— Also on TTHealthWatch: Pediatric Diabetes Post-COVID

TTHealthWatch is a weekly podcast from Texas Tech, hosted by Elizabeth Tracey, the director of electronic media at Johns Hopkins, and Dr. Rick Lange, president of Texas Tech University Health Sciences Center, El Paso. Each week, they delve into the most significant medical news.

This episode's discussions include topics such as the efficacy of nasal sprays for respiratory infections, the preventive use of Paxlovid, endometriosis and ovarian cancer, and the occurrence of Type 1 diabetes after COVID.

Episode breakdown:

• 0:53 – Investigation on nirmatrelvir/ritonavir for COVID prevention
• 1:49 – Paxlovid did not significantly decrease infection risk
• 2:51 – Variants don’t seem to change results
• 3:14 – Nasal sprays and behavioral strategies for URIs
• 4:14 – Stress management reduces respiratory symptoms
• 5:14 – Less antibiotic use with interventions
• 6:14 – Stress reduction can lower susceptibility
• 6:35 – Type 1 diabetes increase post-COVID
• 7:32 – COVID potentially triggers pancreatic attack
• 8:32 – Implications for adults?
• 8:42 – Endometriosis and heightened risk of ovarian cancer
• 9:44 – Study of 597 women with ovarian cancer
• 10:45 – Insights if both originate similarly
• 11:45 – Cancer possibly starts in fallopian tubes
• 12:35 – Conclusion

Transcript:

Elizabeth: Could nasal sprays shorten common colds?

Rick: The link between COVID and rising diabetes diagnoses.

Elizabeth: The connection between ovarian cancer and endometriosis.

Rick: Is it possible Paxlovid could prevent COVID in those exposed at home?

Elizabeth: Those are our key topics this week on TTHealthWatch, your source for medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m your host, Elizabeth Tracey, reporting from Baltimore.

Rick: And I’m Dr. Rick Lange, president of the TTUHSC in El Paso and the dean at the Paul L. Foster School of Medicine.

Elizabeth: Rick, it feels like it’s been a while since we had any deep dive into COVID-related issues. But since cases are back on the rise, why don’t we start with one of your picks?

Rick: Absolutely, Elizabeth. It's surprising to see such an increase in infections this summer. Earlier, when COVID struck a household, it had a secondary attack rate of about 10%–12%. Now, with evolving variants, that rate’s jumped to 60%–80%.

Here’s the thought: Could Paxlovid, also known as nirmatrelvir/ritonavir, help prevent infection in those exposed within their home? The study explored this by enrolling 2,700 participants who were not infected initially but were exposed to COVID. Subjects were randomly assigned either Paxlovid for 5 or 10 days or a placebo.

Results? Paxlovid didn’t significantly reduce infection rates. Only 3.9% of those on placebo developed COVID, compared to 2.4% of those given Paxlovid. A major factor might be that 90% of participants had prior immunity from either previous infections or vaccinations.

The main side effect was a distorted taste sensation, or dysgeusia. Given these modest results, broad use of Paxlovid for prevention might not be ideal.

Elizabeth: It’s certainly a disappointment when a treatment doesn’t impact as hoped. Could this imply that newer variants are less responsive to Paxlovid?

Rick: Perhaps. We've seen that antibody treatments in earlier variants weren’t effective against newer strains. However, Paxlovid hasn’t shown variant-specific inconsistencies when used for treatment. The true issue is likely that widespread vaccinations and previous infections are keeping subsequent infections low without much room for Paxlovid to further bring down risk.

Elizabeth: Let’s shift gears to something related: nasal sprays and behavioral remedies for upper respiratory illnesses, detailed in The Lancet. This study looked at alternatives to conventional care in the U.K. general practice setting.

Participants were randomized into four groups: a gel-based carrageenan nasal spray, a saline nasal spray, a behavioral intervention geared toward physical activity and stress management, and standard care. Among nearly 12,000 participants, using the nasal sprays reduced illness to just 6.5 days, compared to the usual care group's 8.2 days. Behavioral intervention also offered slight improvement.

Encouragingly, less antibiotic usage was noted across all treatment groups.

Rick: This trial stands out. It highlights the effectiveness of simple, low-cost solutions like nasal sprays. Such interventions could help reduce unnecessary antibiotic prescriptions, vital for combating antibiotic resistance. Overall, this provides a helpful alternative for common colds.

Elizabeth: Absolutely. The premise is that sprays physically wash out viruses before they can wreak havoc. The stress management website also suggests that a more relaxed immune system might brush off infections better. Let's hope it prompts future research.

Rick: Agreed. Managing stress seems to continue playing a role in staying healthy.

Elizabeth: Let’s return to COVID for a brief moment with a JAMA study examining COVID’s potential to accelerate Type 1 diabetes in children. Researchers wanted to determine if COVID hastens the progression from prediabetes to clinical diabetes.

This German study followed 509 children, aged 1 to 6, from 2015 to 2020. Pre-COVID, the rate of diabetes development was about 6.4 cases per 100 person-years. After COVID exposure, the rate doubled.

Rick: The COVID infection seemingly triggers an immune response that attacks the pancreas, essentially speeding up diabetes onset. The virus-induced autoantibodies to the pancreas aren't totally surprising, but this study gives strong evidence for the connection.

Elizabeth: I found the prediabetes diagnosis interesting. How do doctors know to test for it?

Rick: This was part of a German screening program – not something typically done in regular pediatric care in the U.S. unless there are high-risk factors.

Elizabeth: What are the broader takeaways?

Rick: Be aware that viral infections, including COVID, might tip the scales in susceptible children toward diabetes. This raises significant questions about whether vaccination could prevent such progression. Also, could something similar occur in adults? More research is critical.

Elizabeth: Our final study, also from JAMA, spotlights the connection between endometriosis and ovarian cancer, which has shifted in understanding over recent years. Many experts now believe that what we call "ovarian cancer" often originates in the fallopian tubes. This research used data from the Utah Population Database to explore ovarian cancer risks in women diagnosed with endometriosis.

They evaluated nearly 79,000 women, noting that women with endometriosis had almost 4 times the likelihood of developing ovarian cancer, especially more indolent, type 1 cancer. Specific high-risk endometriosis types included deep infiltrating and ovarian endometriomas.

Rick: Around 1 in 3 women with endometriosis could be at increased risk for ovarian cancer. If endometriosis and ovarian cancer share origins, studying one might give us valuable insight into preventing or treating the other. In the future, high-risk groups may benefit from targeted screening, rather than broad population screening, which has shown to be ineffective in catching ovarian cancer early.

Elizabeth: One interesting thing here is how endometriosis-related symptoms could disguise early signs of ovarian cancer. Painful menses might mute awareness of more serious symptoms, which are known to be pretty subtle.

Also, the theory gaining traction that ovarian cancer starts in the fallopian tubes is intriguing – removing them could be a low-risk preventative measure for those done with childbearing.

Rick: That may be true, but if ovarian endometriosis directly contributes to cancer risk, we might need to address the ovaries themselves, not just the fallopian tubes.

Elizabeth: Certainly a topic that warrants more follow-up. Well, that concludes our review of the week’s medical news. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Stay informed and make healthy choices, folks.