Patients with mental distress after MI likely to have PTSD, finds study

A recent cross-sectional epidemiological study sheds light on a concerning trend among individuals who have experienced myocardial infarction (MI). The research, conducted as part of the Tromsø Study, aimed to investigate the prevalence of post-traumatic stress disorder (PTSD) among patients following a confirmed diagnosis of myocardial infarction and explore the relationship between PTSD symptoms and exposure to traumatic events.

This study was published in the journal BMC Psychiatry by Geir Fagerjord Lorem and colleagues. The study, encompassing a sample of 79 participants who had experienced myocardial infarction, unveiled a noteworthy discovery: 11.6% of these individuals exhibited symptoms indicative of probable PTSD. This prevalence was notably higher than what is typically postulated for the general population in Norway, marking a statistically significant difference.

Interestingly, the research didn’t establish a direct correlation between myocardial infarction as an illness trauma and the severity of PTSD symptoms. However, an intriguing pattern emerged concerning the association between PTSD symptom severity and lifetime exposure to traumatic events. As the number of traumatic events experienced by individuals increased, a proportional rise in symptom severity was observed.

The findings highlight a crucial aspect: anxiety or depression symptoms experienced by myocardial infarction patients might be secondary manifestations of PTSD rather than direct consequences of the cardiac event itself. This emphasises the importance for clinicians to be vigilant in their assessment of post-MI patients, considering the potential for underlying PTSD-related symptoms.

While this study offers valuable insights, the interaction between myocardial infarction and PTSD requires more extensive exploration. Future research endeavours are crucial to deepen our understanding of how these conditions intersect and influence each other. Such investigations could pave the way for more targeted and effective interventions aimed at improving the mental well-being of individuals recovering from myocardial infarction.

Reference:

Lorem, G. F., Næss, E. T., Løchen, M.-L., Lillevoll, K., Molund, E.-M., Rösner, A., Lindkvist, S., & Schirmer, H. Post-traumatic stress disorder among heart disease patients: a clinical follow-up of individuals with myocardial infarction in the Tromsø Study. BMC Psychiatry,2023;23(1). https://doi.org/10.1186/s12888-023-05431-2

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Higher scores for systemic inflammatory markers linked to higher prevalence of hypertension

In a sweeping epidemiological analysis aimed at unraveling the mysteries of hypertension, researchers have unveiled a significant breakthrough in understanding the associations between systemic inflammation markers and the prevalence of this prevalent health condition. They found a robust and significant positive correlation between systemic immune inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) with the prevalence of hypertension, thus underscoring the intricate relationship between systemic inflammation and hypertension.

The study results were published in the journal BMC Cardiovascular Disorders.

Also Read: Brain lesions in former football players linked to vascular, brain changes

Hypertension significantly impacts cardiovascular outcomes, being a major predictor of global mortality and public health concerns. Research suggests links between autoimmunity, inflammation, metabolism, and hypertension. While the systemic immune inflammation index (SII) and hypertension association are explored, the correlations between the system inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI) remain uninvestigated. Hence, researchers conducted a cross-sectional study to comprehensively analyze these inflammation markers, seeking potential biomarkers for early hypertension detection.
The present cross-sectional study engaged a substantial cohort of 119,664 individuals participating in the National Health and Nutrition Examination Survey. A meticulous examination of the three systemic inflammation markers—namely, the systemic immune inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI)—and their associations with hypertension prevalence was carried out.

Findings:

  • The findings unveiled a gradual increase in hypertension prevalence rates with ascending quartiles of logSII, logSIRI, and logAISI.
  • In continuous analyses, each unit increase in logSII, logSIRI, and logAISI corresponded to a 20.3%, 20.1%, and 23.7% elevated risk of hypertension, respectively.
  • When compared to individuals in the lowest quartiles, those in the highest quartiles of logSII, logSIRI, and logAISI faced hypertension risks elevated by 1.114-fold, 1.143-fold, and 1.186-fold, respectively.
  • The Restricted Cubic Splines (RCS) analysis further illuminated a non-linear relationship between the escalation of systemic inflammation markers and the prevalence of hypertension.
  • Specifically, a per standard deviation increase in any of these variables correlated with a 9%, 16%, and 11% respective rise in hypertension prevalence.
Also Read: Peribulbar anaesthesia in ophthalmic surgery linked to development of pulmonary oedema
Thus, the present comprehensive cross-sectional study establishes robust and significant positive correlations between systemic immune inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) with the prevalence of hypertension. These findings not only underscore the intricate relationship between systemic inflammation and hypertension but also pave the way for potential biomarkers that could revolutionize early detection strategies. As hypertension remains a global health concern, these insights hold immense promise for advancing proactive healthcare approaches and refining our understanding of the complex interplay between inflammation and cardiovascular health.
Further reading: Jin N, Huang L, Hong J, et al. The association between systemic inflammation markers and the prevalence of hypertension. BMC Cardiovasc Disord. 2023;23(1):615. Published 2023 Dec 14. doi:10.1186/s12872-023-03661-6

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DAPT within 72 hours can help improve stroke symptoms

Dual antiplatelet treatment (DAPT) has proven to lower the risk of recurrent stroke as compared with aspirin alone when treatment is initiated early (≤24 hours) after an acute mild stroke.

The effect of clopidogrel plus aspirin as compared with aspirin alone administered within 72 hours after the onset of acute cerebral ischemia from atherosclerosis has not been well studied. A new study in New England Journal of Medicine says that DAPT  initiated within 72 hours after stroke onset led to a lower risk of new stroke at 90 days than aspirin therapy alone but was associated with a low but higher risk of moderate-to-severe bleeding.

Around 222 hospitals in China, researchers conducted a double-blind, randomized, placebo-controlled, two-by-two factorial trial involving patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) of presumed atherosclerotic cause who had not undergone thrombolysis or thrombectomy. Patients were randomly assigned, in a 1:1 ratio, within 72 hours after symptom onset to receive clopidogrel (300 mg on day 1 and 75 mg daily on days 2 to 90) plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 21) or matching clopidogrel placebo plus aspirin (100 to 300 mg on day 1 and 100 mg daily on days 2 to 90). There was no interaction between this component of the factorial trial design and a second part that compared immediate with delayed statin treatment (not reported here). The primary efficacy outcome was new stroke, and the primary safety outcome was moderate-to-severe bleeding-both assessed within 90 days.

Researchers found that a total of 6100 patients were enrolled, with 3050 assigned to each trial group. TIA was the qualifying event for enrollment in 13.1% of the patients. A total of 12.8% of the patients were assigned to a treatment group no more than 24 hours after stroke onset, and 87.2% were assigned after 24 hours and no more than 72 hours after stroke onset. A new stroke occurred in 222 patients (7.3%) in the clopidogrel–aspirin group and in 279 (9.2%) in the aspirin group (hazard ratio, 0.79; 95% confidence interval [CI], 0.66 to 0.94; P=0.008). Moderate-to-severe bleeding occurred in 27 patients (0.9%) in the clopidogrel–aspirin group and in 13 (0.4%) in the aspirin group (hazard ratio, 2.08; 95% CI, 1.07 to 4.04; P=0.03).

Among patients with mild ischemic stroke or high-risk TIA of presumed atherosclerotic cause, combinedclopidogrel–aspirin therapyclopidogrel–aspirin therapy initiated within 72 hours after stroke onset led to a lower risk of new stroke at 90 days than aspirin therapy alone but was associated with a low but higher risk of moderate-to-severe bleeding.

Reference:

Ying Gao, Weiqi Chen, Yuesong Pan, Jing Jing, Chunjuan Wang, Claiborne Johnston, Pierre Amarenco, Philip M. Bath, Lingling Jiang, Yingying Yang, Tingting Wang, Shangrong Han, Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke, N Engl J Med 2023, DOI: 10.1056/NEJMoa2309137.

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How Repetitive Head injury leads to dementia in Football Players, reveals MRI study

In a groundbreaking study conducted between April 2021 and October 2022, researchers have uncovered alarming connections between repetitive head impacts (RHIs) in American football and an increased burden of white matter hyperintensity (WMH). They found that Fluid-attenuated inversion recovery (FLAIR) WMH in RHI-exposed individuals exhibits distinct risk factors and underlying pathologies when compared with asymptomatic unexposed men.

The study results were published in the journalNeurology.

Also Read: Risk of young onset dementia could be reduced through targeting health and lifestyle factors – study

Recent findings connect repetitive head impacts (RHIs) in American football to heightened white matter hyperintensity (WMH) burden. WMH may exhibit distinctive features in the context of RHI, extending beyond vascular risk and typical aging processes. Hence researchers conducted a study to assess the impact of repeated head injuries using encompassed biological markers like amyloid, tau, inflammation, axonal injury, neurodegeneration, and vascular health in former American football players.

Participants, as part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project, underwent clinical interviews, MRI scans, and lumbar punctures. Structural equation modeling assessed both direct and indirect effects between log-transformed total fluid-attenuated inversion recovery (FLAIR) lesion volumes (TLV) and various factors, including the revised Framingham stroke risk profile (rFSRP), MRI-derived metrics of cortical thickness and fractional anisotropy (FA), and cerebrospinal fluid (CSF) levels of amyloid β1–42, p-tau181, soluble triggering receptor expressed on myeloid cells 2 (sTREM2), and neurofilament light. Covariates considered in the analysis included age, race, education, body mass index, APOE ε4 carrier status, and evaluation site. Separate models were conducted for former football players and a control group of asymptomatic men not exposed to repetitive head impacts (RHI).

Findings:

  • In a cohort of 180 former football players (mean age = 57.2, 36% Black), elevated log-transformed total fluid-attenuated inversion recovery (FLAIR) lesion volumes (TLV) were directly linked to several factors.
  • These included a higher revised Framingham stroke risk profile (rFSRP) score (B = 0.26, 95% CI 0.07–0.40), increased p-tau181 (B = 0.17, 95% CI 0.01–0.43), diminished fractional anisotropy (FA) (B = −0.28, 95% CI −0.42 to −0.13), and reduced cortical thickness (B = −0.25, 95% CI −0.45 to −0.08).
  • Conversely, in a group of 60 asymptomatic unexposed men (mean age = 59.3, 40% Black), no direct effects on log(TLV) were observed.
  • This was evident in the negligible impact on rFSRP (B = −0.03, 95% CI −0.48 to 0.57), p-tau181 (B = −0.30, 95% CI −1.14 to 0.37), FA (B = −0.07, 95% CI −0.48 to 0.42), and cortical thickness (B = −0.28, 95% CI −0.64 to 0.10).
  • Comparatively, former football players exhibited notably stronger associations between log(TLV) and rFSRP (1,069% difference in estimates), p-tau181 (158%), and FA (287%) when contrasted with the unexposed men.
  • These findings underscore the distinct impact of repetitive head impacts in former football players, revealing significant correlations with various neurological markers compared to individuals without a history of such exposure.
Also Read: Modified Epley maneuver bests traditional approach for treating PC-benign paroxysmal positional vertigo

Risk factors and the biological relationships with white matter hyperintensity (WMH) vary significantly between former American football players and asymptomatic individuals without exposure to repetitive head impacts (RHI). Apart from considering vascular health, the former football players demonstrated more robust associations between WMH and factors like p-tau181 and diffusion tensor imaging indices, indicating a more profound connection to white matter integrity. These results suggest that fluid-attenuated inversion recovery (FLAIR) WMH in those exposed to repetitive head impacts may have unique risk factors and distinct underlying pathological mechanisms.

Further reading: Association of Vascular Risk Factors and CSF and Imaging Biomarkers With White Matter Hyperintensities in Former American Football Players. doi: https://doi.org/10.1212/WNL.00000000002080

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Low-Carbohydrate Diet helps in Weight Change

Low-carbohydrate diets (LCDs) are popular and gained considerable attention, as they hold the promise for promoting weight loss and improving metabolic health. LCDs, include diets such as ketogenic diets with only 5% to 10% of energy from carbohydrates, have led to favorable short-term weight changes.

A recent cohort study suggests LCDs that emphasized high-quality proteins, fats and carbohydrates from whole grains and other healthy plant-based foods were significantly associated with slower weight gain in the long term. In contrast, LCDs emphasizing animal-sourced proteins and fats or refined carbohydrates were associated with faster weight gain. This study is published JAMA Network.

The associations of low-carbohydrate diets (LCDs) with long-term weight management remains unclear, and the source and quality of macronutrients within LCDs are less explored.

To prospectively examine associations between changes in LCD indices and weight change among US adults.

Researchers designed a prospective cohort study included initially healthy participants at baseline from the Nurses’ Health Study (NHS; 1986-2010), Nurses’ Health Study II (NHSII; 1991-2015), and Health Professionals Follow-up Study (HPFS; 1986-2018). Data analysis was performed between November 2022 and April 2023. Five LCD indices were examined: (1) a total LCD (TLCD) emphasizing overall lower carbohydrate intake; (2) an animal-based LCD (ALCD) that emphasized animal-sourced protein and fat; (3) a vegetable-based LCD (VLCD) that emphasized plant-sourced protein and fat; (4) a healthy LCD (HLCD) emphasizing less refined carbohydrates, more plant protein, and healthy fat; and (5) an unhealthy LCD (ULCD) emphasizing less healthful carbohydrates, more animal protein, and unhealthy fat. The outcome of interest was 4-year changes in self-reported body weight.

The key findings of the study are

  • A total of 123 332 participants (mean [SD] age, 45.0 [9.7] years; 103 320 [83.8%] female) were included in this study. The median carbohydrate intake (as a percentage of energy) of the highest quintiles of TLCD score at baseline ranged from 38.3% in HPFS to 40.9% in NHSII.
  • Mean weight gain over 4-year intervals among participants varied from 0.8 kg in the HPFS to 1.8 kg in the NHSII. After adjusting for demographics and baseline and concomitant changes of selected lifestyle factors, each 1-SD increase in TLCD score was associated with 0.06 (95% CI, 0.04-0.08) kg more weight gain over the 4-year periods.
  • Similarly, participants gained 0.13 (95% CI, 0.11 to 0.14) kg per each 1-SD increase in ALCD score and 0.39 (95% CI, 0.37 to 0.40) kg per each 1-SD change in ULCD score. In contrast, each 1-SD increase in VLCD score was associated with 0.03 (95% CI, 0.01 to 0.04) kg less weight gain, and each 1-SD increase in HLCD score was associated with 0.36 (95% CI, 0.35 to 0.38) kg less weight gain.
  • The associations were more pronounced among obese individuals (per 1-SD increase in HLCD score: BMI ≥30, 0.88 [95% CI, 0.80, 0.97] kg less weight gain; BMI <25, 0.23 [95% CI, 0.20, 0.26] kg less weight gain; P for interaction < .001).

Researchers concluded that “These findings suggest that the quality of LCDs may play a critical role in modulating long-term weight change. Only LCDs that emphasized high-quality protein, fat, and carbohydrates from whole grains and other plant-based foods were associated with less weight gain.”

Reference: Liu B, Hu Y, Rai SK, Wang M, Hu FB, Sun Q. Low-Carbohydrate Diet Macronutrient Quality and Weight Change. JAMA Netw Open. 2023;6(12):e2349552. doi:10.1001/jamanetworkopen.2023.49552.

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Biological E Gets CDSCO Panel Nod to study safety of XBB 1.5-RBD Subunit Covid-19 Vaccine in 5-80 years old

New Delhi: The drug major Biological E has got the go-ahead from the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) to conduct the Phase-III clinical trial of the SARS-CoV-2 (Covid-19) Vaccine (Variant XBB.1.5)

This came after Biological E presented the Phase –III Clinical trial protocol titled “ A prospective single-blind randomized Phase-III comparative study to evaluate immunogenicity and safety of Biological E’s XBB 1.5-RBD subunit Covid-19 vaccine in 5-80 years old Individuals.”

The COVID-19 Omicron subvariant XBB.1.5 has become more prevalent due to a potent combination of mutations that facilitate its transmission, even among individuals who have already been vaccinated or infected.

The COVID-19 Omicron strain has undergone several subvariants’ mutations. It was BA.1 at first, and subsequently the Omicron subvariant of BA.5. After a while, it transformed into BQ.1.1 and BQ.1.

Next, there is XBB.1.5, sometimes known as the Kraken, which is a subvariant of BA.2 Omicron. It belongs to the XBB family of variants, which became identified a few months ago and attracted the attention of virologists due to the fact that it has more mutations that escape immunity than other variants that have been observed so far. It is thought that a mutation in the XBB.1.5 subvariant facilitates the virus’s ability to bind to cells and increase its transmissibility.

Symptoms with XBB.1.5 appear to be similar to the earlier Omicron subvariants. Those can range from typical cold symptoms such as cough and congestion to shortness of breath and low oxygen levels that require emergency medical attention.

However, as XBB.1.5 continues to spread, the signs and symptoms of COVID-19 may seem different than what was seen earlier in the pandemic with Alpha or Delta variants. Symptoms such as the temporary loss of taste and smell can still happen in some instances, but it has become less common with the Omicron variant and subvariants.

Other symptoms may include fever, chills, fatigue, muscle or body aches, sore throat, nausea or vomiting, and diarrhea. Symptoms can last between five to seven days but vary from person to person.

At the recent SEC meeting for Covid 19 held on 7th December 2023, the expert panel reviewed the Phase –III Clinical trial protocol presented by Biological E titled “ A prospective single-blind randomized Phase-III comparative study to evaluate immunogenicity and safety of Biological E’s XBB 1.5-RBD subunit Covid-19 vaccine in 5-80 years old Individuals.”

The expert panel noted that permission in CT-23 was already granted to the firm for the SARS-CoV-2 vaccine containing the Receptor Binding Domain (RBD) of SARS-CoV-2 gene (CORBEVAX) in the age group of ≥5 to <12 years, ≥ 12 years and ≥ 18 years old individuals.

After detailed deliberation, the committee recommended a grant of permission to conduct the Phase-III clinical trial as per the protocol presented by the firm.

Also Read: Modify phase III clinical trial protocol: CDSCO panel tells Akum Pharma on antidiabetic FDC

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Zydus Healthcare gets Rs 284.58 crore income tax demand notice

Zydus Lifesciences on Tuesday said its arm Zydus Healthcare Ltd has been served an income tax notice demand of Rs 284.58 crore for the assessment year 2023-2024.

Zydus Healthcare Ltd (ZHL), a wholly-owned subsidiary, has received an intimation under section 143(1) of the Income Tax Act, 1961 (IT Act), determining demand of Rs 284.58 crore, Zydus Lifesciences said in a regulatory filing.

For more details, check out the link given below:

Zydus Healthcare Gets Rs 284.58 Crore Income Tax Demand Notice

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Govt doctors in Haryana observe daylong strike, OPD services hit at some hospitals

Government doctors in Haryana observed a strike on Wednesday in support of their various demands, impacting outpatient department (OPD) services at some hospitals.

The strike was observed on a call given by the Haryana Civil Medical Services Association (HCMS).

For more news & updates, check out the link given below:

https://medicaldialogues.in/

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JJ Hospital 780 resident doctors on indefinite strike from today

A total of 780 resident doctors at JJ Hospital in Mumbai have initiated an indefinite strike in solidarity with the 21 resident doctors from the dermatology department who have been on mass leave for the past two weeks. The strike is a response to alleged mental harassment and inadequate patient care attributed to the head of the dermatology department, resulting in six deaths this year. The Maharashtra Association of Resident Doctors (MARD) had previously demanded action against the dermatology head, citing mental harassment and mismanagement of patient care.

For more news & updates, check out the link given below:

https://medicaldialogues.in/

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CISF seizes medicines worth Rs 80 lakh at IGI airport, two held

Two international passengers were apprehended for allegedly carrying medicines worth Rs 80 lakh at IGI Airport in New Delhi, an official statement issued by the Central Industrial Security Force (CISF) said on Tuesday.

According to CISF, the two persons identified as Md Raihan Fazal and Azeem Khan were planning to go to Kabul via Dubai on a flight.

For more details, check out the link given below:

2 International Passengers Held For Allegedly Carrying Medicines Worth Rs 80 Lakh At IGI Airport

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