Yoga may help to prevent frailty in older adults

1. Yoga may help to prevent frailty in older adults
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2553
URL goes live when the embargo lifts
A systematic review of 33 randomized controlled trials (RCTs) found that yoga improved gait speed and lower extremity strength in inactive older people. However, yoga did not seem to offer a benefit for frailty markers over activities like exercise or tai chi. The review is published in Annals of Internal Medicine.

Older adults have an increased burden of chronic disease, disability, and frailty. Frailty affects up to 50 percent of adults aged 80 years and older, and its prevention and management are high priority
areas in public health and clinical practice. Yoga may be a prevention and management strategy and is already used to improve balance and mobility in older adults.

Researchers from Brigham and Women's Hospital and Harvard Medical School reviewed 33 RCTs comprised of 2,384 participants aged 65 years or older to evaluate the available trial evidence on the effect of yoga-based interventions on frailty in older adults. The authors analyzed impacts on frailty markers including measures of gait speed, handgrip strength, balance, lower extremity strength and endurance, and multicomponent physical performance measures. The authors found that when compared to education-only or inactive control groups, there was moderate evidence that yoga improved gait speed and lower body strength and endurance. the benefits for balance and handgrip strength were less certain. While there was no clear advantage for a particular style of yoga, the authors suggest clinicians may consider recommending Iyengar-based styles, with a home practice, that can be customized for older adult populations. These findings add to growing literature that yoga plays a role in healthy aging and frailty prevention.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Julia Loewenthal, MD, please email Casandra Falone at CFALONE@PARTNERS.ORG.
--------------------------------
2. Older, Black, and low-income pregnant patients more likely to suffer cardiac arrest when hospitalized for delivery
Survival lowest among women with co-occurring disseminated intravascular coagulation
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2750
URL goes live when the embargo lifts
A study of pregnant women hospitalized during delivery found that cardiac arrest occurred in about 1 in 9,000 deliveries, a rate that is higher than previously reported estimates. Cardiac arrest was more common among patients who were older, were non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. The findings are published in Annals of Internal Medicine.

Cardiac arrest is an uncommon but serious maternal complication that is an indicator of severe maternal morbidity and mortality. Estimates of severe maternal complications occurring during delivery hospitalization can provide information for evidence-based strategies to reduce pregnancy-related death.

Researchers from the Centers for Disease Control and Prevention (CDC) studied data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2017 to 2019 to investigate rate of cardiac arrest during delivery hospitalization. The authors also looked at the patient characteristics associated with cardiac arrest and survival rates. Among the 10,921,784 U.S. delivery hospitalizations included in the data, the cardiac arrest rate was 13.4 per 100,000 and about a third of those patients survived to hospital discharge. Survival was lowest with co-occurring disseminated intravascular coagulation (DIC). The researchers could not determine cause of cardiac arrest or identify whether co-occurring severe maternal complications came before or after cardiac arrest. Acute respiratory distress syndrome was the most common co-occurring diagnosis, and cardiac arrest rates were high among hospitalizations where a diagnosis of amniotic fluid embolism was noted. According to the authors, implementing clinical guidelines, ensuring that pregnant people receive risk-appropriate care, and addressing potential knowledge deficits in maternal cardiac arrest and cardiopulmonary resuscitation technique for pregnant people may improve maternal outcomes.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Romeo Galang, MD, please email media@cdc.gov.
--------------------------------
3. AI software like ChatGPT provides benefits, poses risks for researchers and scientific publishing field
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0154
URL goes live when the embargo lifts
In a new ‘Ideas and Opinions,’ authors from Amsterdam University Medical Center outline the possible benefits, problems, and future of medical research assisted or written by artificial intelligence (AI) software applications like ChatGPT. The piece is published in Annals of Internal Medicine.

On 30 November 2022, a company called OpenAI released an online, AI-powered chatbot called ChatGPT (Generative Pre-trained Transformer) that simulates human conversation. Users will now be able to quickly summarize existing medical research findings, assist with medical decision making, and generate educational materials. This new technology may have significant implications for researchers, reviewers, and editors in scientific publishing.

In their piece, the authors argue that software like ChatGPT will allow researchers to create manuscripts more efficiently by assisting in generating complete, standard scientific text. They also highlight that this software may help nonnative English-speaking authors with grammatical errors, likely increasing their chances to have their findings published. However, the authors warn, the knowledge bases of software like ChatGPT are limited and users will need to cross-check information to ensure its accuracy. They note that pre-prints, existing misinformation, and ChatGPT’s tendency to generate nonexistent references while creating text may further complicate this process. The authors suggest that journals create policies for using ChatGPT transparently. They also advise that adding ChatGPT as a coauthor raises concerns because it cannot be responsible for its content and may not meet authorship criteria. Instead, authors could highlight areas of generated text that reviewers and editors can further scrutinize.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Michiel Schinkel, MD, please email m.schinkel@amsterdamumc.nl.
---------------------------
4. Painful, swirling skin lesions a rare symptom of undiagnosed pulmonary tuberculosis
Abstract: https://www.acpjournals.org/doi/10.7326/L22-0453
URL goes live when the embargo lifts
A patient presenting with painful, swirling skin lesions, chills, and weight loss was found to be suffering from erythema gyratum repens (EGR), a rare and striking skin condition that is associated with underlying malignancy in most cases, but in some cases can stem from an autoimmune disease, messenger RNA-based vaccines against COVID-19, or in rare cases, tuberculosis (TB). The patient’s doctors had been initially falsely reassured by a negative TB screening test, though further TB testing should have been pursued because she was from a TB-endemic country and had abnormal lung imaging. Thorough investigation for suspected TB was extremely important because treatment of EGR requires addressing the underlying cause of the immune phenomenon. Once the patient was treated for TB, her symptoms cleared. The case report from authors at Stanford University is published in Annals of Internal Medicine.

EGR is a very rare skin condition causing painful lesions that appear in a distinct circular pattern. The patient’s lesions affected her face, neck, trunk, extremities, palms, and soles. Initially, clinicians believed that her rash was a rare reaction to empagliflozin, which the patient had begun taking for diabetes. However, despite discontinuation of the medication and treatment with prednisone and doxycycline, the rash continued to progress. Since EGR is often caused by an underlying malignancy, the patient was screened for cancers, and none were found. Only after imaging of the chest and sputum analysis did clinicians identify the problem – pulmonary tuberculosis.
The authors say that clinicians should learn to recognize EGR’s annular, or polycyclic, ring-within-ring skin lesions because accurate diagnosis is critical for determining the appropriate treatment. If EGR is identified, the next step is finding and treating the underlying cause.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Caitlin A. Contag, MD, please email Lisa Kim at LiKim@stanford.edu.
---------------------------
Also new in this issue:
Cardiac Amyloidosis
Michelle Weisfelner Bloom, MD; Peter D. Gorevic, MD
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2615