Remote physical therapy yields comparable results to in-person therapy post knee surgery for same-day discharge patients: Study

USA: In a groundbreaking development, a recent randomized clinical trial has unveiled promising findings regarding remote physical therapy programs for patients undergoing total knee arthroplasty (TKA). The study, published in the Journal of Arthroplasty, challenges traditional notions of in-person, supervised therapy post-surgery.

The study found that compared to patients in the electronic remote perioperative management (ERPM) + outpatient physical therapy (OPT), patients in the ERPM + remote physical therapy (RPT) had lower costs, similar outcomes, and saved time after same-day discharge (SDD) total knee arthroplasty (TKA).

Comparing remote physical therapy to traditional outpatient physical therapy following same-day discharge TKA, researchers found no major differences in outcomes between the two groups.

“At the 6, 12 & 52-week follow-ups, the RPT group showed comparable knee range of motion, functional assessments, pain scores, and satisfaction levels to those receiving OPT, with lower time investment & financial burden,” the researchers reported.

A growing number of TKA patients are candidates for same-day discharge. Previous research has shown equivalent outcomes of internet-based remote physical therapy to supervised outpatient physical therapy after TKA. Considering this, Thomas L. Bradbury, Advanced Center for Joint Surgery, and Northside Hospital Forsyth, Cumming, Ga, and colleagues sought to compare outcomes between OPT and RPT in patients undergoing SDD TKA using an electronic remote perioperative management program.

For this purpose, the study enrolled patients undergoing SDD TKA in an ERPM program. They were randomized to ERPM + OPT or ERPM + RPT. Preoperative and 6-week functional assessments included timed up and go (TUG), knee range of motion (ROM), and 4-meter gait speed.

At 6 and 12 weeks, Numerical Rating Scale (NRS) pain scores were evaluated preoperatively, and satisfaction was assessed at 6, 12, and 52 weeks postoperatively. Participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS, Jr.) and Veterans Rand 12 Item Health Survey (VR-12 MCS/PCS) preoperatively and at 6, 12, and 52 weeks postoperatively. Outpatient PT utilization was collected 90 days postoperatively.

The study led to the following findings:

· Out of 197 initially randomized patients, 76 remained in the ERPM + RPT group and 95 in the ERPM + OPT group after withdrawals and crossovers.

· Baseline characteristics showed no significant differences between the two groups.

· No clinically relevant differences were observed in knee ROM, NRS pain, patient-reported outcomes, functional assessments, or satisfaction at any follow-up time.

· Participants in the ERPM + OPT group attended an average of 11.57 PT sessions, incurring a total cost of $462.8 and 133 minutes of travel.

· The ERPM + RPT group experienced no expenses or travel time.

As the healthcare landscape continues to evolve, embracing innovations such as remote physical therapy could play a pivotal role in improving patient outcomes, enhancing healthcare accessibility, and ultimately transforming the delivery of rehabilitative care.

“There is a need for further analysis to determine predictive indicators for crossovers,” the researchers concluded.

Reference:

Bradbury TL, McConnell MJ, Whitacre D, Naylor B, Gibson B, DeCook C. A Remote Physical Therapy Program Demonstrates Similar Outcomes Compared to In-Person, Supervised Physical Therapy after Same-Day Discharge Total Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty. 2024 May 18:S0883-5403(24)00512-6. doi: 10.1016/j.arth.2024.05.040. Epub ahead of print. PMID: 38768768.

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Which are the laboratory indicators of Female Coronary Atherosclerosis regardless of diabetes status?

Diabetes is a syndrome characterized by high glycemic levels that promote significant pathophysiological metabolic changes. Atherosclerotic Cardiovascular Disease (ASCVD), the main cause of morbidity and mortality in people with Diabetes Mellitus (DM), may promote or be favored by free cholesterol deposited into the vessels’ walls

Researchers in medicine have been studying the composition of biochemical markers to determine correlations between during health and disease for several decades. The data helps healthcare professionals to accurately diagnose and treat diseases, some of which are life threatening.

A team of researchers from Brazil has studied biomarkers, ratios, and indexes as indicators of coronary obstructions in women with established coronary artery disease, regardless of whether they have diabetes.

A cross-sectional study was conducted on 42 women with confirmed atherosclerotic coronary disease, divided into diabetic and non-diabetic groups, who were scheduled for angioplasty or coronary bypass surgery. Blood samples were taken right before the coronary procedures to measure various lab values, including blood sugar, HbA1c, insulin, HDL-C, PON-1, free cholesterol, LDL-C, Apo A-1, Apo B, and triglycerides.

In diabetic patients, insulin levels were positively correlated with triglycerides (p < 0.0108; r = 0.2009), apo B (p < 0.0006; r = 0.3737), non-HDL cholesterol (p < 0.0084; r = 0.2156), and free cholesterol (p < 0.0084; r = 0.3251). Using a linear regression model, insulin in diabetic patients was linked to blood sugar, triglycerides, and HOMA-IR (p < 0.001, R2 = 0.9868). In non-diabetics, insulin was only associated with HOMA-IR (p = 0.002, R2 = 0.9031). When triglycerides were used as the dependent variable, they were associated with HOMA-IR in both groups (diabetics: p = 0.006, R2 = 0.2504; non-diabetics: p = 0.014, R2 = 0.4697). Additionally, the TG/HDL-C ratio was higher than 2.5 in 90% of diabetics and 83.33% of non-diabetic patients.

The high number of women with a TG/HDL-C ratio over 2.5, along with the links between insulin, HOMA-IR, and TG/HDL-C, as well as the correlations with apoB, non-HDL-C, and free cholesterol, should be considered as indicators of early coronary atherosclerosis in women.

For further reference log on to: https://bit.ly/4bPZoW8

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Potential of Polypill Intervention in Stroke and Cognitive Impairment Prevention,reveals PROMOTE Study

The PROMOTE study, sponsored by the Program of Support for Institutional Development for the Unified Health System (PROADI-SUS) of the Hospital Moinhos de Vento in partnership with the Ministry of Health of Brazil, was conducted by a collaborative team of researchers from different Institutions, led by Professor Sheila Cristina Ouriques Martins.

The study was designed to prove the World Stroke Organisation’s concept of a comprehensive intervention approach in primary prevention to “Cut Stroke in Half”, conceived by former World Stroke Organisation President Michael Brainin from Austria, and Professor Valery Feigin from New Zealand. The intervention is based on lifestyle modification utilising the Stroke Riskometer and a polypill containing anti-hypertensive and statin for patients at low to moderate risk of stroke, a population that currently has no recommendation for medication use. The main study will explore the efficacy of intervention in reducing the incidence of stroke and cognitive impairment in this population. The polypill regimen comprised valsartan 80mg, amlodipine 5mg, and rosuvastatin 10mg.

PROMOTE is a Phase III, randomised, double-blinded, placebo-controlled clinical trial recruiting participants aged 50-75 years without a history of hypertension, diabetes, stroke, or cardiovascular disease, yet presenting systolic blood pressure (SBP) levels between 120- 139mmHg and at least one lifestyle risk factor (including an unhealthy diet, sedentarism, obesity or smoking). This pilot study aimed to assess the feasibility of this strategy implementation, the tolerability of this new polypill, and the potential impact of this integrated intervention, including as the main outcome a target reduction in 2.5mmHg in SBP and improvement in 0.4 points in the Life’s Simple 7 score over a 9-month period. Participants underwent a 28-day run-in phase to evaluate adherence and tolerance to the polypill regimen. Primary Health Care Units in southern Brazil were randomised into clusters to implement Stroke Riskometer-guided lifestyle modification or provide standard care, while individual participants were allocated to the polypill or placebo.

The pilot study enrolled 371 patients, with a mean age of 59 years, 64% were women and 87% white. The mean estimated 10-year cardiovascular risk was 4-5%. The polypill regimen was very well-tolerated, with only 4% of participants excluded after the run-in period because of mild adverse events. In total, serious adverse events occurred only in 1.4% of patients and were not related to the polypill.

Participants receiving the polypill experienced a significant 13 mmHg reduction in SBP throughout the study duration compared to 4 mmHg in the placebo group. Notably, participants in the Polypill+Riskometer group exhibited the most pronounced reduction in SBP. Participants taking the polypill also showed a reduction of 38 mg/dl in LDL cholesterol, with no difference observed in the placebo group. The riskometer did not add benefit in reducing cholesterol but, encouragingly, 71% of participants utilising the Stroke Riskometer reported its efficacy in facilitating lifestyle modifications.

The PROMOTE pilot study demonstrated that the new polypill can already be used for hypertensive population and it is effective and well tolerated in patients with lower blood pressure but still with an increased risk for stroke. The riskometer is a free app, easy to use, and can assist in lifestyle modification. The findings from the PROMOTE pilot may represent a paradigm shift in preventive healthcare based on combined therapies targeting vascular risk factors to reduce the incidence of stroke and cognitive impairment.

The results of the expansion for a large clinical trial with 8,250 participants is now starting across the entire country. This may demonstrate the impact in stroke and cognitive decline in this new target population with low and middle risk of stroke, with the expectation of cutting stroke rates.

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Tramadol hydrochloride as effective as lidocaine hydrochloride with adrenalin for providing anesthesia for extraction of maxillary bicuspids: Study

Tramadol hydrochloride as effective as lidocaine hydrochloride with adrenalin for providing anesthesia for extraction of maxillary bicuspids suggests a study published in the Journal of Oral and Maxillofacial Surgery.

Tramadol hydrochloride (T-HCl) has demonstrated to have a local anesthetic effect similar to lidocaine hydrochloride (L-HCl) when administered locally for minor oral surgical procedures. The study aimed to compare the anesthetic effect of T-HCl versus L-HCl in maxillary premolar extraction. The study is a split-mouth, double-blind randomized clinical trial at the Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India. The study sample was composed of patients referred for maxillary bicuspid extraction. Patients were excluded from the sample if, allergic to the study drugs, pregnant or lactating females, and smokers. The variable is an anesthetic drug administered for local anesthesia and it is grouped into 2 categories, T-HCl and L-HCl. A supraperiosteal infiltration of T-HCl with adrenaline on one side and L-HCl with adrenaline on the contralateral side was injected. The primary outcome variable was profound anesthesia of T-HCl, where the patient sensed the loss of sensation of touch, temperature, and pain. Secondary outcomes were onset and duration of anesthesia, intraoperative pain, postoperative analgesia, and adverse reactions, were recorded. Inferential statistics, the χ2 Test, the Mann–Whitney Test, and the Wilcoxon signed-rank test were used to compare the parameters. The level of significance was set at ≤ 0.05. Results: A total of 40 patients were included, and 80 teeth were extracted. Profound anesthesia was achieved in all the cases. The mean subjective duration of anesthesia in the T-HCl and L-HCl groups was 130.80 ± 20.01 minutes and 111.40 ± 14.87 minutes, respectively, with a P value of .001. The mean Visual Analogue Scale (VAS) score for pain during the procedure in the T-HCl and L-HCl groups was 0.60 ± 0.67 and 1.10 ± 0.71, respectively, with a P value of .002. The mean Visual Analogue Scale score for pain postoperatively in the T-HCl and L-HCl groups was 0.70 ± 0.72 and 1.40 ± 0.67, respectively, with a P value of .001. Six patients in T-HCl required postoperative analgesia when compared to 18 patients in L-HCl (P value < .003). T-HCl provides similar anesthetic outcomes in the extraction of maxillary bicuspids as L-HCl.

Reference:

Raju Kr Y, Sagar P, Prasad K, Shridhar P, Ranganath K. Comparative Evaluation of the Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline Versus Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia: A Randomized Control Trial. J Oral Maxillofac Surg. 2024 Apr;82(4):478-484. doi: 10.1016/j.joms.2023.12.009. Epub 2023 Dec 22. PMID: 38182119.

Keywords:

Tramadol, hydrochloride, effective, lidocaine, hydrochloride, adrenalin, providing, anesthesia, extraction, maxillary, bicuspids, study, Raju Kr Y, Sagar P, Prasad K, Shridhar P, Ranganath K, Journal of Oral and Maxillofacial Surgery

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Use of intimate care products including genital talc linked to ovarian cancer

Use of intimate care products including genital talc linked to ovarian cancer suggests study published in the Journal of Clinical Oncology.

Intimate care products may contain substances associated with increased risk of hormone-related cancers. The relationship between genital talc use and ovarian cancer, in particular, has been well studied, but concerns about recall bias and exposure misclassification have precluded conclusions. We examined the association between intimate care products and female hormone–related cancers, accounting for potential biases, using data from a US-based cohort study. The Sister Study enrolled 50,884 women who had a sister with breast cancer. Data on genital talc use and douching were collected at enrollment (2003-2009) and follow-up (2017-2019). We used Cox proportional hazards models to estimate hazard ratios (HRs) for associations between intimate care product use and breast, ovarian, and uterine cancers. To account for potential exposure misclassification and recall bias, we conducted quantitative bias analyses under various exposure reassignment assumptions. Results: Across considered scenarios, 41%-64% of participants douched and 35%-56% used genital talc. In models adjusted for exposure misclassification, genital talc use was positively associated with ovarian cancer (HR range, 1.17-3.34) Frequent douching and douching during young adulthood were positively associated with ovarian cancer, but neither douching nor talc was associated with breast or uterine cancer. Differential reporting of talc use by cases and noncases likely produces positive biases, but correcting for error still resulted in HRs above 1.0. For example, HR, 1.40 (95% CI, 1.04 to 1.89) when 25% of exposed cases and 10% of unexposed noncases had talc status reassigned. Although results show how differential recall would upwardly bias estimates, corrected results support a positive association between use of intimate care products, including genital talc, and ovarian cancer.

Reference:

Katie M. O’Brien et al., Intimate Care Products and Incidence of Hormone-Related Cancers: A Quantitative Bias Analysis. JCO 0, JCO.23.02037

DOI:10.1200/JCO.23.02037

Keywords:

Use, intimate care, products, genital talc, ovarian cancer, study, Katie M. O’Brien, Journal of Clinical Oncology

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Study Reveals Sexually Dimorphic Brain Processing in Individuals with Low Sexual Desire

UK: Understanding the complex interplay between biology and psychology in the realm of sexual desire has long been a subject of fascination and inquiry. A recent study has delved into this intriguing area, shedding light on the sexually dimorphic brain processing observed in men and women experiencing distressing low sexual desire.

The study published in Scientific Reports showed that women and men with hypoactive sexual desire disorder (HSDD) — that is, “distressingly” low sexual desire — demonstrated dimorphic brain processing on functional MRI (fMRI).

“The data supports the ‘top-down’ theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes,” the researchers wrote. In women, the ‘top-down’ theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas.

The researchers note that therapies targeted at reducing hyperactivity in higher-cortical regions or boosting activation in lower-limbic regions could improve sexual function in HSDD women. However, there may be a different HSDD model in men, whereby the visual attention to the sexual cues is not relayed effectively to emotional centers involved in the sexual response.

HSDD is the most frequent sexual health complaint, affecting 8% of men and 10% of women. Previous research has found that in women the condition is caused by overactivity in higher-level cognitive brain regions that regulate self-monitoring, introspection, and guilt feelings, which in turn suppress lower-level emotional/sexual brain areas that regulate reward, emotion, and sexual processing. There is no clarity on whether this mechanism is at work in men.

It is essential to directly compare the neurobiological basis of HSDD in both sexes for further understanding of the disorder, which could lead to targeted and effective interventions and treatments. Considering this, Alexander N. Comninos, Section of Endocrinology and Investigative Medicine, Imperial College London, London, UK, and colleagues employed task-based functional MRI in 32 men and 32 women with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, and psychometric questionnaires to evaluate sexual desire/arousal.

The study led to the following findings:

  • Women had greater activation in higher-level and lower-level brain regions, compared to men.
  • Indeed, women who had greater hypothalamic activation in response to sexual videos reported higher psychometric scores in the motivational (r = 0.56), evaluative (r = 0.55), and physiological (r = 0.57) domains of sexual desire and arousal after watching the sexual videos in the scanner.
  • There were no similar correlations in men.

“Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between men and women,” the researchers wrote.

“The data supports the ‘top-down’ theory of HSDD in women, whereas HSDD, in men, appears to be associated with different neurofunctional processes,” they concluded.

Reference:

Ertl, N., Mills, E. G., Wall, M. B., Thurston, L., Yang, L., Suladze, S., Hunjan, T., Phylactou, M., Patel, B., Bassett, P. A., Howard, J., Rabiner, E. A., Abbara, A., Goldmeier, D., Comninos, A. N., & Dhillo, W. S. (2024). Women and men with distressing low sexual desire exhibit sexually dimorphic brain processing. Scientific Reports, 14(1), 1-10. https://doi.org/10.1038/s41598-024-61190-4

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One-month DAPT followed by 5-month Ticagrelor monotherapy in acute coronary syndromes with DCB – results from REC-CAGEFREE II

The Course Directors have selected 3 major Late Breaking Trials (LBTs) that will be presented for the first time during the 2024 edition of EuroPCR. These trials were selected on account of their design, outcomes and potential to influence daily clinical practice. Among them is the REC-CAGEFREE II trial.

Background and methods

The REC-CAGEFREE II trial is an open-label, investigator-initiated, non-inferiority, multicentre randomised trial comparing stepwise de-escalation of dual antiplatelet therapy (DAPT) with standard DAPT in patients with acute coronary syndrome (ACS) treated with paclitaxel-coated balloons (PCB). Eligible patients were randomly assigned to stepwise DAPT de-escalation − consisting of aspirin plus ticagrelor for 1 month, followed by 5 months of ticagrelor monotherapy, and then 6 months of aspirin monotherapy − compared to standard DAPT (aspirin plus ticagrelor for 12 months). The primary efficacy endpoint was net adverse clinical events (a composite of all-cause death, stroke, myocardial infarction [MI], revascularisation, and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) at 1 year.

Results

A total of 1,948 patients were enrolled and randomised to stepwise DAPT de-escalation (n=975) or standard DAPT (n=973). The study shows that stepwise DAPT de-escalation was non-inferior to standard 12-month DAPT for the primary endpoint in patients with ACS treated exclusively with PCB (87 [9.0%] vs 84 [8.7%]; difference: 0.3%, upper boundary of the one-sided 95% confidence interval [CI]: 2.4%; p non-inferiority=0.01). The rates of BARC type 3 or 5 bleeding were 0.4% and 1.7% (difference: −1.24%, 95 % CI: −2.14 to −0.33), and the rates of the composite of all-cause death, stroke, MI, and revascularisation were 8.8% and 7.6% (difference: 1.03%, 95 CI%: −1.40 to 3.47) in the stepwise de-escalation and standard groups, respectively.

Key learnings

The major strength of this study is that it provides the first randomised evidence regarding antiplatelet therapy strategy in drug-coated balloon (DCB) percutaneous coronary intervention (PCI). One of the potential advantages of using DCB is the need for shorter duration DAPT, given the lack of stent struts requiring endothelialisation. However, patients with ACS have higher ischaemic risk, and current guidelines still recommend DAPT for 12 months in patients without high bleeding risk.

The present study supports the value of de-escalation therapy with ticagrelor in ACS patients treated with DCB. However, some important considerations remain. First, evidence for the use of DCB in the context of de novo lesions (particularly in patients with ACS) is quite limited, with no randomised data to demonstrate adequate results in this context. Second, only around 40% of subjects underwent PCI for ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), while the rest had unstable angina. Application of the results to higher-risk patients with STEMI or NSTEMI is therefore debatable. Third, only 9% of all eligible patients were enrolled, indicating a very selected population. The main reason for exclusion was use of a drug-eluting stent (DES) in another vessel, raising concerns about the feasibility of a PCB-only strategy in patients with ACS, who often have multivessel disease, and the external validity of the data. Fourth, with regard to the procedure, only PCB were used, and 60% of the lesions treated were in small vessels (mean PCB diameter: 2.7 mm). In most patients, only one lesion was treated, again suggesting a very selected, low-risk population. Finally, several types of PCB were used, mostly without robust clinical evidence for their use in de novo lesions. There is no class effect for these devices, whose efficacy is influenced by multiple factors such as dose, formulation and release kinetics.

Conclusions and PCR recommendations

REC-CAGEFREE II is a pioneering study that provides the first randomised data concerning the use of antiplatelet therapy in the context of DCB. The results, however, are probably only applicable to low-risk populations (mainly those with unstable angina with single small vessel disease). Using DCB in the context of ACS poses theoretical advantages, including recovery of endothelial function and the lack of delayed endothelialisation and late acquired malapposition. These potential benefits require testing in adequately designed trials comparing the use of DCB in de novo lesions in ACS patients to DES (the current standard of care).

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Double bundle ACL reconstruction tied to better IKDC objective grading at 15 year follow up compared to single bundle reconstruction: study

Arttu Seppänen et al conducted a prospective randomized study to evaluate whether the use of the anatomic double-bundle (DB) method for anterior cruciate ligament (ACL) reconstruction results in better clinical outcomes and a lower incidence of graft failure compared with the anatomic single-bundle (SB) method.

Patients were randomly assigned to either the SB group (n=78) or the DB group (n=75). Evaluation included clinical testing, subjective assessments, functional testing, and International Knee Documentation Committee (IKDC) objective grading. Surgical techniques were anatomic, and the rehabilitation protocol was standardized.

Key findings of the study were:

• At 15-year follow-up, information was available on 100 patients (65%), of whom 55 (36%) were accepted in the final statistical analysis.

• During the 15-year follow-up period, 11 patients in each group sustained ACL tear in the contralateral knee. Moreover, four patients (5%) in the SB group and one patient (1%) in the DB group underwent total knee replacement.

• The median and mean of the follow-up time were 16.3 years (14.6–17.1) and 15.9 years (1.4), respectively.

• There were almost three times as many graft failures in the SB group, but the result wasn´t statistically significant.

• Anterior tibial translation was measured with the KT -1000 arthrometer. The median difference (index minus opposite) was 1 mm in both groups, and the IQR was -1 to 2 mm in the SB group and 0 to 2 mm in the DB group.

• Knee rotational stability was assessed with the pivot shift test. In total, 23 (79%) patients in the SB group and 23 patients (89%) in the DB group had a negative pivot shift test result.

• Subjective assessments, knee stability (KT -1000 and pivot shift), range of motion (ROM), and functional one leg hop test showed no statistically significant differences between the groups.

• However, DB ACL reconstruction resulted in better International Knee Documentation Committee objective grading (P<0.001).

“The main finding of this 15-year follow-up study was that the double-bundle technique resulted in better IKDC objective grading. Otherwise, no difference between the groups was demonstrated” – the authors commented.

Further reading:

Double bundle anterior cruciate ligament reconstruction resulted in better International Knee Documentation Committee objective grading at ffteen year follow up compared to single bundle reconstruction.

Arttu Seppänen et al

International Orthopaedics (2024) 48:905–912

https://doi.org/10.1007/s00264-024-06106-7

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Frailty associated with worse cognitive function regardless of CKD status: Study

Frailty associated with worse cognitive function regardless of CKD status suggests a study published in the BMC Nephrology.

Though older adults with chronic kidney disease (CKD) have a greater mortality risk than those without CKD, traditional risk factors poorly predict mortality in this population. Therefore, we tested our hypothesis that two common geriatric risk factors, frailty and cognitive impairment, and their co-occurrence, might improve mortality risk prediction in CKD. Among participants aged ≥ 60 years from National Health and Nutrition Examination Survey (2011–2014), we quantified associations between frailty (physical frailty phenotype) and global/domain-specific cognitive function (immediate-recall [CERAD-WL], delayed-recall [CERAD-DL], verbal fluency [AF], executive function/processing speed [DSST], and global [standardized-average of 4 domain-specific tests]) using linear regression, and tested whether associations differed by CKD using a Wald test. We then tested whether frailty, global cognitive impairment (1.5SD below the mean), or their combination improved prediction of mortality (Cox models, c-statistics) compared to base models (likelihood-ratios) among those with and without CKD. Results: Among 3,211 participants, 1.4% were cognitively impaired, and 10.0% were frail; frailty and cognitive impairment co-occurrence was greater among those with CKD versus those without (1.2%vs.0.1%). Frailty was associated with worse global cognitive function (Cohen’s d = -0.26SD,95%CI -0.36,-0.17), and worse cognitive function across all domains; these associations did not differ by CKD (pinteractions > 0.05). Mortality risk prediction improved only among those with CKD when accounting for frailty (p[likelihood ratio test] < 0.001) but not cognitive impairment. Frailty is associated with worse cognitive function regardless of CKD status. While CKD and frailty improved mortality prediction, cognitive impairment did not. Risk prediction tools should incorporate frailty to improve mortality prediction among those with CKD

Reference:

Hong, J., Chu, N.M., Cockey, S.G. et al. Frailty, but not cognitive impairment, improves mortality risk prediction among those with chronic kidney disease—a nationally representative study. BMC Nephrol 25, 177 (2024). https://doi.org/10.1186/s12882-024-03613-y

Keywords:

Frailty, associated, worse, cognitive, function, regardless, CKD status, study, BMC Nephrology, Hong, J., Chu, N.M., Cockey, S.G.

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Low-Dose Aspirin fails to Effectively Prevent Age-Related Macular Degeneration: JAMA

A recent study published in the Journal of American Medical Association found that long-term low-dose aspirin use does not prevent the onset or progression of age-related macular degeneration (AMD) which is a leading cause of irreversible vision loss in the elderly. The ASPREE-AMD study was carried out to determine if daily low-dose aspirin could be an effective intervention against AMD. The recommendations for the participants at risk are generally limited to lifestyle, nutritional and supplement advice. This study explored whether aspirin could offer additional protective effects for vision health.

The ASPREE-AMD study was conducted across multiple centers in Australia as part of the international ASPREE trial examines the broader benefits of aspirin in prolonging disability-free survival among older individuals. The participants aged 70 and above who were free from dementia and significant physical disabilities, cardiovascular diseases or other chronic illnesses limiting five-year survival were included. The retinal images were taken at the start of the study between March 2010 and January 2015, and then again at three and five years post-randomization.

The study involved a total of 4,993 participants with 3,171 having complete data for analysis. The participants were randomly assigned to receive either 100 mg of enteric-coated aspirin daily or a placebo. The primary outcomes measured were the incidence of AMD and the progression from early or intermediate to late-stage AMD.

The results indicated no significant difference in AMD incidence between the aspirin and placebo groups. AMD developed in 19.4% of participants in the aspirin group when compared to 19.1% in the placebo group this also yielded a relative risk (RR) of 1.02 (95% CI, 0.85-1.22; P = .86). Also, the progression to late-stage AMD was observed in 2.3% of the aspirin group and 3.1% of the placebo group (RR, 0.72; 95% CI, 0.36-1.44; P = .36), suggesting a trend but not a statistically significant reduction in the progression.

The study concluded that low-dose aspirin that was taken over an average follow-up period of 3.1 years did not significantly impact the incidence or progression of AMD. The research also noted that while there was a slight indication of reduced progression to late-stage AMD in the aspirin group, the evidence was not strong enough due to the low number of cases observed.

Source:

Robman, L. D., Wolfe, R., Woods, R. L., Thao, L. T. P., Makeyeva, G. A., Hodgson, L. A. B., Lepham, Y.-A., Jachno, K., Phung, J., Maguire, E., Luong, H., Trevaks, R. E., Ward, S. A., Fitzgerald, S. M., Orchard, S. G., Lacaze, P., Storey, E., Abhayaratna, W. P., Nelson, M. R., … McNeil, J. J. (2024). Effect of Low-Dose Aspirin on the Course of Age-Related Macular Degeneration. In JAMA Ophthalmology. study’s (AMA). https://doi.org/10.1001/jamaophthalmol.2024.1584

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