High blood pressure may begin in childhood, finds study

A new research to be presented at this year’s European Congress on Obesity, from 12-15 May, suggested that children and teenagers living with overweight or obesity are more likely to have high blood pressure as adults (aged 50-64 years), suggesting the processes behind the condition could begin as early as childhood.

Hypertension is a major global health concern, affecting 1.28 billion adults aged 30-79 years worldwide. It significantly increases the risk of cardiovascular diseases like heart attacks, strokes, and chronic kidney disease. Poor diet, lack of exercise, and obesity are modifiable risk factors. High BMI in adults is strongly linked to high blood pressure, but the impact of elevated BMI during childhood and puberty on midlife blood pressure remains unclear.
In the study, researchers examined 1,683 individuals from two population-based cohorts to investigate the relationship between BMI during development and blood pressure in midlife (50-64 years old). They utilized data from the BMI Epidemiology Study Gothenburg (BEST) cohort and the Swedish Cardio-Pulmonary bio-Image Study (SCAPIS). Developmental BMI was assessed using school health records and military enrolment examinations for young adults. Blood pressure measurements in midlife were obtained from SCAPIS participants not taking medication for high blood pressure. All analyses were adjusted for birth year.
The results revealed that in men, both childhood BMI and pubertal BMI change independently contributed to increased systolic and diastolic blood pressure in middle age. For each one unit increase in childhood BMI, there was a 1.30 mmHg increase in systolic blood pressure and a 0.75 mmHg increase in diastolic blood pressure. In women, only pubertal BMI change was significantly associated with increased blood pressure in midlife, with a 0.96 mmHg increase in systolic blood pressure and a 0.77 mmHg increase in diastolic blood pressure. Childhood BMI did not show a significant association with blood pressure in midlife for women.
“Although the differences in blood pressure are not very large, if blood pressure is slightly elevated over many years, it can damage blood vessels and lead to cardiovascular and kidney disease. Our findings indicate that high blood pressure may originate in early life. Excessive fat mass induces chronic low-grade inflammation and endothelial dysfunction [impaired functioning of the lining of the blood vessels] already in childhood. Higher amounts of visceral abdominal fat increase the risk of developing hypertension in adults. And we have previously shown that a large pubertal BMI change in men is associated with visceral obesity [fat around the internal organs] at a young adult age. So enlarged visceral fat mass might, in individuals with a high BMI increase during puberty, be a possible mechanism contributing to higher blood pressure.” explained co-author Dr Jenny Kindblom from Sahlgrenska University Hospital, Sweden.
Reference: Study suggests high blood pressure could begin in childhood; EUROPEAN ASSOCIATION FOR THE STUDY OF OBESITY; MEETING: European Congress on Obesity (ECO2024)

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How does meat consumption affect mortality risk among frail? Study finds out

A recent study published in The Journal of Nutrition, Health and Aging explored how meat consumption influences the risk of death in frail populations.

Frailty, a clinical syndrome affecting almost 10% of the elderly, undermines their ability to handle stress. Nutrition plays a key role in frailty development, with protein supplements often used to boost strength and physical function in frail older adults. Meat, as a food category, includes red meat, fish, and poultry. Rich in proteins and micronutrients, meat is important for building and maintaining muscle strength, enhancing physical strength, and minimizing the incidence of malnutrition in the elderly. Although meat is a rich protein source, its impact on the health of frail individuals remains under-researched.

In the study, around 20,000 participants, with a mean age of 58 years were enrolled. About 38% and 12% ate red meat and processed meat, respectively. Higher processed meat consumption, particularly more than 4 times a week, increased all-cause mortality by 20% and deaths from cardiovascular disease (CVD) by 25%. Red meat intake showed a U-shaped relationship with mortality, with lower death rates from all causes, cancer, and CVD observed among those consuming red meat up to 2 times a week. Compared to those consuming red meat less than once a week, the risk of all-cause deaths was 14% lower in this group. Additionally, for every additional 25 g of red meat consumed, there was a 7% increase in all-cause mortality and a 16% increase in deaths from CVD among the frail. Overall meat consumption did not show the same impact on mortality.

The findings suggested that a higher processed meat intake was associated with an increased risk of all-cause and cardiovascular mortality among frail individuals. Moderate intake of unprocessed red meat and higher intake of unprocessed substitutes such as poultry was associated with a decreased risk of all-cause, cancer, and cardiovascular mortality. Replacing processed meat or unprocessed red meat with fish or unprocessed poultry may be encouraged to reduce mortality and prolong life expectancy.

Reference: Jie Chen a, Weihao Xu, Lintao Dan, Junhan Tang b, Jirong Yue e, Emiel O. Hoogendijk f, and Chenkai Wu (2024). Associations between meat consumption and all-cause and cause-specific mortality in middle-aged and older adults with frailty. The Journal of Nutrition, Health and Aging. doi: http://dx.doi.org/10.1016/j.jnha.2024.100191.

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Combination of empagliflozin and citalopram effective against major depressive disorder: Study

Iran: Combination therapy of empagliflozin and citalopram is effective in reducing symptom severity in patients with major depressive disorder, a randomized double-blind, placebo-controlled clinical trial has shown.

Empagliflozin is a blood sugar-lowering drug that works as a highly selective and potent inhibitor of sodium-glucose co-transporter 2 (SGLT2).

“This average reduction in symptom severity was statistically significant over time compared to the reduction of symptoms seen in the placebo-citalopram group,” Atefeh Zandifar, Alborz University of Medical Sciences, Karaj, Iran, and colleagues wrote in their study published in BMC Psychiatry.

Considering the promising findings, the researchers recommend further study of empagliflozin as adjunctive therapy in MDD with longer follow-ups and larger sample sizes.

Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with a high disease burden. MDD affects an estimated 300 million people worldwide every year, which accounts for the highest number of years of disability among psychiatric disorders.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that is prescribed commonly as the first line of treatment for MDD. The prescribed SSRIs include fluoxetine, citalopram, paroxetine, and sertraline. However, the researchers note that the current treatment using antidepressants has limitations, so it will be helpful to use medication with anti-inflammatory and neuromodulation properties alongside them.

Against the above background, the researchers studied the effectiveness of empagliflozin as an adjunctive therapy to reduce the severity of depression symptoms.

The study included outpatients with moderate to severe depression (Hamilton Depression Rating Scale (HDRS) > = 17) who were not under related medication or had not taken medication for at least the last two months, with ages 18–60 years and had written informed consent to enter the study (N = 90). They were randomly divided into two groups receiving placebo or empagliflozin (10 mg daily) combined with citalopram (40 mg daily) in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the HDRS in weeks 0, 4, and 8.

The researchers reported the following findings:

· HDRS scores were equal to 28.42, 20.20, and 13.42 in the placebo group during weeks 0, 4, and 8, respectively. These scores were 27.36, 13.76, and 7.00 for the group treated with empagliflozin.

· Compared to the control group, patients treated with empagliflozin using repeated-measures ANOVA showed a greater improvement in reducing the severity of depression symptoms over time.

In conclusion, the study found that empagliflozin is associated with psychiatric usefulness and a reduction in the severity of depression symptoms compared to the control group.

“Considering the multitude of possible mechanisms involved in the formation of this effect along with the vascular and metabolic benefits of this medication, it seems that evaluating empagliflozin’s effect as adjuvant treatment on MDD among different clinical groups in multicenter conditions and with a larger sample size with longer follow-ups may be accompanied by more accurate clinical judgment in this field,” the researchers wrote.

Reference:

Zandifar, A., Panahi, M., Badrfam, R. et al. Efficacy of empagliflozin as adjunctive therapy to citalopram in major depressive disorder: a randomized double-blind, placebo-controlled clinical trial. BMC Psychiatry 24, 163 (2024). https://doi.org/10.1186/s12888-024-05627-0

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Routine Use of albumin in ARDS as supplement to diuresis not required, recommends new Transfusion Medicine Guidelines

Routine Use of albumin in ARDS or as a supplement to diuresis is not advised, new Transfusion Medicine Guidelines suggest a new study published in the Chest.

Albumin is commonly employed across a wide range of clinical settings to improve hemodynamics, facilitate fluid removal, and manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, kidney replacement therapy, or experiencing complications of cirrhosis. Co-chairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception to November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The guideline was revised after public consultation.

Results: The panel made 14 recommendations on albumin use in adult critical care (3 recommendations), pediatric critical care (1 recommendation), neonatal critical care (2 recommendations), cardiovascular surgery (2 recommendations), kidney replacement therapy (1 recommendation), and complications of cirrhosis (5 recommendations). Of the 14 recommendations, 2 had moderate certainty of evidence, 5 had low certainty of evidence, and 7 had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin is commonly transfused. There are currently few evidence-based indications that support the routine use of albumin in clinical practice to improve patient outcomes. This guideline provides clinicians with actionable recommendations on the use of albumin.

Reference:

Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N; ICTMG Intravenous Albumin Guideline Group. Use of Intravenous Albumin: A Guideline from the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Mar 4:S0012-3692(24)00285-X. doi: 10.1016/j.chest.2024.02.049. Epub ahead of print. PMID: 38447639.

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Miscarriages tied to increased risk of gestational diabetes and high BP-related disorders in later pregnancies: Study

Australia: A recent study published in eClinicalMedicine has revealed an association between prior spontaneous abortion and increased odds of gestational diabetes mellitus, but not pre-eclampsia. 

The study further revealed an increased risk of subsequent pre-eclampsia in women who experienced recurrent pregnancy loss. 

The new Curtin University research has revealed a link between miscarriage and the increased risk of developing complications of gestational diabetes and high blood pressure-related disorders in later pregnancies.

Researchers from the Curtin School of Population Health analyzed 52 studies involving more than 4 million pregnancies across 22 countries to investigate the health impacts of miscarriage, abortion, and recurrent pregnancy loss (more than two miscarriages in succession) on subsequent pregnancies.

The study found different health risks for each group.

People who had experienced a miscarriage were 44 percent more likely to develop gestational diabetes during later pregnancies but only 6 percent more likely to develop high blood pressure in subsequent pregnancies.

Conversely, people who had experienced recurrent pregnancy loss showed no increased risk of gestational diabetes but were 37 percent more likely to develop pre-eclampsia, a potentially dangerous complication characterized by high blood pressure, in later pregnancies.

There was no evidence linking abortion to diabetic or hypertensive-related issues, either during or outside of pregnancy.

Lead study author Dr Jennifer Dunne said establishing the links between pregnancy loss, diabetes, and high blood pressure could have a far-reaching impact.

“Miscarriages occur in 15-25 percent of all pregnancies-which is around 23 million per year, globally,” Dr Dunne said.

“Gestational diabetes and high blood pressure disorders in pregnancy can cause a variety of significant health problems; understanding the relationship between pregnancy loss and later pregnancy complications could reveal new ways to mitigate risks or possibly prevent these conditions from progressing.

“Further research into the biological links between pregnancy loss and later health issues might reveal new targets for developing treatments.”

Dr Dunne said the study added to what was already known about pregnancy complications and health later in life, even beyond pregnancy.

“Knowing miscarriage can lead to these pregnancy complications, later on, is important, as these conditions during pregnancy have previously been linked to a higher risk of people developing heart disease later in life,” Dr Dunne said.

“By shedding light on the long-term health effects of miscarriages and repeated pregnancy losses, this study paves the way for improved healthcare strategies, research, and support for those affected enhancing the outcomes for parents and babies in future pregnancies.”

Reference:

Jennifer Dunne, Damien Foo, Berihun A. Dachew, Bereket Duko, Amanuel T. Gebremedhin, Sylvester D. Nyadanu, Gavin Pereira, Gizachew A. Tessema. Diabetic and hypertensive disorders following early pregnancy loss: a systematic review and meta-analysis. eClinicalMedicine, 2024; 102560 DOI: 10.1016/j.eclinm.2024.102560.

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Immediate Weight-Bearing may Improve Clavicle Fracture Rehabilitation: Study

A recent study published in the Journal of Orthopaedic Trauma revealed that immediate upper extremity weight-bearing as tolerated (WBAT) after surgical fixation is safe and does not compromise healing in patients with clavicle fractures. This research was conducted across three Level 1 trauma centers that marks a potential shift in postoperative care and rehabilitation strategies.

Traditionally, patients who undergo open reduction internal fixation (ORIF) for mid-shaft clavicle fractures have been advised to limit the weight-bearing on their affected arm to prevent hardware failure and ensure proper healing of the fracture. However, the outcome of this new study suggests that patients with concomitant lower extremity trauma can safely engage in WBAT using assistive devices like walkers or crutches immediately after surgery.

The retrospective cohort study focused on patients over 18 years who underwent ORIF for mid-shaft clavicle fractures and compared the individuals who allowed immediate WBAT with a matched cohort that adhered to non-weight-bearing (NWB) restrictions. The primary outcomes were to assess the safety of WBAT in terms of hardware failure, infection rates and the overall healing process.

The key findings from this study underline the safety and effectiveness of the immediate WBAT protocol. Among the 39 patients in the WBAT group, there was no significant increase in the risk of acute hardware failure that require surgical intervention when compared to their NWB counterparts. Both groups expressed a 2.5% incidence of such complications, with overall hardware failure rates showing no significant difference. All the patients in this study achieved fracture union regardless of their weight-bearing status, even the individuals who required revision surgery for acute hardware failure.

These results found beneficial implications for the management of clavicle fractures. The study challenges existing postoperative restrictions and opens the door for earlier rehabilitation and potentially quicker recovery times by supporting the safety of immediate WBAT. This could significantly improve patient outcomes in the individuals with additional lower extremity injuries by enabling more efficient use of assistive devices and promoting earlier return to daily activities. Overall, this research represents a leap ahead in improving the existing understanding of bone healing and rehabilitation by encouraging further research that could potentially revise the guidelines to reflect these insights into safe and effective postoperative care.

Source:

Frane, N., Watzig, B., Vohra, A., Deeyor, S., Hui, C., McKee, M., & Dehghan, N. (2024). Immediate Weight-bearing Through Walker or Crutches After Surgical Fixation of Clavicle Fractures in Patients With Lower Extremity Fractures: A Retrospective Cohort Study. In Journal of Orthopaedic Trauma (Vol. 38, Issue 4, pp. 227–233). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/bot.0000000000002773

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Dual Antiplatelet Therapy Prevents Neurological Deterioration in Stroke Patients: JAMA Study

A recent study published in the Journal of American Medical Association revealed compelling evidence supporting the efficacy of dual antiplatelet therapy over single antiplatelet treatment for patients suffering from mild to moderate ischemic strokes. 

The study was conducted across 66 hospitals in China from December 20, 2016 to August 9, 2022 and involved a total of 3000 patients with acute mild to moderate strokes that occur within 48 hours of symptom onset. This trial assess the comparative effectiveness of clopidogrel plus aspirin versus aspirin alone in preventing recurrent strokes and minimizing neurological deterioration.

The results unveiled a clear advantage for dual antiplatelet therapy, with patients receiving clopidogrel plus aspirin demonstrating significantly lower rates of early neurological deterioration at 7 days when compared to those treated with aspirin alone. Among the 2915 participants included in the analysis, only 4.8% of those on dual therapy experienced early neurological deterioration when compared to 6.7% in the aspirin-only group.

This study found no significant difference in bleeding events between the two treatment groups that ensures a comparable safety profile for both therapeutic approaches. These findings provide substantial evidence supporting the adoption of dual antiplatelet therapy as a superior option for managing acute ischemic strokes that are mild to moderate in severity.

This study marks a significant stride in stroke care by emphasizing the potential impact of the findings on clinical practice. Overall, these results underline the importance of dual antiplatelet therapy to prevent neurological deterioration and to improve outcomes for individuals with mild to moderate stroke. 

Reference:

Chen, H.-S., Cui, Y., Wang, X.-H., Ma, Y.-T., Han, J., Duan, Y.-J., Lu, J., Shen, L.-Y., Liang, Y., Wang, W.-Z., Wang, H., Zhao, Y., Zhang, J.-T., Song, Y.-L., He, X.-M., Li, R.-H., Tao, D.-B., Li, J., … Huang, S.-M. (2024). Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2024.0146

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Researchers develop new synthetic surfactant that could improve lung treatments for premature babies

USA: Scientists have developed a synthetic surfactant that could potentially have lower production costs, longer shelf life, less batch variability, and pose less risk of an immune response versus animal-derived lung surfactants. 

The new lung surfactant is produced synthetically rather than using animal tissue. With further development, the formulation could provide a cheaper and more readily available alternative to Infasurf, a medication used to prevent and treat respiratory distress in premature babies.

Surfactants are substances that decrease surface tension where liquids interface with other liquids, gases, or solids. In addition to their use in medicines, they are found in a wide range of products including detergents, cosmetics, motor oils, and adhesives.

Suzanne Farver Lukjan, a lecturer in chemistry at Troy University in Alabama, led the work.

“A synthetic surfactant could potentially have a longer shelf life, lower production costs, have less batch variability and pose less risk of an immune response compared to animal-derived lung surfactants,” she said. “We hope our formulation will one day be used in hospitals.”

Lukjan will present the research at Discover BMB, the annual meeting of the American Society for Biochemistry and Molecular Biology, which is being held March 23–26 in San Antonio.

Lung surfactants help premature babies breathe while their lung cells finish developing. In addition to offering a potential alternative to replace Infasurf for babies, researchers say the new synthetic surfactant could be useful for treating adults with lung injuries as a result of diseases such as chronic obstructive pulmonary disorder, miner’s lung or emphysema.

Researchers have previously attempted to develop synthetic lung surfactants, but some have been removed from the market and others have not been able to lower surface tension as well as animal-derived formulations.

In the new work, Lukjan’s team created candidate surfactants from synthetic lipids (fats) and peptides (short chains of amino acids) and then tested their surface-tension-lowering capabilities. They aimed to mimic the composition, lipid phase behavior and biophysical function of Infasurf as closely as possible.

After tweaking a step in the sample preparation process, the researchers found a few formulations that showed particular promise. Although tests demonstrated that the chemical behavior of the synthetic surfactants was quite different from that of Infasurf, the new surfactants were able to mimic the drug’s functionality in terms of lowering surface tension and seem to achieve the optimal range in terms of peptide concentration.

As a next step, Lukjan said, the group plans to continue to refine and test their formulation to further optimize the combination of lipids and peptides. The surfactant would also need to undergo safety testing before it could be used clinically.

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Intratonsillar Immunotherapy Safe and Effective for Allergic Rhinitis, suggests research

Allergic rhinitis (AR) is a common condition affecting millions globally, often triggered by allergens such as house dust mites (HDM). Allergen-specific immunotherapy (AIT) is the only curative treatment for IgE-mediated allergies like AR; however, its lengthy duration and adverse effects hinder patient adherence. Thus, investigating alternative AIT routes is crucial to improving treatment outcomes.

Traditional AIT involves subcutaneous or sublingual administration, necessitating frequent visits and increasing the risk of systemic adverse reactions. Intratonsillar injection, a novel approach, targets the tonsils, which play a crucial role in immune responses, potentially enhancing treatment efficacy and safety.

A recent randomized, double-blind, placebo-controlled clinical trial aimed to evaluate the efficacy and safety of intratonsillar injection with HDM extract in patients with HDM-induced AR. This study was published in the Annals of Allergy Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology. The study was conducted by Junyan Z. and colleagues.

Eighty patients with HDM-induced AR were randomly assigned to receive either intratonsillar injections of HDM extract or placebo over three months. Various outcome measures, including total nasal symptom score (TNSS), visual analogue scale, symptom and medication score, quality of life questionnaire, and serum allergen-specific IgG4 levels, were assessed at baseline and up to 12 months post-treatment.

The key findings of the study were:

• At 3 months post-treatment, TNSS and ΔTNSS significantly improved in the active group compared to placebo.

• Sustained improvements in visual analogue scale, combined symptom and medication score, and quality of life questionnaire in the per-protocol set.

• Patients receiving intratonsillar immunotherapy exhibited a significant increase in serum Der p IgG4 levels at 3, 6, and 12 months post-treatment.

• No systemic adverse reactions were observed, indicating the safety of intratonsillar injection with HDM extract.

The study demonstrates the potential of intratonsillar immunotherapy as a safe and effective treatment for HDM-induced AR. The observed improvements in symptoms and serum IgG4 levels highlight the promising role of this innovative approach in AIT.

Intratonsillar injection offers a convenient and well-tolerated alternative to traditional AIT methods, potentially enhancing patient adherence and treatment outcomes. Further optimization of protocols and allergen formulations may enhance the efficacy and durability of this novel approach.

Intratonsillar immunotherapy with HDM extract emerges as a promising therapeutic option for patients with AR, offering both efficacy and safety benefits. Continued research and refinement of this approach hold potential for significant advancements in AIT for allergic diseases.

Reference:

Zhang, J., Yang, X., Chen, G., Hu, J., He, Y., Ma, J., Ma, Z., Chen, H., Huang, Y., Wu, Q., Liu, Y., Yu, L., Zhang, H., Lai, H., Zhang, J., Zhai, J., Huang, M., Zou, Z., & Tao, A. (2024). Efficacy and safety of intratonsillar immunotherapy for allergic rhinitis: A randomized, double-blind, placebo-controlled clinical trial. Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, 132(3), 346-354.e1. https://doi.org/10.1016/j.anai.2023.10.029

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Prophylactic pancreatic stent with rectal indomethacin prevents post ERCP pancreatitis: Lancet

Pancreatitis is a known risk following ERCP and has long posed challenges for clinicians due to its complexity and potential harm. A recent study suggests a promising strategy to prevent pancreatitis in high-risk individuals who undergo endoscopic retrograde cholangiopancreatography (ERCP). The key findings were published in the recent edition of the The Lancet journal.

This comprehensive research was conducted across 20 referral centers in the USA and Canada and highlights a combination therapy that involved rectally administered indomethacin and prophylactic pancreatic stent placement. The findings of this study challenge the existing practices and offer a potentially safer and more effective alternative. 

The randomized, non-inferiority trial included over 1950 patients who were aged 18 years and above and deemed to be at high risk for post-ERCP pancreatitis. The patients were randomly assigned to receive either rectal indomethacin alone or a combination of indomethacin and a pancreatic stent. 

The results revealed that post-ERCP pancreatitis occurred in 14.9% of patients in the indomethacin alone group when compared to 11.3% in the combination therapy group. While the difference did not meet the predetermined criteria for non-inferiority, a subsequent analysis suggested that the combined approach was superior to indomethacin alone.

Also, this study highlighted consistent benefits of stent placement across various patient subgroups among the individuals at the highest risk for pancreatitis. Overall, the safety outcomes which includes the serious adverse events and hospital stays did not differ significantly between the two treatment groups.

These findings have significant implications for clinical practice. Dr. [Lead Researcher’s Name], the lead investigator of the study, emphasized the importance of incorporating prophylactic pancreatic stent placement alongside indomethacin administration in high-risk patients, aligning with current clinical guidelines.

These outcomes mark a crucial stride in the management of ERCP by offering clinicians a more robust strategy to reduce the risk of post-procedural pancreatitis. The combined approach demonstrates effectiveness and additionally address the concerns regarding the technical complexity and cost associated with pancreatic stent placement.

Source:

Elmunzer, B. J., Foster, L. D., Serrano, J., Coté, G. A., Edmundowicz, S. A., Wani, S., Shah, R., Bang, J. Y., Varadarajulu, S., Singh, V. K., Khashab, M., Kwon, R. S., Scheiman, J. M., Willingham, F. F., Keilin, S. A., Papachristou, G. I., Chak, A., Slivka, A., Mullady, D., … Durkalski-Mauldin, V. (2024). Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP: a randomised non-inferiority trial. In The Lancet (Vol. 403, Issue 10425, pp. 450–458). Elsevier BV. https://doi.org/10.1016/s0140-6736(23)02356-5

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