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President Joe Biden has announced plans to request additional funding from Congress for the development of a new coronavirus vaccine, as scientists work on updated Covid vaccines to target the omicron variant. The updated vaccine, known as XBB.1.5, is being developed by Pfizer, Moderna, and Novavax. Biden's proposal aims to secure funding for this new vaccine and its distribution. The annual fall Covid shot is expected to be recommended for everyone once it is ready, although hospital admissions due to Covid have risen recently, they are far below previous peaks.

The U.S. is still a few weeks away from rolling out new Covid booster shots, despite an increase in Covid cases and hospitalizations. The Centers for Disease Control and Prevention (CDC) is expected to approve the new booster shots as early as September 12, with the Food and Drug Administration (FDA) giving their approval before that. These boosters will target the omicron subvariants, such as XBB.1.5 and EG.5, which are changing in ways that could potentially make the virus more contagious. While concerns about new subvariants persist, experts believe the boosters will likely help protect against severe outcomes. Despite the increase in Covid cases, there are no discussions of reinstating mask mandates at this point.

Patients and doctors are turning to social media to publicly shame health insurance companies for denying prior authorization for tests, drugs, and treatments. Prior authorization is a common cost-cutting tool used by health insurers that requires approval before moving forward with medical procedures or prescription medications. Patients and doctors argue that the process can delay or deny access to necessary treatments. Some major insurers are voluntarily changing their prior authorization rules to ease preapproval mandates, and many states are passing laws to restrict the use of prior authorization.

The FDA has granted approval to Pfizer's Abrysvo, the first vaccine designed to protect newborns from respiratory syncytial virus (RSV). Administered to pregnant mothers during late pregnancy, the vaccine provides infants with protection during their first six months of life. In a trial involving over 7,000 participants, the vaccine substantially reduced the risk of infants needing medical attention or hospitalization due to RSV. This milestone comes after years of research and unsuccessful vaccine attempts, offering a significant advancement in safeguarding newborns against this common and potentially severe illness.

A national health task force has endorsed a long-acting injectable medication, Apretude, for HIV prevention, which will require health insurers to cover the drug by 2025. However, a legal challenge in the 5th U.S. Circuit Court of Appeals threatens to void this coverage mandate, which could impact the affordability of preventive interventions and screenings for various health conditions. The task force's recommendation could significantly enhance access to preventive therapy for HIV, but legal uncertainties could hinder the implementation of this crucial advancement.

Woman with paralysis speaks through an avatar 18 years after a stroke, thanks to a brain implant and AI

A groundbreaking technology developed by researchers at the University of California, San Francisco, and the University of California, Berkeley, has allowed a woman with paralysis, 18 years after her stroke, to communicate audibly through a digital avatar.

• The technology involves a brain implant placed on the surface of the patient's brain, which intercepts brain signals associated with speech and language. The implant contains 253 electrodes which intercept and diagnose brain signals from thousands of neurons. These signals are translated into sentences and spoken through an animated figure on a screen.
• A cable connects her brain signals to the computer bank, where AI algorithms are utilized to translate these signals into sentences, as well as translating facial movements onto the avatar such as pursed lips and emotional expressions, like anger or confusion.
• The system demonstrated significantly improved speed and accuracy compared to previous technologies attempting similar feats. Similar experiments have also enabled another person with paralysis to communicate through brain signals. However, the technology is not yet wireless and requires further development for integration into daily life.

AF Patients and Cardiovascular Events in the UK: Improved Survival Rates

Atrial fibrillation, often abbreviated as AF, is a prevalent cardiac arrhythmia that disrupts the normal rhythm of the heart’s beating. Instead of contracting in a coordinated manner, the upper chambers of the heart quiver or fibrillate, leading to an irregular and oftentimes rapid heartbeat. This article will help us explain atrial fibrillation and the evolution of patient outcomes.

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Rare cases of mosquito- and tick-borne diseases, including Powassan and dengue, crop up across the U.S.

As summer ends, the United States is seeing a rise in cases of rare insect-borne diseases such as eastern equine encephalitis, dengue fever, West Nile virus, and the tick-borne Powassan virus. Rising temperatures linked to climate change are extending the tick and mosquito season into the fall, contributing to the spread of these diseases. Experts highlight the importance of increased surveillance and vector control to combat the diseases' spread.

Key takeaways

• Alabama reported cases of eastern equine encephalitis, while Connecticut saw cases of Powassan virus. The country also recorded its first cases of locally transmitted malaria in decades.
  
  
• According to a report from the US Centers for Disease Control and Prevention, West Nile virus remains the leading cause of viral disease spread by insects in the continental United States. In 2021, there were over 3,000 reported cases of arboviral diseases, with 2,911 cases being attributed to West Nile virus. Neuroinvasive West Nile virus disease, which affects the nervous system, had the highest incidence rate since 2012 at 0.6 cases per 100,000 people, primarily due to an outbreak in Arizona.
  
  
• While West Nile virus was the most common cause of neuroinvasive arboviral disease, another virus called La Crosse virus continued to be the most common cause of neuroinvasive arboviral disease in children. Public health experts advise using insect repellent and wearing protective clothing to prevent mosquito bites and reduce the risk of infection.
  

By the digits

• 30%: The rare disease of eastern equine encephalitis, or EEE, has a 30% fatality rate, and many survivors have lasting neurological issues.
  
  
• 25%: About 1 in 4 people infected with dengue get sick, with symptoms including fever, vomiting, rash and muscle pain, according to the CDC. Most people recover within a week, but about 1 in 20 develop severe dengue, which can become lifethreatening within just a few hours after an individual’s fever begins to drop.
  
  
• 642: The U.S. has logged 642 cases of dengue this year, according to the CDC. That is far below last year’s total of more than 1,200, but experts said the disease typically peaks in late summer, especially August.
  
  
• 247: West Nile virus remains the leading mosquito-borne disease threat in the U.S. As of Aug. 22, 247 cases had been confirmed this year, with Arizona and Colorado reporting the most, according to the CDC.

Is There a Doctor in the House?

A 23-year-old man comes to the office because of a 7-day history of fever, crampy abdominal pain, and diarrhea. He says the abdominal pain worsens with oral intake. He has been having 8 to 10 episodes of diarrhea daily. He has not traveled recently and has had no sick contacts. Medical history is unremarkable, and he takes no medications. He does not smoke cigarettes, drink alcoholic beverages, or use illicit drugs. He is not sexually active. Vital signs are temperature 38.3°C (101.0°F), pulse 118/min, respirations 18/min, and blood pressure 108/58 mm Hg. Bowel sounds are hyperactive. The abdomen is diffusely tender to palpation; no masses are palpated. Neither the liver edge nor the spleen can be palpated. Digital rectal examination shows grossly bloody stool. A stool culture is obtained, and empiric pharmacotherapy is initiated.

Results of the stool culture show growth of Campylobacter jejuni. The patient returns to the office 3 weeks later. He reports total resolution of his fever and gastrointestinal symptoms after completion of prescribed ciprofloxacin therapy, but he has had pain and swelling of his left knee during the past 3 days. The pain worsens with weight bearing. He rates the pain as a 6 on a 10-point scale. Vital signs are temperature 37.1°C (98.8°F), pulse 78/min, respirations 16/min, and blood pressure 112/58 mm Hg. Physical examination discloses erythema and warmth of the left knee with marked synovitis. Direct palpation and flexion of the knee elicit pain.

Which of the following is the most appropriate diagnostic study to determine the cause of this patient's symptoms?

The number of gender-affirming surgeries in the U.S. nearly tripled between 2016 and 2019, with around 48,000 patients undergoing such procedures from 2016 to 2020. The increase is attributed to expanded insurance coverage for transgender care and anti-discrimination measures. In 2020, the numbers slightly decreased due to the pandemic. Most patients were aged 19 to 30, with breast and chest surgeries being most common among the younger group, allowing transgender males to transition comfortably. Private insurance and Medicaid covered most of these surgeries.

Bronny James, son of basketball legend LeBron James, experienced a cardiac arrest during a workout due to a congenital heart defect. However, medical evaluations indicate that the defect can be treated, and he is expected to make a full recovery and continue his basketball career. The incident occurred at the University of Southern California, where Bronny, aged 18, plans to play basketball as an incoming freshman. He was swiftly attended to by medical personnel, leading to his prompt release from the hospital within three days.

Wildfires in Canada, which led to smoky conditions in parts of the United States, caused a 17% increase in emergency department visits related to asthma, according to a study by the US Centers for Disease Control and Prevention (CDC). The study found that during days with wildfire smoke, emergency visits for asthma were higher than expected. The areas most affected included Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New Jersey, and New York. The study emphasizes the importance of public health responses and strategies to address health inequities, especially for vulnerable populations such as children, the elderly, and pregnant women.

Gun-related deaths among children in the US reached a record high in 2021, claiming 4,752 young lives, surpassing the previous record seen during the pandemic's first year, according to a study based on Centers for Disease Control and Prevention data. The analysis shows that gun-related injuries solidified their position as the leading cause of death among children and adolescents for two consecutive years, surpassing motor vehicle accidents, drug overdoses, and cancer. This alarming trend highlights the need for stronger gun control measures and addressing the root causes of gun violence, particularly affecting communities of color.

Thank you for reading! More next week,

My best wishes for a productive and idea-filled week ahead. Thanks for your ongoing efforts to improve the lives of the patients we all serve. Please send any news, comments, suggestions and ideas to hello@morningmed.email.

Quiz answer: The correct answer is C) "Human leukocyte antigen-B27 assay"

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