Low Serum Albumin Levels Increase Mortality Risk in Elderly: Lancet Study

A recent study from the Moli-sani study cohort revealed that low levels of serum albumin are significantly associated with increased mortality risk among the individuals over 65 years. The findings published in the Lancet eClinicalMedicine illuminate the importance of serum albumin as a potential biomarker for mortality in the context of cancer and vascular diseases.

This comprehensive study analyzed data from a population-based cohort that comprised a total of 17,930 individuals of 35 years and above. Over a median follow-up period of 13.1 years this research meticulously examined the relationship between serum albumin levels and cause-specific mortality using competing-risk survival analysis.

Hypoalbuminemia (serum albumin levels of 35 g/L or lower) was found in 2.3% of the study participants. Among the 1428 recorded deaths, 574 were attributed to cancer and 464 to vascular causes. The analysis revealed that hypoalbuminemia was independently associated with mortality when compared to the individuals with serum albumin levels above 40 g/L.

A decrease of 1 standard deviation in serum albumin levels corresponded to a higher risk of total mortality, vascular mortality and cancer mortality. Further stratification by age demonstrated that hypoalbuminemia was linked to mortality in individuals aged 65 and above. The elderly individuals with serum albumin levels ≤35 g/L had a significantly higher risk of total, cancer and vascular mortality when compared to their younger counterparts.

These findings underline the critical role of serum albumin as a prognostic marker for mortality risk among the older adults. Serum albumin plays a crucial role in maintaining the oncotic pressure and transporting various substances in the blood. The decline has been associated with inflammation, malnutrition and chronic diseases, all of which are known risk factors for mortality.

This study suggest that monitoring serum albumin levels could help identify individuals at elevated risk of mortality by allowing for targeted interventions and preventive measures.  These outcomes may potentially reduce the risk of death from cancer and vascular diseases by identifying and addressing hypoalbuminemia in older adults. Overall, this study provides strong evidence of the association between low serum albumin levels and increased mortality risk among the elderly individuals.

Reference:

Di Castelnuovo, A., Bonaccio, M., Costanzo, S., De Curtis, A., Magnacca, S., Persichillo, M., Panzera, T., Bracone, F., Pignatelli, P., Carnevale, R., Cerletti, C., Donati, M. B., de Gaetano, G., Iacoviello, L., Violi, F., Iacoviello, L., de Gaetano, G., Donati, M. B., Cerletti, C., … Bonanni, A. (2024). The association between hypoalbuminemia and risk of death due to cancer and vascular disease in individuals aged 65 years and older: findings from the prospective Moli-sani cohort study. In eClinicalMedicine (p. 102627). Elsevier BV. https://doi.org/10.1016/j.eclinm.2024.102627

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High and very high volumes of physical activity during follow-up not related to CAC progression: JAMA

USA: Physical activity has long been hailed as a cornerstone of good health, but its specific impact on cardiovascular health continues to interest researchers. A recent study published in JAMA Cardiology has shed light on the relationship between physical activity and coronary artery calcification (CAC) progression in both men and women, offering valuable insights into preventive measures against cardiovascular diseases.

The cohort study involving 8771 apparently healthy adults 40 years and older revealed that ongoing leisure-time physical activity (PA), even at high volumes is not related to CAC progression, a marker of atherosclerotic cardiovascular disease (ASCVD).

“High and very high volumes of physical activity during follow-up were unrelated to CAC progression,” the researchers reported. Moreover, higher baseline volumes of physical activity were not associated with clinically meaningful CAC at follow-up.

Previous cross-sectional studies have suggested that very high PA levels are associated with a higher prevalence of coronary artery calcium (CAC). However, little is known about the association between high-volume PA and CAC progression. To fill this knowledge gap, Kerem Shuval, The Cooper Institute, Dallas, Texas, and colleagues aimed to explore the association between PA (measured at baseline and during follow-up) and the progression of CAC over time.

The study included data from 8771 apparently healthy women and men 40 years and older with multiple preventive medicine visits at the Cooper Clinic (Dallas, Texas), with a mean follow-up of 7.8 years between the first and last clinic visit. Participants with reported CAC and PA measurements at each visit from 1998 to 2019 were included in the study.

PA reported at baseline, and follow-up was examined continuously per 500 metabolic equivalents of task minutes per week (MET-min/wk) and categorically: less than 1500, 1500 to 2999, 3000 or more MET-min/wk.

The rate of mean CAC progression between visits, with potential modification by PA volume, calculated as the mean of PA at baseline and follow-up was estimated using negative binomial regression. Furthermore, proportional hazard regression was used to estimate hazard ratios for baseline PA as a CAC progression predictor to 100 or more Agatston units (AU).

The following were the key findings of the study:

  • Among 8771 participants, the mean age at baseline was 50.2 years for men and 51.1 years for women.
  • The rate of mean CAC progression per year from baseline was 28.5% in men and 32.1% in women, independent of mean PA during the same period. That is, the difference in the rate of CAC progression per year was 0.0% per 500 MET-min/wk for men and women.
  • Baseline PA was not associated with CAC progression to a clinically meaningful threshold of 100 AU or more over the follow-up period.
  • The hazard ratio for a baseline PA value of 3000 or more MET-min/wk versus less than 1500 MET-min/wk to cross this threshold was 0.84 in men and 1.16 in women.

The findings revealed that physical activity volume was not associated with CAC progression in a large cohort of healthy women and men initially free of overt cardiovascular disease.

“This conclusion is based on the results showing that high and very high PA volumes are not related to the CAC progression (regardless of baseline CAC levels) among this sample of community-dwelling adults,” the researchers wrote. “Thus, even high-volume PA likely does not accelerate CAC progression and atherosclerosis burden, though there is a need for additional longitudinal research on more diverse samples.”

Reference:

Shuval K, Leonard D, DeFina LF, et al. Physical Activity and Progression of Coronary Artery Calcification in Men and Women. JAMA Cardiol. Published online May 15, 2024. doi:10.1001/jamacardio.2024.0759

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Early Mobility Interventions in the Intensive Care Units Improve Patient Outcomes, claims research

A recent study published in the American Journal of Critical Care reveals that early mobility interventions in intensive care units (ICUs) significantly improve patient outcomes, though the optimal “dose” of mobility remains uncertain. The outcomes of this comprehensive research highlights the importance of out-of-bed activities for critically ill adults but points to variations in implementation across different ICU settings.

The primary goal of the study was to examine the relationship between the daily dose of out-of-bed mobility and patient outcomes in various ICUs. This retrospective cohort analysis utilized the electronic health records from seven adult ICUs within the hospital. They employed multivariable linear regression to assess the impact of out-of-bed events per mobility-eligible day on key outcomes such as the duration of mechanical ventilation, length of ICU stays and overall hospital stays.

The study included data from a total of 8609 adults hospitalized in ICUs from 2015 to 2018. The findings revealed that patients were mobilized out of bed on 46.5% of ICU days and were eligible for mobility interventions on a median of 2.0 (IQR: 1–3) out of 2.7 (IQR: 2–9) ICU days. The median number of out-of-bed events per mobility-eligible day was 0.5 (IQR: 0–1.2) across all patients.

Also, the study found that for every additional out-of-bed event per mobility-eligible day before extubation, the duration of mechanical ventilation decreased by 10% (adjusted coefficient [95% CI], −0.10 [−0.18 to −0.01]). While the increase in daily mobility extended ICU stays by 4% (adjusted coefficient [95% CI], 0.04 [0.03–0.06]), it reduced the overall hospital stays by 5% (adjusted coefficient [95% CI], −0.05 [−0.07 to −0.03]).

The research illuminated a dose-response relationship between daily mobility and improved the patient outcomes in reducing the length of mechanical ventilation and hospital stays. However, the effects were varied among different ICU subpopulations which indicates that a one-size-fits-all approach may not be applicable. This variability suggests that while early mobility is beneficial, tailored approaches based on specific ICU environments and patient needs are necessary for optimal results. The outcomes of this study indicates that increasing daily out-of-bed mobility can significantly improve outcomes for critically ill patients. And still, further research is imperative to determine the optimal mobility dose and to understand the differing impacts across various ICU settings. 

Source:

Fazio, S. A., Cortés-Puch, I., Stocking, J. C., Doroy, A. L., Black, H., Liu, A., Taylor, S. L., & Adams, J. Y. (2024). Early Mobility Index and Patient Outcomes: A Retrospective Study in Multiple Intensive Care Units. In American Journal of Critical Care (Vol. 33, Issue 3, pp. 171–179). AACN Publishing. https://doi.org/10.4037/ajcc2024747

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Balanced TyG Index May Play a Role in Hearing Health, finds study

Researchers have found that the Triglyceride-Glucose (TyG) index may have an impact on sensorineural hearing loss (SNHL) in adults, according to a study analyzing data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). The study explored the relationship between the TyG index and pure tone hearing thresholds in 1226 adults aged 20 to 69 years. This study was published in Journal Of Multidisciplinary Healthcare by Pan JY. and colleagues.

Sensorineural hearing loss (SNHL) is a common human sensory impairment, yet few studies have explored the relationship between metabolic indicators such as the Triglyceride-Glucose (TyG) index and hearing health. The TyG index is an indicator of insulin resistance and metabolic health, and its association with hearing loss could provide insight into potential new strategies for hearing health management.

The study analyzed data from 1226 adults aged 20 to 69 years from the 2015–2016 NHANES data. Participants were scored into three quartiles based on their TyG index. The researchers used weighted univariate analysis, weighted multivariate linear regression analyses, and smooth curve fittings to evaluate the associations between the TyG index and pure tone hearing thresholds.

The key findings of the study were as follows:

  • The study involved 1226 participants with an average age of 44.44 ± 14.11 years. The sample included 45.87% male and 54.13% female participants.

  • Most participants (72.15%) were overweight, and a significant percentage had conditions such as hypertension (26.71%) and diabetes (5.94%).

  • The mean pure tone hearing thresholds for low-frequency, speech-frequency, and high-frequency were 8.22 ± 8.49, 10.36 ± 9.57, and 20.87 ± 17.13 dB, respectively.

  • A significant association was found between the continuous TyG index and low-frequency, speech-frequency, and high-frequency hearing thresholds (P < 0.001).

  • Age, gender, hypertension, diabetes, noise exposure, insulin, and HbA1c were all factors significantly associated with the hearing thresholds.

  • In the crude model, the continuous TyG index was significantly related to low-frequency, speech-frequency, and high-frequency hearing threshold shifts.

  • However, in Model II (adjusted for confounders), the TyG index was not significantly correlated with hearing thresholds across low-frequency, speech-frequency, and high-frequency.

  • In both Model I and Model II, the second tertile of the TyG index showed a negative association with high-frequency hearing threshold shifts.

  • No significant relevance was found for low-frequency or speech-frequency hearing threshold shifts in Models I and II.

  • The relationship between the TyG index and speech-frequency and high-frequency hearing thresholds was found to be non-linear and U-shaped.

  • The inflection points were calculated at TyG index values of 8.35 for speech-frequency and 8.57 for high-frequency hearing thresholds.

  • The hearing thresholds initially decreased with increases in TyG index, but then increased once the inflection points were exceeded.

The U-shaped association between the TyG index and hearing thresholds suggests that maintaining a balanced TyG index may be important for optimal hearing health. This finding underscores the potential link between metabolic health and sensory impairments such as SNHL.

The study’s findings suggest that the TyG index has a nearly U-shaped association with both speech-frequency and high-frequency hearing thresholds, highlighting the importance of maintaining a balanced TyG index in overall health management. Further research is needed to better understand the mechanisms underlying the relationship between the TyG index and hearing health. Additionally, these findings may have implications for the development of new preventive and therapeutic strategies for managing SNHL.

Reference:

Pan, J.-Y., Chen, Y., Lin, Z.-H., Lv, B., Chen, L., & Feng, S.-Y. (2024). Association between triglyceride-glucose index and hearing threshold shifts of adults in the United States: National health and nutrition examination survey, 2015–2016. Journal of Multidisciplinary Healthcare, 17, 1791–1801. https://doi.org/10.2147/jmdh.s454678

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Antipsychotic drug breakthrough may help ward off side effect of weight gain, claims study

Thousands of Australians struggle with serious mental health conditions. But when the recommended treatment involves antipsychotic medications, the side effects are excess kilos, which only adds weight to an already complex diagnosis.

Now, world first research from the University of South Australia shows that antipsychotics can be reformulated with a strategically engineered coating that not only mitigates unwanted weight gain but also boosts serotonin levels by more than 250%.

Funded by the Hospital Research Foundation (THRF) Group, researchers specifically tested Lurasidone, a drug used in the treatment of schizophrenia and bipolar depression, finding that the new coatings target the gut microbiome to improve drug absorption by 8-fold, while concurrently overcoming common side effects such as weight gain.

The coatings are created from tiny core-shell particles made from the dietary fibre, inulin, and bioactive medium chain triglycerides. The inulin shell boosts the gut microbiome by providing an energy source for gut bacteria, while the medium chain triglycerides facilitate drug absorption into the bloodstream.

It’s a breakthrough discovery that has the potential to change the lives of millions of people worldwide.

Lead researcher UniSA’s Dr Paul Joyce says microbiota-targeting microcapsules have the potential to improve treatment outcomes of mental health medications.

“Most patients suffering from schizophrenia or bipolar disorder are prescribed a range of antipsychotic medications, which trigger significant adverse effects by disrupting the gut microbiome – the microbial ecosystem that naturally colonises the gut,” Dr Joyce says.

“The most notable side effect is weight gain, with many patients often seeing increases of between 10-15% of their body weight after just three months of treatment.

“Because the gut microbiome plays a major role in regulating overall health, especially mood and cognition, the detrimental impact of these medications on the microbiome often makes them counterproductive.

“Instead of improving mood and cognition, the medication leads to a cascading cycle of poor mental and metabolic health as patients now struggle with excess weight and mental health issues.

“To make matters worse, most antipsychotics need to be consumed with food to maximise their effect. Yet for a very vulnerable patient population, ensuring this happens is challenging, with most patients gaining suboptimal drug levels.

“Clearly, new strategies are needed to eliminate side effects and the need for these medications to be taken with food – and that’s exactly what we’ve achieved with the drug Lurasidone.

“This research shows that when antipsychotic drugs are formulated with our new smart core-shell microparticles, drug absorption increases, mitigating the need for the medication to be consumed with food, while also boosting the diversity and abundance of the gut microbiome to overcome common side effects, such as weight gain.

“Importantly, because we are not developing new drugs, rather reformulating them, the new therapies can be fast-tracked for clinical use, so we could expect them within the next few years rather than the 10-15 years needed for new drug molecules to be approved by regulatory bodies.”

Next steps are to test the efficacy of these re-formulated therapies within human patients, with longer term goals being to extend these technologies across all mental health therapies, including anti-depressants, to mitigate any adverse effects.

Reference:

Tahlia R. Meola, Aurelia Elz, Anthony Wignall, Kara Paxton, Alexander Hunter, Amin Ariaee, Srinivas Kamath, Stephanie E. Reuter, Clive A. Prestidge, Paul Joyce. Inulin‐Lipid Core–Shell Microcapsules Target the Gut Microbiota and Mimic the Pharmaceutical Food Effect for Improved Oral Antipsychotic Delivery. Advanced Functional Materials, 2024; DOI: 10.1002/adfm.202403914.

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Higher Waist Circumference Linked to Increased Risk of Asthma Attacks, States study

Researchers have found a significant correlation between waist circumference and the likelihood of experiencing asthma attacks in adults. This study was published in the journal BMC Public Health. The study was conducted by Xiang Liu and colleagues. The study, which analyzed data from 5,530 U.S. adults diagnosed with asthma, indicates that waist circumference may be an important predictor of asthma attacks, independent of other factors such as obesity and other metabolic syndrome components.

Asthma is a chronic respiratory condition that can severely impact an individual’s quality of life. Previous research has focused on various risk factors associated with asthma, but the potential link between waist circumference and asthma attack risk has not been thoroughly explored. This cross-sectional study aimed to investigate this relationship in a large sample of U.S. adults.

Participants were categorized into two groups based on their experience with asthma attacks: those who had experienced attacks and those who had not. The median age of participants was 43 years, and the median waist circumference was 98.9 cm. The study used adjusted weighted logistic regression models, weighted restricted cubic splines, subgroup, and sensitivity analyses to assess the association between waist circumference and asthma attacks.

The key findings of the study were:

  • Participants who experienced asthma attacks had significantly higher waist circumferences compared to those who did not experience attacks (P < 0.001).

  • After adjusting for confounders such as BMI-defined obesity, age, gender, race, education levels, poverty income ratio levels, smoking status, and metabolic syndrome, researchers found that every 5 cm increase in waist circumference was associated with a 1.06 times higher likelihood of experiencing an asthma attack.

  • Weighted restricted cubic spline analysis revealed that the risk of asthma attacks increased with rising waist circumference.

  • Subgroup analyses confirmed this relationship across various groups differentiated by gender, age, and smoking status.

This study concludes that waist circumference is an independent predictor of asthma attacks in adults. The findings highlight the importance of measuring waist circumference when assessing the risk of asthma attacks in patients. Clinicians and public health professionals should consider waist circumference as a key metric in asthma management and prevention strategies.

Reference:

Liu, X., Tian, S., & Zhao, T. (2024). The association between waist circumference and adult asthma attack using nationally representative samples. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-18656-x

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Minimally invasive nonsurgical therapy linked to significant clinical and radiographic improvements in intrabony defects

Minimally invasive nonsurgical therapy linked to significant clinical and radiographic improvements in intrabony defects suggests a study published in the Journal of Clinical Periodontology.

A study was done to assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. Results: Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects.

Reference:

Mehta, J., Montevecchi, M., Garcia-Sanchez, R., Onabolu, O., Liñares, A., Eriksson, F., Ghezzi, C., Donghi, C., Lu, E. M.-C., & Nibali, L. (2024). Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study. Journal of Clinical Periodontology, 1–10. https://doi.org/10.1111/jcpe.13984

Keywords:

Minimally, invasive, nonsurgical, therapy, clinical, radiographic, improvements, intrabony, defects, study, Mehta, J., Montevecchi, M., Garcia-Sanchez, R., Onabolu, O., Liñares, A., Eriksson, F., Ghezzi, C., Donghi, C., Lu, E. M.-C., & Nibali, L, Journal of Clinical Periodontology

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ACOG Study Reveals: Only Half of Initial Prenatal Visits Address Gestational Weight Gain Discussions

USA: Pregnancy, a transformative journey for expecting mothers, necessitates comprehensive prenatal care to ensure the health and well-being of both mother and child. However, a recent study sheds light on a concerning trend: only half of initial prenatal visits include discussions about gestational weight gain (GWG), a crucial aspect of maternal health.

The study revealed that discussion of gestational weight gain occurred in only half of first-time obstetric visits, most often brought up by the provider. The findings were presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

“Weight can be a challenging and sensitive topic at a healthcare visit. Providers discussed weight gain recommendations in less than half of conversations,” Malini Harinath, an undergraduate research assistant at Magee-Women’s Research Institute at the University of Pittsburgh Medical Center, told attendees.

The researchers analyzed an existing dataset of audio-recorded first obstetric visits to determine how often gestational weight gain was brought up, who initiated the discussion, whether ACOG guidelines were discussed, and the provider’s comments.

The researchers reported the following findings:

· Among 150 visits, half (50%) involved discussion of weight, with patients bringing it up 24% of the time and providers bringing it up 72% of the time.

· In the other 3% of visits, it was brought up by a third party, such as a partner or other family member with the patient.

· Only two of those visits mentioned body mass index (BMI) specifically, and ACOG guidelines on gestational weight gain were brought up in only six visits (8% of the visits where weight was mentioned).

· Mention of recommendations on gestational weight gain was more frequent, coming up in nearly half (46.7%) of the visits where weight was mentioned, though that was still just 23% of all visits.

· Concern about weight was brought up in 25.3% of visits where weight was discussed, and the provider’s reassurance to the patient occurred in about a third (32%) of those visits. General comments about the patient’s body occurred in 16% of visits, such as a clinician saying.

Ms. Harinath intends to look in future research at whether patient race or BMI are associated with the frequency and content of gestational weight gain conversations and to explore how patients react to different ways that discussion of weight is brought up.

As the field of obstetrics continues to evolve, studies like this serve as a wake-up call to prioritize holistic prenatal care that encompasses essential discussions about gestational weight gain and other critical aspects of maternal well-being.

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Pre-operative kidney disease negatively affects outcomes of endoscopic BPH surgery: Study

Lebanon: In a recent study leveraging the extensive National Surgical Quality Improvement Program (NSQIP) database, researchers delved into the intricate relationship between kidney disease and perioperative outcomes following endoscopic surgery for benign prostatic hyperplasia (BPH). The findings, published in the World Journal of Urology, shed light on the significant impact of kidney disease on surgical outcomes, emphasizing the importance of tailored approaches for patients with underlying renal conditions.

The study found that pre-operative kidney disease may pose an increased complication risk for patients undergoing endoscopic BPH surgery. The study notes a lack of information on the effect of pre-operative kidney disease on endoscopic BPH surgeries in the literature.

“In endoscopic BPH surgery, there is a heightened risk of complications for those with impaired renal function,” the researchers reported.

“Patients with mild to moderate kidney disease faced increased risks of renal complications (OR 2.43), while those with severe kidney disease faced higher odds of pneumonia (OR 4.02), sepsis/septic shock, renal & cardiac complications, prolonged hospital stays, and need for blood transfusion.”

Rami W. Nasr, American University of Beirut Medical Center, Beirut, Lebanon, and colleagues sought to assess the impact of kidney function in patients with BPH undergoing surgery before Transurethral resection of prostate (TURP), Laser Vaporization of the prostate (LVP), and Laser enucleation of the prostate (LEP) on operative and post-operative outcomes using the ACS-NSQIP database.

For this purpose, the research team reviewed the ACS-NSQIP database for patients who underwent LEP, TURP, and LVP for treating BPH patients between 2008 and 2021. Comorbidities, demographics, operative time, surgical procedures performed, and bleeding disorders were collected to compare between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease.

A multivariate logistic regression analysis was performed while adjusting for all confounding variables, and the 30-day peri-operative complications were measured. Propensity score matching was performed between the G1 and G4-G5 cohorts.

The study led to the following findings:

· 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56–3.79].

· After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02, cardiac complications OR = 4.53, renal complications with OR = 7.62, and sepsis/septic shock OR = 1.76.

· They also had a higher need for blood transfusion OR = 3.58, and prolonged hospital stay with OR = 1.49.

“The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries,” the researchers wrote. “There is a need for further studies to compare post-operative outcomes of LVP and LEP as compared to TURP across kidney function status.”

Reference:

Nasrallah, O.G., Herrera, M.T., Heidar, N.F.A. et al. Impact of kidney disease on perioperative outcomes of endoscopic BPH surgery: a propensity score matched analysis from the NSQIP database. World J Urol 42, 337 (2024). https://doi.org/10.1007/s00345-024-05039-5

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Assessment of Tongue Thickness Using Ultrasound for Predicting Difficult Airway: Study

Recently published research paper investigates the potential of ultrasound-based measurement of tongue thickness in predicting difficult laryngoscopy and intubation. The study involved 85 patients undergoing elective surgeries under general anesthesia, where tongue thickness was measured using submental ultrasonography. The findings revealed that patients with difficult intubation had significantly higher tongue thickness compared to those without difficult intubation. The ratio of tongue thickness to thyromental distance was also significantly higher in the difficult intubation group. The study calculated the sensitivity, specificity, positive and negative predictive value, and accuracy of tongue thickness for predicting difficult intubation. The results showed a sensitivity of 72% and a specificity of 59%, with an overall accuracy of 72%.

Conclusion and Recommendations

The paper concluded that ultrasound-based assessment of tongue thickness can be a useful predictor of difficult airway, with higher accuracy than other clinical parameters. It highlighted the increasing familiarity of anesthesiologists with ultrasound machines and the potential for ultrasound-based airway assessment as a bedside, non-invasive, and convenient method for predicting difficult airway. The paper also discussed the limitations of the study, including the need for larger studies in different populations and emphasized the importance of combining tongue thickness measurement with other clinical and ultrasound airway parameters for a comprehensive assessment of difficult airway.

Study’s Implications

Overall, the study provides valuable insights into the utility of ultrasound-based measurement of tongue thickness as a potential predictor of difficult intubation, offering potential benefits in preanesthetic evaluation and preparedness for handling the airway in clinical practice.

Key Points –

– The research paper investigates the potential of ultrasound-based measurement of tongue thickness in predicting difficult laryngoscopy and intubation. The study involved 85 patients undergoing elective surgeries under general anesthesia, where tongue thickness was measured using submental ultrasonography.

– Findings revealed that patients with difficult intubation had significantly higher tongue thickness compared to those without difficult intubation. The ratio of tongue thickness to thyromental distance was also significantly higher in the difficult intubation group. The study calculated the sensitivity, specificity, positive and negative predictive value, and accuracy of tongue thickness for predicting difficult intubation. The results showed a sensitivity of 72% and a specificity of 59%, with an overall accuracy of 72%.

– The paper concluded that ultrasound-based assessment of tongue thickness can be a useful predictor of difficult airway, with higher accuracy than other clinical parameters. It highlighted the potential for ultrasound-based airway assessment as a non-invasive, convenient method for predicting difficult airway, but also discussed the need for larger studies in different populations and the importance of combining tongue thickness measurement with other clinical and ultrasound airway parameters for a comprehensive assessment of difficult airway.

References –

Furia, Jhanvi Sunil; Nadkarni, Manali Mohan. Ultrasound-based assessment of tongue thickness for prediction of difficult laryngoscopy and intubation. Journal of Anaesthesiology Clinical Pharmacology 40(2):p 235-241, Apr–Jun 2024. | DOI: 10.4103/joacp.joacp_395_22.

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