human studies can sniff out the benefits and risks, one of which may be exacerbating antibiotic resistance. But we commend the innovative thinking—and hope the next effective, affordable, accessible medication is already in our homes.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

Alissa Scott, author
Aylin Madore, MD, MEd, editor
Margaret Oliverio, MD, editor
Ariel Reinish, MD, MEd, editor
Emily Ruge, Author, editor

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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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An Unambiguous Warning

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Rethinking Beta-Blockers Post-MI

CARDIO CORNER

REDUCE-AMI

Beta-block buster

Key takeaways

Guideline Update

Study Syncs Afib Rhythm with Gum Health

CARDIO CORNER

Key takeaways

FDA Approves …

A Viral Infection Prevention Right Under Our Noses?

EMERGING TRENDS

Neosporin’s all that?

Key takeaways

Morning Report is written by:

Enjoying Morning Report? Subscribe & Share It With Your Colleagues!

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