KGMU Orthopaedic Surgery Dept to soon add 120 beds

Lucknow: Giving a boost to the existing bed matrix, King George’s Medical University (KGMU) has announced the
addition of 120 new beds to its orthopaedic surgery department increasing the total bed count to 280. The facility is all set to make the addition after the elections and the step will make it
the largest facility of its kind in any hospital.

The expansion aims to reduce waiting times and improve access to care
for patients with bone-related issues. Currently, the department’s 160 beds are
fully occupied, often leading to prolonged waits for treatment. The new beds
will accommodate more patients promptly, facilitating quicker and more
efficient medical attention.

Also Read:KGMU to Host ‘Scientific Program on Robotic Surgery’ On May 29, Details

According to the Times of India, the additional beds include 60 dedicated to paediatric orthopaedics and
another 60 for sports injury orthopaedics, addressing specific needs within the
broader orthopaedic discipline. These beds will be added to the nearby block
adjacent to the Rehabilitation and Artificial Limb Centre (RALC) building. “In next two months, eight more faculty members will join and new nurses
have already been recruited, therefore there will be no issue in operation of
these beds,” said Dr Ashish.

KGMU Vice-Chancellor Prof Sonia Nityanand and Head of the Orthopaedic
Surgery Department Prof Ashish Kumar emphasized that the addition of MRI and
CT scan facilities will further enhance diagnostic capabilities. These
improvements will ensure comprehensive care under one roof, eliminating the
need for patients to travel to different places for advanced imaging services, reports The Daily. 

KGMU has been implementing different plans to improve the facility. KGMU
organized a “Scientific Program on Robotic
Surgery” a few days ago. Prof Ashutosh Tiwari, MD, Chairman, Milton
and Carrol Petrie Department of Urology at Medicine Mount Sinai, New York, USA
will deliver a Guest Lecture on the topic “Journey of a Surgeon Scientist
Through Neural Pathways, Genomic Complexity, Cancer Immunology and 10,000
Robotic Prostatectomies”.  

Also Read:KGMU to begin Post-Doctoral Certificate Courses in 28 Depts

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Dual Defibrillator Pad Effective in Treating Atrial Fibrillation in Obese Patients: JAMA

A recent clinical trial revealed that using two sets of defibrillator pads simultaneously is more effective than the traditional single set in restoring normal heart rhythm in obese patients with atrial fibrillation. The study was conducted across three centers in Louisiana and the outcomes were published in the recent issue of Journal of American Medical Association.

The study from August 2020 to 2023 was carried forward by the team of Joshua Aymond to address the increasing prevalence of atrial fibrillation and obesity. Both conditions are rising throughout the globe and obesity has been linked to reduced success in cardioversion using standard methods.

The trial included 200 patients who met the stringent eligibility criteria, which was a body mass index (BMI) of 35 or higher, age 18 or older and a planned nonemergent electrical cardioversion for atrial fibrillation. These participants were randomly assigned to receive either the dual direct-current cardioversion (DCCV) or the traditional single DCCV, ensuring a balanced comparison between the two methods.

The results found that the dual DCCV method, which involves two sets of defibrillator pads delivering a combined energy of 400 joules, demonstrated a significantly higher success rate in converting patients back to a normal sinus rhythm on the first attempt. Also, 98% of patients in the dual DCCV group achieved successful cardioversion when compared to 86% in the single DCCV group.

The study highlighted that even patients in the single DCCV cohort who initially failed to revert to sinus rhythm could be successfully treated with subsequent dual DCCV attempts. This sequential approach showed that 12 out of 14 patients were successfully converted on the second attempt with the remaining two achieving success on the third attempt.

The research found no significant differences in adverse cardiovascular events between the two groups and both the groups reported minimal chest discomfort post-procedure. The median discomfort rating was zero out of ten for both methods which indicates the dual DCCV technique does not increase patient discomfort despite the higher energy delivery. This study provides robust evidence that dual DCCV is a superior method for cardioversion in obese patients by offering higher success rates without compromising safety.

Source:

Aymond, J. D., Sanchez, A. M., Castine, M. R., Bernard, M. L., Khatib, S., Hiltbold, A. E., Polin, G. M., Rogers, P. A., Dominic, P. S., Velasco-Gonzalez, C., & Morin, D. P. (2024). Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2024.1091

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Postprandial hyperinsulinemia during pregnancy may portend favourable metabolic function in years to come: Study

Canada: In a recent study published in the journal EClinicalMedicine, a group of investigators observed 306 pregnant women in the third trimester to investigate the long-term cardiometabolic effects of postprandial insulin hypersecretion in response to oral glucose tolerance testing over 4 years.

They found that higher corrected insulin responses at one year were associated with a lower risk of pre-diabetes or diabetes.

“A robust post–challenge insulin secretory response does not indicate adverse cardiometabolic health but, rather, portends favourable metabolic function in the years to come,” Ravi Retnakaran, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada, and colleagues reported.

Fasting hyperinsulinemia is commonly recognised as a marker of insulin resistance. By contrast, there has been less clarity on the interpretation of postprandial hyperinsulinemia and has been the subject of recent debate. Postprandial insulin secretion is a physiologic response that is essential for the maintenance of glucose homeostasis. However, there has been no clarity on the cardiometabolic implications of postprandial hyperinsulinemia with recent studies suggesting both adverse and beneficial associations.

Dr Retnakaran and colleagues, therefore, aimed to evaluate the longitudinal cardiometabolic implications of the post–challenge insulin secretory response over 4-years follow-up in a prospective cohort study conducted in Toronto (Ontario, Canada).

For this purpose, the researchers recruited a diverse group of pregnant women with a broad glucose tolerance spectrum for cardiometabolic testing spanning several years postpartum. The participants underwent testing late in their second trimester.

Participants underwent oral glucose tolerance tests (OGTT) at 1 year, 3 years, and 5 years postpartum, enabling serial assessment of insulin sensitivity or resistance (Matsuda index, HOMA-IR), glucose tolerance, cardiovascular risk factors, and beta-cell function—via Insulin Secretion-Sensitivity Index-2 (ISSI-2) and insulinogenic index/HOMA-IR (IGI/HOMA-IR).

Baseline post–challenge insulinemia was evaluated with the corrected insulin response (CIR) at 1-year. A comparison was made between cardiometabolic factors between baseline CIR tertiles.

The study led to the following findings:

· 306 women were enrolled between Oct 23, 2003 and March 31, 2014. In this study population, there was a progressive worsening of waist circumference, HDL, insulin sensitivity, and CRP from the lowest to middle to highest tertile of CIR at 1-year. However, these adverse features were accompanied by progressively better beta-cell function, coupled with lower fasting and 2-h glucose on the OGTT.

· On adjusted longitudinal analyses, higher CIR tertile at 1 year was independently associated with (i) higher ISSI-2 and IGI/HOMA-IR and (ii) lower fasting and 2-h glucose at both 3-years and 5-years, but was not associated with BMI, waist, lipids, CRP or insulin sensitivity/resistance.

· The highest CIR tertile at 1 year predicted a lower risk of pre-diabetes or diabetes at both 3 years (adjusted OR = 0.19) and 5 years (aOR = 0.18), relative to the lowest tertile.

Findings revealed that on unadjusted cross-sectional analyses, higher corrected insulin response has associations with both favourable and adverse cardiometabolic features. However, adjusted longitudinal analyses reveal only beneficial future implications, with higher baseline CIR independently associated with lower glycaemia and better beta-cell function at both 2 years and 4 years thereafter.

Also, higher CIR at baseline is a significant independent predictor of a lower future risk of diabetes or prediabetes.

“Thus, a robust post–challenge insulin secretory response does not indicate adverse cardiometabolic health but, rather, predicts favourable metabolic function in the years to come,” the researchers concluded.

Reference:

Ravi Retnakaran, Jiajie Pu, Anthony J. Hanley,et al. Future cardiometabolic implications of insulin hypersecretion in response to oral glucose: a prospective cohort study, EClinicalMedicine, 2023, DOI- https://doi.org/10.1016/j.eclinm.2023.102363, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00540-0/fulltext

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Very early BP control confers both benefits and harms in acute stroke, suggests study

Early identification of stroke type could be key to harnessing the benefits of very early in-ambulance blood pressure lowering treatment in patients with suspected acute stroke, according to new research.

The findings were presented at the 10th European Stroke Organisation Conference in Basel, Switzerland and simultaneously published in the New England Journal of Medicine.

Professor Craig Anderson, Director of Global Brain Health at The George Institute for Global Health and lead investigator on the study, said that although more research was needed, the results provided a potential pathway to improving outcomes in patients with the most deadly type of stroke.

“Our study shows clear benefits from administering early blood pressure lowering treatment to patients with intracerebral haemorrhage in the ambulance, although overall there was no difference in outcome from this early intervention for all patients with suspected stroke.

“In fact, in patients with a final diagnosis of ischaemic stroke, it actually worsened their outcome, so the ability to make a reliable diagnosis at this early stage is key to harnessing the benefits of very early blood pressure treatment.”

The Intensive ambulance-delivered blood pressure reduction in hyper-acute stroke trial (INTERACT4) was a multicentre, randomised, open-label, blinded-outcome study conducted across dozens of ambulance services in China.

2404 ambulance-assessed patients with suspected acute stroke causing a motor deficit within two hours of onset and elevated systolic blood pressure (≥150mmHg) were randomly assigned to immediate blood pressure-lowering (target 130-140mmHg) or usual blood pressure (BP) management in hospital.

The pre-hospital ambulance-initiated BP reduction group with haemorrhagic stroke had a 30% lower likelihood of a poor functional outcome whereas the group with cerebral ischaemia had an equivalent 30% higher likelihood of a poor functional outcome, when compared to patients with these stroke types who received usual care BP management upon arrival at the hospital.

Overall, the effects of pre-hospital BP reduction had a balanced benefit and harm effect so that there was no overall difference in the functional outcome between those who received the usual care in all the stroke patients. Between-group rates of serious adverse events were similar.

Around 80 percent of strokes worldwide are ischaemic, caused by the loss of blood flow to an area of the brain due to a blockage in a blood vessel, leading to a loss of neurological function.

Intracerebral haemorrhage (ICH) represents over a quarter of all cases of stroke and occurs when blood leaks out of a blood vessel into the brain tissue. ICH is the most deadly type of stroke, with up to one third of patients dying in 30 days, and it is more common in China where the study was conducted.

“All treatments for acute stroke are highly time dependent-brain cells die rapidly when deprived of oxygen. But knowing the best treatment approach to take before being able to identify the type of stroke a patient has experienced, is difficult without brain imaging,” Professor Anderson said.

“The results do not support in-ambulance administration of blood pressure lowering treatment in patients with suspected acute stroke-that is clear.

“But in the last few years, we’ve seen the introduction of mobile stroke ambulances equipped with a CT scanner and other diagnostic tools that aim to identify cases of ischaemic stroke for early administration of clot-busting treatment.

“But our results do support the case for in-ambulance treatment to be administered to patients with haemorrhagic stroke as well.

“In the meantime, while acute stroke treatment happens in the hospital, quicker diagnosis and swift action as soon as the patient arrives at the emergency department is critical to preserving brain function.”

Reference:

Gang Li, Yapeng Lin, M.M., Jie Yang, Craig S. Anderson, Chen Chen, Feifeng Liu, M.M., Laurent Billot, Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke, New England Journal of Medicine, DOI: 10.1056/NEJMoa2314741.

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MAFLD tied to hyperfiltration and amplification of age-related eGFR decline across all glycaemic spectrum: Study

Spain: In a pioneering cross-sectional population study, researchers have uncovered a significant association between Metabolic Associated Fatty Liver Disease (MAFLD) and glomerular hyperfiltration across varying states of glucose metabolism. The study offers valuable insights into the intricate interplay between liver health and kidney function in individuals with different glucose metabolic statuses.

The researchers revealed increases in MAFLD prevalence across the glycaemic spectrum. MAFLD is significantly associated with hyperfiltration and amplifies the age-related decline in eGFR (estimated glomerular filtration rate). The findings were published online in Diabetes/Metabolism Research and Reviews. 

MAFLD, formerly known as non-alcoholic fatty liver disease (NAFLD), represents a spectrum of liver conditions characterized by hepatic steatosis, inflammation, and fibrosis. While the association between MAFLD and glucose metabolism abnormalities has been well-documented, its impact on renal function remains a subject of ongoing investigation.

Against the above background, Miquel Bennasar-Veny, Research Group on Global Health, University of the Balearic Islands, Palma, Spain, and colleagues aimed to assess MAFLD prevalence and its association with glomerular hyperfiltration and age-related worsening of kidney function in subjects with prediabetes, normoglycemia, and type 2 diabetes mellitus (T2DM).

For this purpose, the researchers analyzed data recorded during occupational health visits of 125,070 Spanish civil servants aged 18–65 years with a de-indexed GFR estimated with the chronic-kidney-disease-epidemiological (CKD-EPI) equation (eGFR) ≥60 mL/min.

According to fasting plasma glucose levels, subjects were classified as <100 mg/dL (normoglycemia), ≥100 and ≤ 125 mg/dL (prediabetes), or ≥126 mg/dL, and antidiabetic treatment (T2DM).

The association between MAFLD and glomerular hyperfiltration, defined as a de-indexed eGFR above the gender- and age-specific 95th percentile, was evaluated by multivariable logistic regression.

The study revealed the following findings:

  • In the whole study group, MAFLD prevalence averaged 19.3%.
  • The prevalence progressively increased from 14.7% to 33.2% and 48.9% in subjects with normoglycemia, prediabetes, and T2DM, respectively.
  • The adjusted odds ratio for the association between MAFLD and hyperfiltration was 9.06 in the study group considered as a whole, and 8.60, 9.52, and 8.31 in subjects with normoglycemia, prediabetes, and T2DM considered separately.
  • In stratified analyses, MAFLD amplified age-dependent eGFR decline in all groups.

The study showed that in the general population of subjects with preserved kidney function, MAFLD prevalence increases across the glycaemic spectrum in parallel with the progressively increasing prevalence of glomerular hyperfiltration.

“The strong association between MAFLD and hyperfiltration at any glucose level suggests that these two abnormalities may share common and interconnected pathogenic mechanisms that could also contribute to the CKD onset and progression,” the researchers wrote. This could explain why MAFLD’s presence amplified the age-related eGFR decline.

“There is a need for longitudinal studies to investigate whether and to what extent the MAFLD is an independent risk factor for accelerated GFR decline (and possibly excess CVD risk) and whether sustained MAFLD amelioration could translate into a substantial nephroprotection (and cardioprotection) in the long-term, even in the non-diabetic population,” they concluded.

Reference:

Abbate, M., Parvanova, A., López-González, Á. A., Yañez, A. M., Bennasar-Veny, M., Ramírez-Manent, J. I., Reseghetti, E., & Ruggenenti, P. (2024). MAFLD and glomerular hyperfiltration in subjects with normoglycemia, prediabetes and type 2 diabetes: A cross-sectional population study. Diabetes/Metabolism Research and Reviews, 40(4), e3810. https://doi.org/10.1002/dmrr.3810

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Increased healthy plant-based diet can effectively reduce gout risk: JAMA

Plant-based diets are increasingly embraced for their marked health benefits for cardiometabolic diseases and their positive environmental impact. However, the relationship between such diets and gout risk has been less clear. A recent study published in the Journal of American Medical Association highlighted this connection by examining how adherence to various forms of plant-based diets correlates with the incidence of gout. This prospective study utilized data from the Health Professionals Follow-Up Study (1986 to 2012) and the Nurses’ Health Study (1984 to 2010) included a total of 1,22,679 men and women who were free of gout at the outset of this study.

The diets of the participants were assessed using a comprehensive plant-based diet index (PDI) were further divided into healthy (hPDI) and unhealthy (uPDI) versions. The diet indices comprised 18 specific food groups and evaluated through a validated food frequency questionnaire. The study spanned from March 2020 to August 2023 and used the Cox proportional hazards regression models to analyze the associations. Over 2.7 million person-years of follow-up, a total of 2,709 participants developed gout.

The key findings of this study revealed;

The overall PDI that included both healthy and unhealthy plant-based foods did not show a significant association with gout risk. However, a closer look at the quality of diet provided clearer insights. The healthy plant-based diet index (hPDI) was significantly inversely linked with gout risk. The participants with the highest adherence to hPDI had a 21% lower risk of developing gout when compared to the participants with the lowest adherence.

Also, the unhealthy plant-based diet index (uPDI) was positively associated with an increased gout risk. The women with the highest adherence to uPDI were 31% more likely to develop gout than those with the lowest adherence. The study also delved into individual food groups which found that higher intakes of whole grains, tea/coffee and dairy were independently linked to a lower gout risk.

Each additional daily serving of whole grains reduced the gout risk by 7%, while an extra daily serving of dairy lowered the risk by 14%. Also, certain unhealthy plant foods like fruit juice and sugar-sweetened beverages were associated with an increased gout risk.

These findings support existing dietary recommendations advocating for the consumption of healthy plant foods while minimizing unhealthy plant-based foods to reduce gout risk. Overall, the study underlines the importance of diet quality in managing gout and highlights the precise impact of different plant-based foods on health.

Source:

Rai, S. K., Wang, S., Hu, Y., Hu, F. B., Wang, M., Choi, H. K., & Sun, Q. (2024). Adherence to Healthy and Unhealthy Plant-Based Diets and the Risk of Gout. In JAMA Network Open (Vol. 7, Issue 5, p. e2411707). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.11707

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Obstetricians and Gynecologists Empower Patients with Anti-Obesity Medications for Weight Management: ACOG meeting

USA: In a groundbreaking development, obstetricians and gynecologists (Ob.Gyns) are emerging as pivotal players in the battle against obesity. Traditionally known for their focus on women’s reproductive health, these medical professionals are now stepping into the realm of weight management by incorporating anti-obesity medications into their practice. This innovative approach represents a significant shift in the medical community’s efforts to combat the obesity epidemic, offering new hope to millions of individuals struggling with excess weight.

An estimated 40% in the United States are obese, and women are likely to be receptive toward weight management help from their ob.gyns, given the potential challenges of losing pregnancy weight postpartum or staving off the weight gain associated with menopause. A whole new armamentarium of anti-obesity medications has become available in the past decade, providing patients and physicians with more treatment options.

Ob.gyns. are therefore well-poised to offer treatment and counseling for obesity management for their patients, Johanna G. Finkle, MD, clinical assistant professor of obstetrics and gynecology at the University of Kansas Health System, told attendees at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

Physical activity, healthy nutrition, and behavioral modification remain key pillars of weight management, but interventions such as medications or surgery or medications are also important tools, said Dr. Finkle. 

“One size does not fit all in terms of treatment,” Dr. Finkle said. ”When I talk to a patient, I think about other medical complications that I can treat with these medications.”

Women for whom anti-obesity medications may be indicated are those with a body mass index (BMI) of 30 or greater, and those with a BMI of at least 27 along with at least one obesity-related comorbidity, such as high cholesterol, hypertension, sleep apnea, or diabetes. The goal of treating obesity with medication is at least a 5%-10% reduction in body weight.

Dr. Finkle reviewed three basic categories of anti-obesity medications: Food and Drug Administration–approved long-term and short-term medications and then off-label drugs that can also aid in healthy weight loss. Short-term options include diethylpropion, phentermine,  benzphetamine, and phendimetrazine. Long-term options include phentermine/topiramate ER, orlistat, naltrexone HCl/bupropion HCl ER, and the three GLP-1 receptor agonist drugs, semaglutide, liraglutide, and tirzepatide.

Short-term medications are stimulants that increase satiety, but adverse effects can include hypertension, tachycardia, insomnia, constipation, dry mouth, and diarrhea.

For anyone with hyperthyroidism, uncontrolled hypertension, MAOI use, cardiovascular disease, glaucoma, or a history of substance use, these medications are contraindicated. The goal is a 5% weight loss in 3 months, and 3 months is the maximum prescribing term.

Dr. Finkle, then, reviewed the contraindications and side effects of the oral long-term medications. Orlistat, which can aid in up to 5% weight loss, can result in fecal incontinence and oily stools and is contraindicated for people with cholestasis or chronic malabsorption.

Phentermine/topiramate ER, which can aid in weight loss of up to 10%, can result in hypertension, constipation, or paresthesia and is contraindicated for those with hyperthyroidism, glaucoma, and kidney stones. After the initiating dose of 3.75 mg/23 mg, Dr. Finkle increases patients’ dose every 2 weeks, ”but if they’re not tolerating it, if they’re having significant side effects, or they’re losing weight, you do not increase the medication.”

Side effects of naltrexone HCl/bupropion HCl ER, which can lead to weight loss of 5%-6%, can include suicidal ideation, hypertension, and glaucoma, and it’s contraindicated in those taking opioids or with a history of anorexia or seizures. 

Dr. Finkle discussed the newest but most effective medications, the GLP-1 agonists semaglutide, liraglutide, and tirzepatide. The main contraindications for these drugs are a personal or family history of medullary thyroid cancer, any hypersensitivity to this drug class, or multiple endocrine neoplasia type II syndrome.

The two main serious risks are pancreatitis — a 1% risk — and gallstones. Though Dr. Finkle included suicidal ideation as a potential risk of these drugs, the most recent evidence suggests no link between suicidal ideation and GLP-1 agonists. The most common side effects are vomiting, nausea, constipation, diarrhea, dyspepsia, and an increased heart rate, though these eventually resolve. 

The mechanisms of all three drugs for obesity treatment are similar; they work to slow gastric emptying and curb central satiety, though they also have additional mechanisms with benefits for blood glucose levels and the heart and liver.

Finally, Dr. Finkle reviewed medications that can cause weight gain: medroxyprogesterone acetate for birth control; the antidepressants amitriptyline, paroxetine, venlafaxine, and trazodone; beta blockers for hypertension or migraine; the mood stabilizers gabapentin, lithium, valproate, and carbamazepine; and diphenhydramine and zolpidem for sleep. 

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Antihypertensive drugs like calcium channel blockers and diuretics may increase risk of eczematous dermatitis: JAMA

Researchers have found that antihypertensive drug use is associated with an increased risk of eczematous dermatitis in older adults. This conclusion comes from a longitudinal cohort study conducted using data from primary care practices in the UK, highlighting the need for clinicians to consider medication use when managing eczema in this age group. This study was published in JAMA Dermatology by Ye M. and colleagues.

Rates of physician-diagnosed eczema have been increasing among older adults, but little is known about the underlying mechanisms and optimal treatments for this subgroup. Preliminary data suggested a potential link between antihypertensive medications and eczematous dermatitis, prompting further investigation into this association.

The study analyzed a population-based sample of individuals aged 60 years and older without a prior diagnosis of eczematous dermatitis. Conducted from January 1, 1994, to January 1, 2015, the study utilized data from The Health Improvement Network in the UK. Data analyses were performed from January 6, 2020, to February 6, 2024. The primary exposure was the first prescription of an antihypertensive drug, categorized by drug class.

  • The study included 1,561,358 older adults with a mean age of 67 years (SD 9), and 54% were female.

  • The overall prevalence of eczematous dermatitis was 6.7% during a median follow-up of 6 years (IQR 3-11). Incidence was higher among those receiving antihypertensive drugs (12 vs. 9 per 1000 person-years).

  • Adjusted Cox proportional hazard models indicated a 29% increased hazard rate for eczematous dermatitis among those using any antihypertensive drugs (HR 1.29; 95% CI 1.26-1.31).

  • Diuretic drugs showed the largest effect size (HR 1.21; 95% CI 1.19-1.24).

  • Calcium channel blockers also had a significant effect (HR 1.16; 95% CI 1.14-1.18).

  • Angiotensin-converting enzyme inhibitors had a smaller effect (HR 1.02; 95% CI 1.00-1.04).

  • β-blockers showed a similar smaller effect (HR 1.04; 95% CI 1.02-1.06).

The findings indicate a small but significant increased risk of eczematous dermatitis associated with antihypertensive drugs, particularly with diuretics and calcium channel blockers. While the exact mechanisms remain unclear, the data suggest that clinicians should consider these potential side effects when prescribing antihypertensive medications to older adults.

These results could guide clinicians in managing patients who develop eczema later in life. Awareness of the potential link between antihypertensive medications and eczematous dermatitis may prompt more careful selection of antihypertensive therapy, possibly opting for drugs with a lower associated risk when appropriate.

Researchers have found that the use of antihypertensive drugs in older adults is associated with a higher rate of eczematous dermatitis. The effect size varies by drug class, being largest for diuretic drugs and calcium channel blockers. These findings underscore the importance of considering medication history in the management of eczema in older adults.

Reference:

Ye, M., Chan, L. N., Douglas, I., Margolis, D. J., Langan, S. M., & Abuabara, K. (2024). Antihypertensive medications and eczematous dermatitis in older adults. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2024.1230

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Galectin 3 promising biomarker for predicting long COVID among patients of Covid 19: Study

Researchers have found that Galectin-3 could serve as a reliable biomarker for predicting post-COVID syndrome, especially when measured 60 to 120 days after SARS-CoV-2 infection. This finding comes from a detailed study aimed at identifying biomarkers that can forecast the development of post-COVID syndrome. This recent study was published in the journal Respiratory Medicine by Andrea Portacci and colleagues.

Post-COVID syndrome, characterized by persistent symptoms such as exercise-induced dyspnea, poses a significant challenge for clinicians. Despite various studies, reliable biomarkers that can predict its development remain scarce. This study aimed to explore the relationship between Galectin-3 blood concentrations and post-COVID syndrome.

The objective of the study was to evaluate the potential of Galectin-3 as a predictive biomarker for post-COVID syndrome by analyzing its blood concentrations in patients who had recovered from acute COVID-19.

The study was a single-center, prospective, observational study involving 437 consecutive patients attending an outpatient clinic for post-COVID assessment. For each patient, clinical, functional, and radiological data were recorded, along with several blood biomarkers associated with COVID-19, including Galectin-3. The predictive performance of Galectin-3 for post-COVID syndrome was assessed using Receiver Operating Characteristic (ROC) and multivariate regression analysis.

The key findings of the study were as follows:

  • Among the blood biomarkers tested, Galectin-3 was the only one correlated with the development of post-COVID syndrome.

  • Although the Cox regression model showed insufficient performance statistically, correlation coefficients and ROC curve analysis demonstrated a strong relationship between Galectin-3 levels and the time elapsed since acute COVID-19.

  • Specifically, Galectin-3 showed greater predictive power when measured 60 to 120 days after infection.

  • The findings suggest that Galectin-3 could be a valuable biomarker if evaluated correctly during follow-up to avoid misinterpretations.

The study’s results indicate that Galectin-3 could play a crucial role as a predictive biomarker for post-COVID syndrome. Its predictive power is particularly strong when measured within the 60 to 120-day window post-infection. These findings underscore the importance of timing in the evaluation of Galectin-3 levels to maximize its predictive accuracy.

Galectin-3 has the potential to serve as an important biomarker for predicting post-COVID syndrome, but its evaluation should be carefully timed during follow-up assessments to ensure accurate predictions and avoid misinterpretations. This discovery could significantly enhance the management and treatment strategies for patients recovering from COVID-19.

Reference:

Portacci, A., Amendolara, M., Quaranta, V. N., Iorillo, I., Buonamico, E., Diaferia, F., Quaranta, S., Locorotondo, C., Schirinzi, A., Boniello, E., Dragonieri, S., & Carpagnano, G. E. (2024). Can Galectin-3 be a reliable predictive biomarker for post-COVID syndrome development? Respiratory Medicine, 226(107628), 107628. https://doi.org/10.1016/j.rmed.2024.107628

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Vital sign criteria may help identify children at greatest risk of trauma-related morbidity and mortality: JAMA

Vital sign criteria may help identify children at greatest risk of trauma-related morbidity and mortality suggests a new study published in the JAMA.

Vital signs are essential components in the triage of injured children. The Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS) physiologic criteria are frequently used for trauma assessments. A study was done to evaluate the performance of ATLS and PALS criteria vs empirically derived criteria for identifying major trauma in children. This retrospective cohort study used 2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) data contributed by US trauma centers. Included encounters involved pediatric patients (aged <18 years) with severe injury, excluding those who experienced out-of-hospital cardiac arrest, were receiving mechanical ventilation, or were transferred from another facility. Data were analyzed between April 9 and December 21, 2023. Major trauma, determined by the Standard Triage Assessment Tool, a composite measure of injury severity and interventions performed. Multivariable models developed from PALS and ATLS vital sign criteria were compared with models developed from the empirically derived criteria using the area under the receiver operating characteristic curve. Validation of the findings was performed using the 2019 TQIP dataset. Results: A total of 70 748 patients (median [IQR] age, 11 [5-15] years; 63.4% male) were included, of whom 3223 (4.6%) had major trauma. The PALS criteria classified 31.0% of heart rates, 25.7% of respiratory rates, and 57.4% of SBPs as abnormal. The ATLS criteria classified 25.3% of heart rates, 4.3% of respiratory rates, and 1.1% of SBPs as abnormal. Among children with all 3 vital signs documented (64 326 [90.9%]), PALS had a sensitivity of 88.4% (95% CI, 87.1%-89.3%) and specificity of 25.1% (95% CI, 24.7%-25.4%) for identifying major trauma, and ATLS had a sensitivity of 54.5% (95% CI, 52.7%-56.2%) and specificity of 72.9% (95% CI, 72.6%-73.3%). The empirically derived cutoff vital sign z scores had a sensitivity of 80.0% (95% CI, 78.5%-81.3%) and specificity of 48.7% (95% CI, 48.3%-49.1%) and area under the receiver operating characteristic curve of 70.9% (95% CI, 69.9%-71.8%), which was similar to PALS criteria (69.6%; 95% CI, 68.6%-70.6%) and greater than ATLS criteria (65.4%; 95% CI, 64.4%-66.3%). Validation using the 2019 TQIP database showed similar performance to the derivation sample. These findings suggest that empirically derived vital sign criteria strike a balance between the sensitivity of PALS criteria and the specificity of ATLS criteria in identifying major trauma in children. These criteria may help to identify children at greatest risk of trauma-related morbidity and mortality.

Reference:

Gorski JK, Chaudhari PP, Spurrier RG, et al. Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma. JAMA Netw Open. 2024;7(2):e2356472. doi:10.1001/jamanetworkopen.2023.56472

Keywords:

Vital sign criteria, children, greatest risk, trauma-related, morbidity, mortality, JAMA, Gorski JK, Chaudhari PP, Spurrier RG

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