How many people in the US have been vaccinated against COVID-19?

Centers for Disease Control and Prevention

, as of today, April 16, 2021, at 12:51 PM, EDT:

The 5 states with the highest percentage of population fully vaccinated are:

How many cases of COVID-19 have been confirmed in the US?

, as of today, April 16, 2021 at 1:21 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 60 860 reported fatalities, followed by 

How many cases of COVID-19 have been confirmed globally?

Articles

Data from the Johns Hopkins COVID-19 interactive map and the CDC on COVID-19 cases, mortalities, vaccinations, and more.

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of April 16, 2021

Virtually every state that has legalized medical marijuana and other cannabis products has included chronic pain as one of the problems for which these can be prescribed. However, questions remain regarding the strength of the evidence supporting the use of these products for the management of pain. 

To determine the extent and quality of such evidence, the International Association for the Study of Pain (IASP)—the leading international pain organization for health care professionals—established a presidential task force to review the evidence and make recommendations on the use of cannabis and cannabinoids for the management of pain. The IASP Presidential Task Force on Cannabis and Cannabinoid Analgesia reviewed existing preclinical and clinical research, and released a position statement on March 16, 2021, in the journal 

In the slides below, find details on what the task force concluded.

Cannabis and Cannabinoids For the Management of Pain

The International Association for the Study of Pain recently released a statement on the strength of current research on cannabis and cannabinoid use in pain management. What did they find? 

A new approach to assessing the purported link between red meat consumption and cardiovascular risk found that greater intake of red and processed meat was associated with worse results for 3 imaging measures of heart health.

The findings were reported during ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).

“Previous studies have shown links between greater red meat consumption and increased risk of heart attacks or dying from heart disease,” said study author Dr. Zahra Raisi-Estabragh of Queen Mary University of London, UK, in an 

. “For the first time, we examined the relationships between meat consumption and imaging measures of heart health. This may help us to understand the mechanisms underlying the previously observed connections with cardiovascular disease.”

The observational study was conducted among 19 408 participants in the UK Biobank database. The researchers examined associations of self-reported intake of red and processed meat with 3 assessments of heart anatomy and function:

 (CMR) assessments of heart function used in clinical practice such as volume of the ventricles and measures of the pumping function of the ventricles.

used in research to extract detailed information from heart images such as shape and function

After multivariable adjustment (included age, sex, deprivation, education, smoking, alcohol, exercise, hypertension, hyperlipidemia, diabetes, BMI), Raisi-Estabragh et al found worse imaging measures across the 3 measures. Specifically, higher red and processed meat intake was associated with smaller ventricular size, reduced ventricular function, and increased arterial stiffness.

Researchers compared these results with observed relationships between heart imaging measures and intake of oily fish, finding that as the amount of oily fish consumed rose, heart function improved and there was less arterial stiffness.

According to the ESC statement, the associations between imaging measures of heart health and meat intake were only partially explained by hypertension, hyperlipidemia, diabetes, and obesity.

“It has been suggested that these factors could be the reason for the observed relationship between meat and heart disease,” said Raisi-Estabragh in the statement “For example, it is possible that greater red meat intake leads to raised blood cholesterol and this in turn causes heart disease. Our study suggests that these four factors do play a role in the links between meat intake and heart health, but they are not the full story.”

Although the study did not explore alternative mechanisms, “There is some evidence that red meat alters the gut microbiome, leading to higher levels of certain metabolites in the blood, which have in turn been linked to greater risk of heart disease,” said Raisi-Estabragh.

“This was an observational study and causation cannot be assumed. But in general, it seems sensible to limit intake of red and processed meat for heart health reasons.”

Measures of heart function and anatomy were used to assess the effects of red and processed meat on cardiovascular health; findings were reported at ESC Preventive Cardiology 2021. 

Functional Assessment Strengthens Red Meat-Heart Disease Association 

Current evidence is insufficient to support broad screening for vitamin D deficiency in adults without signs or symptoms, the US Preventive Services Task Force (USPSTF) concluded in a final recommendation statement (I statement) published April 13, 2021, in 

This new recommendation is consistent with the 

 on screening for vitamin D deficiency in community-dwelling, nonpregnant, asymptomatic adults aged ≥18 years.

Vitamin D performs an important role in calcium homeostasis, bone metabolism, and other cellular regulatory functions; however, vitamin D requirements can vary by individual, so there is no one 25(OH)D level that defines deficiency.

“We know that vitamin D is an important nutrient for keeping bones healthy and may also have a role in other aspects of good health,” said USPSTF member Michael Silverstein, MD, MPH, professor of pediatrics, chief of the Division of General Academic Pediatrics, vice chair of research, Department of Pediatrics, Boston University School of Medicine, in a 

. “However, we need more research on what level of vitamin D people need to stay healthy before we can make a recommendation for or against screening.”

To update its 2014 statement, the USPSTF examined a 46-study 

 on screening for vitamin D deficiency, including the benefits and harms of screening and early treatment.

The systemic review found, “treatment with vitamin D has no effect on mortality or the incidence of fractures, falls, depression, diabetes, cardiovascular disease, cancer, or adverse events.”

The new recommendation does not apply to persons who already have health conditions that require vitamin D supplementation. If patients are concerned about their vitamin D levels, they should talk with their physician about their individual health needs, according to the press release.

USPSTF also cautioned that it did not review emerging evidence on vitamin D and COVID-19 outcomes.

The authors concluded by highlighting more research that is needed to address the following areas:

Determine whether total serum 25(OH)D levels are the best measure of vitamin D deficiency and whether the best measure of vitamin D deficiency varies by subgroups defined by race, ethnicity, or sex.

Determine the cutoff that defines vitamin D deficiency and whether that cutoff varies by specific clinical outcome or by subgroups defined by race, ethnicity, or sex.

When vitamin D deficiency is better defined, studies on the benefits and harms of screening for vitamin D deficiency will be helpful.

 ends with a note on recommendations for vitamin D screening made by other professional organizations:

No organization recommends population-based screening for vitamin D deficiency, and the American Society for Clinical Pathology recommends against it. The American Academy of Family Physicians supports the USPSTF 2014 recommendation. The Endocrine Society and the American Association of Clinical Endocrinologists recommend screening for vitamin D deficiency in individuals at risk. The Endocrine Society does not recommend population screening for vitamin D deficiency in individuals not at risk.

In a new recommendation statement, the US Preventive Services Task Force concluded that current evidence is insufficient to support broad screening for vitamin D deficiency in adults. 

USPSTF: Evidence Still Lacking to Support Screening for Vitamin D Deficiency in Asymptomatic Adults

, as of today, April 15, 2021, at 12:28 PM, EDT:

, as of today, April 15, 2021 at 1:21 PM, EDT, there have been:

 with 60 766 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of April 15, 2021

What, exactly, is an alcoholic drink-equivalent? Also known as the US standard drink, the National Institute on Alcohol Abuse and Addiction (NIAAA) definition of an alcoholic drink-equivalent is "any beverage that contains ~0.6 fluid oz (14g) of pure alcohol."

How much of any alcoholic beverage, exactly, comprises a US standard drink? How many US standard drinks are in a can, bottle, a half pint, or "a fifth?" 

 has answers to these questions and many more that might help you talk to your patients who are curious or who you feel may need information and support for a "drinking problem." Click through the slides below for an overview, then please visit the site.  

The shapes, sizes, and content of a US alcoholic drink-equivalent vary widely. Get a quick educational summary of the variety and more data that may help in your daily clinical practice. 


What, Exactly, is an Alcoholic Drink-equivalent? 

Loss of smell, loss of taste, dyspnea, and fatigue are the 4 most common symptoms that health care professionals in Sweden report 8 months after mild coronavirus disease 2019 (COVID-19) infection, according to research letter published online April 7, 2021, in 

“We investigated the presence of long-term symptoms after mild COVID-19 in a relatively young and healthy group of working individuals, and we found that the predominant long-term symptoms are loss of smell and taste. Fatigue and respiratory problems are also more common among participants who have had COVID-19 but do not occur to the same extent,” said senior author Charlotte Thålin, MD, PhD, department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden, in a 

“We do not see an increased prevalence of cognitive symptoms such as brain fatigue, memory and concentration problems or physical disorders such as muscle and joint pain, heart palpitations or long-term fever,” added Thålin.

The findings are part of the ongoing COVID-19 Biomarker and Immunity (COMMUNITY) study that examines long-term immunity after mild COVID-19. Health care professionals at Danderyd Hospital were invited to enroll in the COMMUNITY study between April 15-May 8, 2020.

Blood samples are collected from the participants every 4 months. Demographics, symptoms and severity (mild or severe), and chronic diseases were obtained through participant questionnaires at baseline. Participants who were seropositive for SARS-CoV-2 anti–spike IgG at baseline and who reported severe symptoms were excluded, as were initially seronegative participants who seroconverted during follow-up.

Thålin and colleagues compared symptom reporting between 323 health care workers (83% women; median age, 43 years) who had mild COVID-19 at least 8 months earlier with 1072 health care workers (86% women; median age, 47 years) who did not have COVID-19 throughout the study.

At the 8-month follow-up, participants reported the presence, duration, and severity of 23 predefined symptoms via a smartphone app. Researchers used the Sheehan Disability Scale to gauge functional impairment from long-term COVID-19 symptoms.

The results showed that 1 in 10 of participants with mild COVID-19 experienced ≥1 moderate-to-severe COVID-19 symptoms that negatively impacted their quality of life.

Researchers found that 26% of seropositive health care workers, as compared to 9% in the control group, had at least 1 moderate-to-severe symptom that lasted >2 months. Also, 11% of seropositive participants reported at least 1 symptom that negatively affected their work, social, or home life at 8 months vs 2% of the control group.

"Despite the fact that the study participants had a mild COVID-19 infection, a relatively large proportion report long-term symptoms with an impact on quality of life,” said co-author Sebastian Havervall, MD, deputy chief physician, Danderyd Hospital, PhD student in the project at Karolinska Institutet, in the press release. “In light of this, we believe that young and healthy individuals, as well as other groups in society, should have great respect for the virus that seems to be able to significantly impair quality of life, even for a long time after the infection."

Thålin and colleagues plan to continue the COMMUNITY study, with the next follow-up to take place in May 2021 when a large proportion of participants are expected to be vaccinated.

“We will, among other things, be studying COVID-19-associated loss of smell and taste more closely, and investigate whether the immune system, including autoimmunity, plays a role in post-COVID," concluded Thålin in the press release.

For additional information on long COVID-19, please see 

Long COVID Review Lead Author Highlights Knowns, Unknowns

And for additional information on lasting neurological symptoms, please see 

Novel Study Finds Mild COVID-19 Associated with Prominent, Persistent Neurologic Symptoms

Fatigue was among the most common symptoms that health care workers in Sweden reported 8 months after mild COVID-19 infection, according to a new research letter. 

New Evidence Reveals Most Common Long-term COVID-19 Symptoms among Health Care Workers

, as of today, April 14, 2021, at 12:43 PM, EDT:

, as of today, April 14, 2021 at 2:21 PM, EDT, there have been:

 with 60 606 reported fatalities, followed by 

COVID-19 Updates: US Vaccinations and Global Cases and Deaths as of April 14, 2021

In the absence of pharmacotherapies for nonalcoholic fatty liver disease (NAFLD), weight loss is the primary intervention recommended and is known to be successful, with greater weight reduction associated with greater improvements in a range of disease markers.

 published recently in Metabolism Clinical and Experimental looked further to identify the relationship between magnitude of weight loss and improvements in NAFLD. We break down the study for easy-reading in the slides that follow. 

Weight loss is known to improve markers of fatty liver disease but authors of a recent meta-analysis took their investigation deeper. Scan through the research to the findings. 

Impact of Weight Loss on NAFLD: Is there a Dose-Response Relationship? 

The anti-inflammatory capacity of high-density lipoprotein (HDL) was found inversely associated with incident cardiovascular (CV) events in a study 

The association was independent of HDL cholesterol and HDL cholesterol efflux capacity and there were very limited associations with other established CVD biomarkers, leading authors to suggest that HDL anti-inflammatory capacity may help improve current CVD risk assessment tools.

“The HDL cholesterol level is a good, established, simple and cost-efficient CVD risk biomarker," said senior study author, Professor Uwe Tietge at the Department of Laboratory Medicine, Karolinska Institutet, Sweden, in 

. "Our results, however, demonstrate that the anti-inflammatory capacity or assays looking at HDL function in general have the potential to provide clinically relevant information beyond the static HDL cholesterol measurements that are currently used.”

Participants included 680 adults (average age 59 years, 70% men) participating in the large population-based PREVEND study (N=8592) in the Netherlands, initiated in 1997. All participants were healthy at study enrollment.

From the larger study participants were identified who had experienced a first CVD event (combined end point of death from CV causes, ischemic heart disease, nonfatal myocardial infarction and coronary revascularization) during a median of 10.5 years of follow-up. Based on availability of blood samples to allow assessment of HDL anti-inflammatory capacity in 357 original controls and 352 cases, 340 matched case-control pairs were included in the current analysis. Controls were matched based on age, sex, smoking status, and HDL levels.

Among laboratory values examined were total cholesterol, LDL cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, anti-inflammatory capacity, and cholesterol efflux capacity.

HDL anti-inflammatory capacity was determined as its ability to suppress expression of tumor necrosis factor α–induced vascular cell adhesion molecule-1 mRNA in endothelial cells in vitro 

(results expressed as achieved percent reduction by individual HDL related to the maximum TNFα effect with no HDL present).

 among patients experiencing a first CV event vs controls (27% vs. 31.6%; 

In a fully adjusted model, HDL anti-inflammatory capacity was inversely associated

 with incident CVD (odds ratio [OR] per 1 standard deviation [SD] = 0.74; CI, 0.61-0.9; 

= .002); the association was similar for individual components of the CVD endpoint.

HDL anti-inflammatory capacity was not correlated

In a fully adjusted model, both HDL anti-inflammatory and cholesterol efflux

 capacity were independently associated with incident CVD (OR per 1 SD for efflux = 0.74; 

=.002; OR per 1 SD for anti-inflammatory capacity = 0.66; 

Adding HDL anti-inflammatory capacity to the Framingham

 risk score improved its predictive ability, with a model likelihood-ratio statistic increase from 10.5 to 20.4 (

“It is notable that the HDL anti-inflammatory capacity was independent of a large number of established cardiovascular biomarkers” including high-sensitivity C-reactive protein, the researchers wrote. 

• HDL anti-inflammatory capacity has the potential to provide independent clinical information for cardiovascular disease risk assessment. 

• The HDL anti-inflammatory capacity could represent a novel pharmacological intervention target for improving cardiovascular disease risk.

“Our results point to new opportunities for improved cardiovascular risk assessment by using a biologically meaningful functional biomarker for HDL instead of its cholesterol content,” said Tietge in the statement. “However, the method for analysing the anti-inflammatory activity of HDLs is currently rather complex and difficult. Our next goal is therefore to make the method simpler and more clinically implementable.”

Among study limitations acknowledged by the authors was the all-White composition of the PREVEND cohort, which limits generalizability of the findings. They also note that stroke was not included as a primary endpoint. Because of the study’s case-control design, there is limited ability to investigate the association of the HDL anti-inflammatory capacity with other known CVD risk factors. Also, HDL function assays are not yet standardized, so interpretations can be made only in the context of the assay conditions applied.

The indicator of vascular protection against atherosclerotic progression was inversely associated with incident CV events, independent of traditional CVD biomarkers and improved Framingham Risk Score prediction. 