Shorts and follow ups: vaccination, psychiatric drugs, transgender care, bariatric surgery and a medical miracle
November 8, 2024
(A) Many vaccinations critical in pregnancy
Giving vaccinations in pregnancy provides protection to both the mother and the future newborn, which is especially important since babies’ immune systems are underdeveloped and infants under six months often have very serious illness from infectious diseases that are otherwise mild. Some examples:
Ninety percent of infants six months or younger who were hospitalized with COVID-19 were born to unvaccinated mothers. Babies under six months were almost as likely to be hospitalized for COVID-19 as those over age 75. Twenty-two percent of infants hospitalized with COVID-19 were treated in the ICU, and about 1% died.
From now until November women in their last month of pregnancy are eligible to be vaccinated against respiratory syncytial virus (RSV), which causes tens of thousands of hospitalizations in infants each fall. Babies of mothers who are vaccinated need not receive a monoclonal antibody to protect them from RSV. The maternal RSV vaccination decreases risk of requiring mechanical ventilation by 82% at 3 months and 69% at six months.
Whooping cough (pertussis) infections are at the highest level in two decades. Pregnant women who are not up to date on pertussis vaccination (part of the combined Tdap tetanus vaccine) should be vaccinated, and the vaccine protects their newborns.
(B) New treatments for psychosis
Cobenfy (xanomeline and trospium chloride), is the first drug in a new class of antipsychotics approved in decades. It might not cause the weight gain, lethargy and neurologic complications associated with currently used antipsychotic agents, although there are not yet long-term published studies. The drug will retail for about $22,000 a year, while some generic second- generation antipsychotic medicines cost under $200 a year. There are no head-to-head trials with Cobenfy and other antipsychotic medications.
Researchers have also reported promising initial findings are also studying using virtual reality and digital avatars to treat those with schizophrenia who are troubled by hearing voices.
Drugs and cognitive behavioral therapy have not been effective in many, so additional treatment modalities are welcome.
(C) Bariatric surgery led to decreased disability in the UK
Source: Office of National Statistics (UK) October 23, 2024
The journal BMJ reports that patients who received bariatric surgery had an initial decrease in employment and income as they recovered, but from four months on their income and employment level was higher than pre-surgery, reaching 4.3% higher than preoperative income at five years. These findings suggest that treatment of severe obesity can decrease disability.
(D) Transgender hormone and puberty blocker multi-year follow up
Source: Olson, et al JAMA Pedi October 21, 2024
JAMA Pediatrics published a small study of 220 transgender youth (and 57 of their parents) to assess satisfaction with puberty blockers (follow-up average was 4.9 years) and gender-affirming hormones (follow-up average was 3.4 years). Only 3% of the youth (and 5% of parents) said they were dissatisfied, and 4% of youths and 4% of parents expressed regret at use of puberty blockers or gender affirming hormones. A substantial portion of those surveyed wished they had started earlier. Ninety-eight percent of patients continued their treatment. This survey was performed in a predominantly high income and overwhelmingly White population and therefore might not be applicable to the general community. Most youth in this survey were satisfied with their gender affirming care, and few discontinued this care.
(E) Heartening case report of a medical miracle
Here’s a gift link to a New York Times story of a public radio interviewer who developed difficulty talking and was found to have a brain mass. After surgery performed while she was awake to avoid damaging the speech area of her brain, she has returned to radio interviews.