Higher HbA1c levels in early pregnancy without diabetes tied to increased risk of spontaneous pregnancy loss: Study

China: Findings from a prospective cohort study have shown an association between serum glycated haemoglobin (HbA1c) levels at early gestation and the risk of subsequent pregnancy loss in pregnant women without diabetes mellitus.

The findings published in JMIR Public Health and Surveillance support the need for monitoring HbA1c levels to identify individuals at high risk of subsequent spontaneous pregnancy loss (SPL) in the general population of pregnant women.

Spontaneous pregnancy loss (spontaneous abortion), defined as fetal death occurring before 28 gestational weeks, is one of the serious morbidities during pregnancy and leads to an increased risk of reduced fertility, long-term anxiety, and depression among pregnant women. The aetiology of SPL remains largely unknown. Serum HbA1c level is an established predictor of SPL risk among diabetic women, but not much is known about the existence of an association among pregnant women without diabetes when glycemic levels are within the normal range.

Xiaotian Chen, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China, and colleagues, therefore, aimed to quantify the association between maternal HbA1c levels in early pregnancy and subsequent risk of spontaneous pregnancy loss in a cohort of pregnant women without diabetes.

The study included 10,773 pregnant women without diabetes enrolled at their first antenatal care visit at a hospital’s early pregnancy clinic from 2016 to 2018 in Shanghai, China. Fasting blood glucose (FBG) and HbA1c levels were examined at enrollment. SPL diagnosis was derived from medical records and confirmed via telephone interviews.

Generalized linear models were used to quantify the associations of continuous and dichotomized maternal HbA1c levels with SPL risk and reported crude and adjusted risk ratios (RRs). The potential nonlinear dose-response relationship was assessed using a restricted cubic spline (RCS) regression model. Adjusted covariates included education level, maternal age, gestational weeks, preconception BMI, history of adverse pregnancy outcomes, gravidity, folic acid supplementation, family history of diabetes, and drinking and smoking during the periconception period.

The study revealed the following findings:

· A total of 273 cases of spontaneous pregnancy loss occurred.

· Every 0.5% increase in HbA1c levels was linearly associated with a 23% increase in SPL risk (adjusted RR [aRR] 1.23). The RCS model revealed that this association was linear.

· Analyses based on dichotomized HbA1c levels showed a significantly increased risk of SPL when HbA1c levels were ≥5.9% (aRR 1.67), and the significance threshold was ≥5.6% (aRR 1.60).

· Sensitivity analyses showed similar results when including the participants with missing SPL records or HbA1c data.

· Linear associations of HbA1c levels remained significant even in the subgroups without alcohol consumption, overweight, and a family history of diabetes and adverse pregnancy outcomes.

· Every 1 mmol/L increment in maternal FBG levels was associated with a >2-fold higher risk of SPL (aRR 2.12).

“In this large prospective cohort study, we provide solid evidence that HbA1c levels in early gestation within the clinically normal range were associated with an increased risk of SPL in a linear dose-response manner among pregnant women without diabetes,” the researchers wrote.

“Our findings in a prospective cohort are novel and deepen our understanding of the important pathophysiologic role of impaired maternal glycemic metabolism in the development of spontaneous pregnancy loss,” they concluded.

Reference:

Chen X, Zhang Y, Chen H, Dou Y, Wang Y, He W, Ma X, Sheng W, Yan W, Huang G. Association Between Serum Glycated Hemoglobin Levels at Early Gestation and the Risk of Subsequent Pregnancy Loss in Pregnant Women Without Diabetes Mellitus: Prospective Cohort Study/ JMIR Public Health Surveill 2023;9:e46986. URL: https://publichealth.jmir.org/2023/1/e46986. DOI: 10.2196/46986

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Targeting TyG index more effective for primary and secondary prevention of hypertension, study suggests

China: Early identification of increasing triglyceride glucose index (TyG index) could provide insights for hypertension prevention later in life, a recent study has suggested. The study was published online in Cardiovascular Diabetology on December 15, 2023.

Hui Zhao, Health Management Center of the Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, Liaoning, China, and colleagues showed that elevated triglyceride glucose index at baseline and long-term trajectories of TyG index were associated with hypertension risk.

Previous studies have demonstrated that TyG index trajectories are associated with cardiovascular diseases (CVDs). However, no investigation has been performed on the association between the patterns of TyG index trajectories and hypertension risk. The research team, therefore, aimed to identify distinct TyG index trajectories over 12 years and describe their association with the incidence of hypertension in a longitudinal general population.

For this purpose, they retrospectively recruited 15,056 adults from the Physical Examination Center of the Second Affiliated Hospital of Dalian Medical University in the northeast of China. The median age of the population was 38 years, and 48.83% of the participants were men.

TyG index was calculated as ln (fasting TG [mg/dL] × FPG [mg/dL]/2) and the TyG index trajectories were developed using group-based trajectory modelling. The association between the TyG index and the incidence of hypertension was assessed using the Cox regression analysis.

The researchers reported the following findings:

  • Three distinct TyG index trajectories were identified: “low increasing” (N = 7241), “moderate increasing” (N = 6448), and “high stable” (N = 1367).
  • Using the “low increasing” trajectory as a reference, “moderate increasing” and “high stable” trajectories were associated with an increased risk of hypertension (HR = 2.45 and HR = 3.88).
  • After adjusting for baseline age, sex, smoking, diabetes, systolic blood pressure, diastolic blood pressure, cholesterol, BMI, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose, triglyceride, uric acid, urea and glomerular filtration rate, the HR were slightly attenuate in “moderate increasing” and “high stable” trajectories to 1.38 and 1.69 respectively. Similar results were observed in multiple sensitivity analyses.
  • The HR of the “moderate increasing” and “high stable” trajectory groups were 2.63 and 4.66 in females and 1.66 and 2.33 in males.

“Our findings indicate that not only the baseline TyG index but also high TyG index growth trajectories were associated with hypertension development,” the researchers wrote. “Long-term monitoring of dynamic changes of the TyG index may identify people at high hypertension risk.”

“Prevention programs that target the TyG index may be more effective for primary and secondary prevention of hypertension,” they concluded.

Reference:

Xin, F., He, S., Zhou, Y. et al. The triglyceride glucose index trajectory is associated with hypertension: a retrospective longitudinal cohort study. Cardiovasc Diabetol 22, 347 (2023). https://doi.org/10.1186/s12933-023-02087-w

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Warfarin use reduces mortality risk after aortic valve replacement

USA: Warfarin use after bioprosthetic surgical aortic valve replacement (sAVR) was tied to lower all-cause mortality and decreased thromboembolism risk compared with not receiving warfarin, a recent retrospective study has revealed. The findings were published online in Mayo Clinic Proceedings. 

The use of bioprosthetic aortic valve replacement has increased significantly during the past decade. Among its advantages is that most patients can avoid warfarin for anticoagulation treatment. Even so, research has been conflicting on whether patients would benefit from more aggressive early postoperative anticoagulation treatment.

The researchers compared thromboembolic events and all-cause mortality in patients undergoing surgical aortic valve replacement receiving anticoagulation with warfarin versus patients with no systemic anticoagulation.

Mayo Clinic researchers analyzed nationwide data on more than 10,000 patients who underwent bioprosthetic aortic valve replacement. Warfarin use was associated with a 32% reduction in mortality risk. Patients treated with warfarin early postoperatively also had an increased risk of major bleeding events. 

Key findings:

  • Of 10,589 patients having sAVR, 72.3% were in the
    nonwarfarin group and 27.7% were in the warfarin group. After PS matching, 2930
    pairs of patients were analyzed. Median follow-up was 4.1 months for the
    warfarin group and 21.3 months for the nonwarfarin group.
  • Overall mortality was lower for the warfarin
    group than for the nonwarfarin group (hazard ratio [HR], 0.68), and there was a
    trend toward decreased cumulative incidence of thromboembolic events
    (subdistribution HR [SHR], 0.62).
  • The cumulative incidence of major bleeding events
    was higher for the warfarin group vs the nonwarfarin group (SHR, 1.94). Results
    were similar in a subgroup analysis of patients undergoing isolated sAVR.

“The findings support early warfarin use in appropriately selected patients, such as patients with low bleeding risk,” says Hartzell Schaff, M.D., a Mayo Clinic cardiovascular surgeon who contributed to the study. “There’s often reluctance to prescribe anticoagulant treatment early after surgery due to concerns about bleeding and uncertainty about benefits. Our research finds that the small increased hazard of bleeding (4% versus 2.3%) may be an acceptable risk given the benefits in terms of mortality risk as well as reduced risk of thromboembolism.”

The Mayo Clinic study analyzed deidentified patient data from 2007 to 2019 using OptumLabs Data Warehouse, which contains claims data of commercially insured and Medicare Advantage enrollees of all ages and races throughout the U.S.

Reference:

Huang Y, Schaff HV, Swarna KS, Sangaralingham LR, Nishimura RA, Dearani JA, Crestanello JA, Greason KL. Benefit of Anticoagulation Early After Surgical Aortic Valve Replacement Using Bioprosthetic Valves. Mayo Clin Proc. 2023 Dec;98(12):1797-1808. doi: 10.1016/j.mayocp.2023.08.012. 

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Polihexanide monotherapy safe and effective in Acanthamoeba Keratitis, finds study

In a groundbreaking phase 3 study, researchers have compared the effectiveness of two treatment regimens for Acanthamoeba keratitis (AK), a rare but potentially severe eye infection. The trial, focused on evaluating the outcomes of patients treated with topical polihexanide (PHMB), with one group receiving a combination therapy and the other a novel monotherapy approach found that polihexanide (PHMB) 0.08% monotherapy was as effective as dual therapy with PHMB 0.02% + propamidine, with medical cure rates of more than 86%.

The trial results were published in the journal Ophthalmology. 

Acanthamoeba keratitis (AK) is one of the less common causes of microbial keratitis, but also one of the most severe diseases requiring prolonged treatment time, high rates of surgical intervention, and poor visual outcomes. Recent studies have shown that topical polihexanide (PHMB) treatments have cure rates within 12 months. Hence, researchers conducted a trial to evaluate topical PHMB (polihexanide) 0.02% (0.2 mg/ml)+ propamidine 0.1% (1 mg/ml) with PHMB 0.08% (0.8 mg/ml)+ placebo (PHMB 0.08%) for Acanthamoeba keratitis (AK) treatment. 

Also Read: Vitamin D Deficiency Linked to Higher Risk of Noninfectious Uveitis

The research involved 135 participants aged 12 and older, presenting with clinical findings consistent with AK. Inclusion criteria allowed for the enrollment of individuals with concurrent bacterial keratitis, using topical steroids, and antiviral, and antifungal drugs before randomization. Exclusion criteria ruled out patients with concurrent herpes or fungal keratitis and those on antiamebic therapy (AAT). The study design was a prospective, randomized, double-masked, and active-controlled trial with a multicenter approach. Participants were randomized 1:1, utilizing a computer-generated block size of 4. The primary objective was to determine the medical cure rate (MCR) within 12 months without the need for surgery or a change in antiamebic therapy.

Findings:

  • The findings have significant implications for the treatment landscape of Acanthamoeba keratitis. The novel monotherapy approach not only showcases promising efficacy but also offers a potential alternative to current treatment protocols. As researchers continue to delve into the intricacies of ocular infections, this study marks a substantial step forward in improving outcomes for individuals affected by Acanthamoeba keratitis.
  • Results from the study’s full-analysis subset, consisting of 127 participants, revealed intriguing findings.
  • The adjusted MCR within 12 months was remarkably similar for both groups—86.6% for the combination therapy of PHMB 0.02% + propamidine and 86.7% for the novel PHMB 0.08% monotherapy.
  • The noninferiority requirement for the latter was met, with an adjusted difference of only 0.1 percentage points and a lower one-sided 95% confidence limit of -8.3 percentage points.
  • Secondary outcomes, including best-corrected visual acuity and treatment failure rates, were comparable between the two treatment groups.
  • The median best-corrected visual acuity was an impressive 20/20, and the overall treatment failure rate was reported at 13.4%. Of those patients experiencing treatment failure, 6.3% required therapeutic keratoplasty.
Also Read: Combination of cyclosporine and loteprednol may significantly improve corneal higher-order aberrations

Importantly, the study demonstrated the safety of both treatment regimens, with no serious drug-related adverse events reported. This suggests that PHMB 0.08% monotherapy could potentially match the efficacy of the widely used dual therapy with PHMB 0.02% + propamidine in populations with similar disease severity.

Further reading: The Orphan Drug for Acanthamoeba Keratitis (ODAK) Trial. PHMB 0.08% (Polihexanide) and Placebo versus PHMB 0.02% and Propamidine 0.1%. https://doi.org/10.1016/j.ophtha.2023.09.031

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ALR RSI score may help evaluate psychological readiness to return to sport after acute Achilles tendon tear

The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport.

E. Shitrit et al conducted a study to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair. The study been published in “Knee Surgery, Sports Traumatology, Arthroscopy” journal.

The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires.

Open surgical repair of a recent Achilles tendon tear was performed in all patients of different centres. Patients were immobilised in a boot-with-heel lifts and no weight-bearing for 3 weeks, then, in same position with weight-bearing allowed. Afterwards, they followed an equivalent rehabilitation protocol, including joint range of motion recovery and muscle strengthening.

Key findings of the study were:

• 50 patients were included in the study, 8 women and 42 men.

• The level of sports activity of the patients were:

Five patients (10%) were professional athletes (1 basket, 2 handball, 2 football),

20 patients (40%) practised a sport at the competitive level, and

25 (50%) at the amateur level.

• Eleven of the 50 patients (22%) had returned to sport at 6.8 months of follow-up. Four (36.4%) of these patients returned to sport at the preinjury level of play and 7 patients (63.6%) at a lower level of play.

• No correlation was found between the type, level of sport, and the return to sport.

• The ALR-RSI score was strongly (r>0.5) correlated to the EFAS score: r=0.68 [0.50–0.80] the FAMM sport score: r=0.7 [0.52–0.84] the FAAM AVQ score (r=0.6 [0.35–0.78]), and the VISA A score (r=0.54 [0.26–0.76]).

• The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40–81.4) compared to those that did: 83.2 (64.3–100) p=0.001.

• Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097–1.00]. The internal consistency was excellent (alpha coefficient=0.95).

The authors concluded – “The results of this series show that the ALR-RSI score is a valuable tool to assess the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair.”

Level of evidence – III.  

VISA-A Victorian institute of sport assessment-Achilles

EFAS European Foot and Ankle Society

FAAM Foot ankle ability measurement

Further reading:

The ALR RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear

E. Shitrit, E. Valentin et al

Knee Surgery, Sports Traumatology, Arthroscopy (2023) 31:4961–4968

https://doi.org/10.1007/s00167-023-07548-z

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Early Metabolic Syndrome Linked to High Pancreatic Cancer Risk: Lancet

A recent retrospective observational study found compelling evidence of increased incidence of pancreatic cancer associated with the early stages of metabolic syndrome (MetS). The findings of the study were published in Lancet eClinicalMedicine.

This study recruited a staggering 4.6 million Japanese participants in 2005 with rigorous follow up of over a decade. The clinical data, prescribed drug regimens, and the presence of MetS using modified criteria from the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) were meticulously analyzed. Out of the 2,707,296 subjects without pancreatic cancer at enrollment, 87,857 eventually developed pancreatic cancer during the 40.7-month average follow-up.

The incidence of pancreatic cancer was markedly higher in the MetS group (4.9%) compared to the non-MetS group (3.0%), with a statistically significant hazard ratio (HR) of 1.37 (95% confidence interval [CI], 1.34–1.39) after adjusting for age, smoking, and sex. Also, with increase in the number of MetS constituent factors from one to five, there was a corresponding rise in the incidence of pancreatic cancer which signify a dose-response relationship.

Also, the study extended its analysis to include pre-metabolic syndrome (pre-MetS) according to Japanese criteria and found a robust link between pre-MetS and the occurrence of pancreatic cancers. The findings strongly suggest a significant association between MetS particularly in its early stages, and the development of pancreatic cancer but, the study falls short in establishing causality.

This extensive study provides robust evidence to affirm the link between metabolic syndrome and pancreatic cancer. The finding that even the early stages of MetS are tightly correlated with pancreatic cancer underscores the importance of vigilant monitoring and intervention in individuals exhibiting the metabolic syndrome indicators.

Source:

Miyashita, Y., Hitsumoto, T., Fukuda, H., Kim, J., Ito, S., Kimoto, N., Asakura, K., Yata, Y., Yabumoto, M., Washio, T., & Kitakaze, M. (2024). Metabolic syndrome is linked to the incidence of pancreatic cancer. EClinicalMedicine, 67(102353), 102353. https://doi.org/10.1016/j.eclinm.2023.102353

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Chia seeds could be future treatment of high blood pressure and cancer

A study at Oregon State University (OSU) has mapped the genome of chia seeds to help future researchers take advantage of the plant’s potential for benefiting human health in various ways.

The study identifies genetic properties in chia seeds that may one day be leveraged in pharmaceuticals for treating high blood pressure and cancer. Other study findings support chia seeds’ antioxidant and anti-inflammatory properties.

The chia plant, Salvia hispanica L., belongs to the family Lamiaceae. It is commonly grown on subsistence farms in marginal agricultural areas.

The chia plant was once considered secondary, along with cassava, yams, millet, small grains, and pulses such as lentils. Being less prioritized, these plants were often considered “orphan” crops.

Historically, more attention has been paid to primary crops, cereal plants like rice, wheat, and maize, and small grains, such as legumes, oilseed, and tubers. These have all been important to the fight against global hunger.

However, orphan foods are growing in popularity for their health benefits. As climate change alters the agricultural landscape, these lesser-grown plants are becoming of interest. The mapping of chia seeds’ genomes is one step in this direction.

The new study presents an entire chia seed reference genome. It is 303.6 MB in size and encodes 48,090 annotated protein-coding genes. It identifies chia genes associated with valuable nutrients.

The study is published in Frontiers in Plant Science.

A closer look at the health benefits of chia seeds

This is the first report of in silico mapping of a plant genome for the purpose of assessing its health benefits.

Dr. Pankaj Jaiswal is a member of OSU’s Department of Botany and Plant Pathology. He was the senior investigator of the new study.

While the study is important for what it reveals about chia seeds, Dr. Jaiswal noted, “It was the first time a plant genome was analyzed for its potential nutritional quality and discovery of biopeptides that may play a role in improving human health conditions.”

Chia seeds are hardly alone in their nutritional qualities that have caught the attention of pharmaceutical researchers.

According to the U.S. Department of Agriculture (USDA), 40% of pharmaceutical drugs currently available in pharmacies in the United States are derived from plants, including the top 20 best-selling medications.

Aspirin, for example, is derived from the bark of a willow tree. Leukemia in children is treated with a medicine based on molecules from the Madagascar periwinkle.

The use of plants for medicinal purposes has a long history, dating back to 3,500 BC and Ancient Egypt. Chinese healers were using plants as drugs by 2,700 BC.

Why are chia seeds so good for you?

For many people in the West, chia seeds are perhaps best-known for the growing “hairs” in chia pets, a favorite childhood and decorative toy.

Nutritionists know, however, they are far more than that.

Michelle Routhenstein, registered dietitian nutritionist and preventive cardiology dietitian at EntirelyNourished.com, not involved in the study, listed some health benefits attributed to chia seeds:

“Chia seeds contain several minerals like calcium and magnesium, which play a role in reducing blood pressure. Additionally, their rich antioxidant and alpha-linolenic acid content, an omega-3 fatty acid derived from plants, may help to alleviate oxidative stress and inflammation, both factors that could contribute to heart disease.”

Dr. Jaiswal likened chia seeds to a “treasure trove” of nutrients.

Describing his chia-seed genetic blueprint as a work in progress, Dr. Jaisway was cautious about ascribing all the reported benefits to the plant.

Still, he said the results of his research thus far have been promising. “It is likely a target for discovering beneficial biomolecules,” Dr. Jaiswal said.

“All of the anti-aging peptides previously reported from chia were found present in the proteins encoded by the genes that were expressed in seeds. In their native form in the seed, they play a role as seed storage protein, but when digested by the digestive juices, the released biopeptides may acquire a different role,” he said.

“Many such health benefit studies were conducted using the whole seeds or the flour. Therefore, we need a lot of support for the research and investigation to connect the molecules we discovered to their health benefits,” Dr. Jaiswal continued.

New research could lead to improved chia seed crops

According to Dr. Jaiswal, one of the study’s benefits is that the chia genome blueprint will “help the plant breeding community in developing genetic resources” to improve crops. Traits of improved chia seed crops might include:

• yield and nutrition quality

• shorter flowering and seed development time

• improved frost and cold tolerance in the northern latitudes

• improved day-neutral or short-day flowering

“We are investigating climate resilience and disease resistance in rice,a global staple food crop, and plan to combine chia and dry beans to discover potential human health benefits by studying molecular interactions,” Dr. Jaiswal said.

Finally, accompanying the research is the development of the Salvia genomics database (SaliviaGDB) to aid future studies and help develop applications for chia seeds.

Reference:

Parul Gupta, Matthew Geniza, Justin Elser, Noor Al-Bader, Rachel Baschieri, Jeremy Levi Phillips, Ebaad Haq, Justin Preece, Sushma Naithani, Pankaj Jaiswal, Reference genome of the nutrition-rich orphan crop chia (Salvia hispanica) and its implications for future breeding,|Frontiers in Plant Science, https://doi.org/10.3389/fpls.2023.1272966

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Is there a relation between stillbirth Risk in Grandchild and Grandmother’s Obesity?

Women’s obesity and overweight problems have reached epidemic levels, making them the most significant preventable risk factors for stillbirth.

Eduardo Villamor, in a recent investigation published in the American Journal of Epidemiology, said grandmaternal overweight and obesity are associated with grand offspring stillbirth.

In this Swedish population-based study, researchers investigated the association between maternal grandmaternal early pregnancy BMI and grand offspring stillbirth risk. This three-generation cohort included nearly 176,908 grandmothers, 197,579 mothers, and more than 316,459 grand offspring born 1997-2016, using Swedish Medical Birth Register.

Key findings are:

  • There were 998 stillbirths reported in grand offspring with risk, 3.2 per 1000 births.
  • Compared to the grandmaternal normal BMI of 18.5-24.9 mg/kg2, stillbirth risk increased by 41 % (Relative risk 1.41).
  • With increasing BMI ≥30, stillbirth risk increased by 62 % (relative risk 1.62).
  • Maternal overweight and obesity in early pregnancy increased stillbirth risk in offspring by 32% and 77%, respectively.
  • As indicated by causal mediation analysis, Maternal BMI mediated only 19% of this relation.

They said, In 101,368 pregnancies, we studied the relationship between maternal full sisters’ BMI and stillbirth risk to determine if shared familial factors explain the association. The stillbirth risk for full sisters with a BMI of 25.0-29.9 and ≥30 compared to 18.5-24.9 was 0.76 and 0.88, respectively. Our conclusion is that shared familial factors do not fully explain the association.

This study revealed an association between grandmaternal body mass index (BMI) and grand offspring stillbirth.

Observational design and selection bias due to missing data were the limitations of this study.

National Institutes of Health funded the study.

Reference:

Eduardo Villamor, Sven Cnattingius, Grandmaternal body mass index in early pregnancy and risk of grand offspring stillbirth: A nationwide, three-generation cohort study, American Journal of Epidemiology, 2023; kwad235, https://doi.org/10.1093/aje/kwad235

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Diffuse gingival enlargement can be manifestation of hematological malignancies- Case report

Greece: A recent case study published in Cureus describes an unusual case of acute myeloid leukaemia (AML) in a 26-year-old male patient who presented to the clinic with a complaint of persistent bilateral gingival bleeding in the posterior areas of the maxilla.

“Hematological malignancies can manifest in the oral cavity and that manifestation could be the only diagnostic sign as observed in this case,” Vasileios Zisis, Oral Medicine/Pathology, Aristotle University of Thessaloniki, Thessaloniki, GRC, and colleagues wrote.

They added, “It is, therefore, vital for the clinician to not rule out malignancy when such a clinical situation presents and to make an appropriate early referral.”

Acute myeloid leukaemia is a malignancy characterized by its extreme aggressiveness. It accounts for about 25% of leukaemia cases in the pediatric population. Therefore, in the case described, the age of the patient may be considered atypical, according to the authors.

Gingival hyperplasia may occur due to microbial-related local irritation, drug administration, mouth breathing, leukaemia, genetic disorders, Crohn’s disease, Wegener granulomatosis, and sarcoidosis. The background may be fibrotic, inflammatory, or combined. In the study, Dr. Zisis and colleagues aimed to present the diagnostic procedure for a case of gingival enlargement, which was the only sign of severe systemic disease in a young male adult.

The 26 years old male patient was referred by his dentist to the Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, complaining of persistent gingival bleeding in the posterior area of the maxilla, bilaterally, and mild pain due to food impaction in the interdental area. The patient provided written informed consent before the examination. Subsequently, the patient was examined thoroughly. The physical examination revealed diffuse reddish swelling, palpable gingival masses, bleeding on probing, and the presence of pseudopockets of 4-6mm. Clinically, a diffuse gingival enlargement was seen without lymphadenopathy.

The histopathological examination demonstrated abundant neoplastic cells of hemopoietic origin with strong and diffuse positivity for CD45 and CD68. In addition, scattered neoplastic cells exhibited mild to moderate positivity for c-kit (CD117), indicating the diagnosis of acute myeloid leukaemia, which diffusely infiltrated the lamina propria of the gingiva.

“The several conditions leading to gingival enlargement other than periodontitis or gingivitis are diagnostic challenges in clinical practices,” the team wrote. “The dentist plays an important role in the timely identification of hematologic disorders.” They note the significant role that dentists play in commencing leukaemia diagnosis in cases of oral manifestations.

“Therefore, these manifestations must be easily identifiable, prompting a comprehensive inquiry involving supplementary tests or a referral to a qualified practitioner to arrive at a definitive diagnosis,” they concluded.

Reference:

Zisis V, Zisis S, Anagnostou E, et al. (October 30, 2023) Gingival Enlargement Can Constitute the Only Diagnostic Sign of Leukemia: Report of an Unusual Case. Cureus 15(10): e47959. doi:10.7759/cureus.47959

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Maternal influenza vaccination during pregnancy may protect infant in first few months of life: JAMA

A recent study exploring the impact of maternal influenza vaccination during pregnancy has shown promising outcomes in reducing influenza-related hospitalizations and emergency department (ED) visits in infants under 6 months of age. The study, conducted using data from the New Vaccine Surveillance Network across multiple influenza seasons, sheds light on the protective benefits of maternal vaccination against influenza-associated illnesses in young infants.

The study was published in the journal of JAMA Pediatrics by Leila Sahni and colleagues. The study included 3764 infants, among whom 53% were born to mothers who received influenza vaccination during pregnancy. The overall effectiveness of maternal vaccination in infants against influenza-related hospitalizations and ED visits was estimated at 34%. Specifically, the vaccine demonstrated a 39% effectiveness in preventing hospitalizations and a 19% effectiveness in mitigating ED visits associated with influenza.

Among infants younger than 3 months, the effectiveness of maternal vaccination soared to 53%, indicating a stronger protective effect in this vulnerable age group. Notably, infants born to mothers vaccinated during the third trimester exhibited a higher effectiveness rate of 52%, whereas those whose mothers were vaccinated during the first or second trimesters showed a lower effectiveness rate of 17%.

The study’s findings underscore the significance of maternal influenza vaccination during pregnancy in reducing the risk of influenza-associated hospitalizations and ED visits in infants below 6 months of age. The observed effectiveness was particularly notable in younger infants and those born to mothers vaccinated during the later stages of pregnancy.

These results emphasize the importance of promoting maternal influenza vaccination as a crucial preventive measure to safeguard both maternal and infant health. Encouraging vaccination, especially during the third trimester, could offer substantial protection against influenza-related complications in vulnerable newborns.

Reference:

Sahni, L. C., Olson, S. M., Halasa, N. B., Stewart, L. S., Michaels, M. G., Williams, J. V., Englund, J. A., Klein, E. J., Staat, M. A., Schlaudecker, E. P., Selvarangan, R., Schuster, J. E., Weinberg, G. A., Szilagyi, P. G., Boom, J. A., Patel, M. M., Muñoz, F. M., McNeal, M., Rohlfs, C., … New Vaccine Surveillance Network Collaborators. Maternal vaccine effectiveness against influenza-associated hospitalizations and emergency department visits in infants. JAMA Pediatrics,2023. https://doi.org/10.1001/jamapediatrics.2023.5639

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