Exercise bouts could improve efficacy of cancer drug, claims study

Bouts of moderate-to-vigorous intensity exercise could improve the efficacy of antibody therapies used to treat chronic lymphocytic leukaemia, new research has shown.

Researchers at the Universities of Birmingham and Bath found that a bout of exercise increased the number of anti-cancer immune cells-called natural killer cells-and that these cells were around twice as effective at killing cancer cells in ‘ex vivo’ tests carried out on blood samples from patients.

In addition, the researchers found that the number of cancer cells present in blood samples transiently increased immediately after exercise-making them more susceptible to attack by natural killer cells and the antibody therapy.

The research, funded by Cancer Research UK, could hold promise for antibody therapy treatment for some forms of cancer, although more work is needed to determine the ‘in vivo’ effects in patients undergoing treatment.

Dr James Turner, a co-author on the study at the University of Birmingham, said: “These findings show a potential benefit to patients undergoing a very particular type of treatment and could open up new avenues of research to determine whether exercise can improve the way other cancer treatments work.”

In the study, published in Brain Behaviour and Immunity, the researchers wanted to test the effects of exercise on an antibody therapy called Rituximab. It is a common treatment for chronic lymphocytic leukaemia, which is a cancer of white blood cells, and is the second most common adult blood cancer in the UK. The therapy works by attaching itself to a specific protein on the surface of cancer cells, which natural killer cells are able to recognise and attack.

The researchers worked with 20 people between the ages of 45 and 82 who were diagnosed with chronic lymphocytic leukaemia but had not yet begun treatment. Participants were asked to do a 30 minute bout of moderate-to-vigorous intensity cycling. Blood samples were taken before and immediately after the exercise bout, and then a third sample was taken an hour later.

In the blood samples, under ‘ex vivo’ conditions, the researchers measured the number of natural killer cells present at each of the sample points and tested their ability to kill cancer cells with and without Rituximab present.

They found the number of natural killer cells increased by 254% after exercise and that in the blood samples taken after exercise, there were 67% more cancer cells compared to blood before exercise.

Next, the team isolated natural killer cells and put them in close contact with cancer cells for 2 hours ‘ex vivo’ with and without the antibody therapy Rituximab. When Rituximab was also present in the blood sample, natural killer cells were just over twice as effective in killing the cancer cells in the samples collected immediately after exercise compared to before.

Dr John Campbell, senior author of the study at the University of Bath said: “Cancer cells often try to ‘hide’ in the body but it seems that exercise works to move them out into the bloodstream, where they are vulnerable to the antibody therapy and the killing capabilities of natural killer cells”.

The results of the study could also have potential for patients who have finished their treatment for leukaemia and are in a monitoring phase in case cancer cells re-appear.

Dr Harrison Collier-Bain, first author of the study at the University Bath said: “Monitoring patients after treatment is complicated because if cancer cells remain or reappear, they are sometimes too low to detect, but a bout of exercise followed by a blood sample immediately afterwards could help to ‘find’ them if they are ‘hiding’ in the body”.

While these results are promising, larger-scale trials would needed in a cohort of patients undergoing Rituximab treatment before treatment recommendations could be made.

Caroline Geraghty, Senior Specialist Information Nurse at Cancer Research UK, said:

“This study adds to a growing body of evidence showing that exercise can be helpful before, during and after cancer treatment. We know that being physically active before and after treatment can help cancer patients cope better with treatment, aid recovery and improve mental wellbeing. It is interesting to see that exercise could also improve the efficacy of treatment for some types of blood cancer, although more research in a larger group of patients is needed.

“Everyone has different needs and abilities, so it’s important that you discuss with your doctor what forms of exercise would work best for you. We encourage all cancer patients to seek their doctor’s advice before starting a programme of exercise before or after treatment, to make sure that the activities suggested are appropriate for them.” 

Reference:

Harrison D. Collier-Bain, Annabelle Emery, Adam J. Causer, Frankie F. Brown, Rebecca Oliver, David Dutton, Josephine Crowe, Daniel Augustine, John Graby, Shoji Leach, Rachel Eddy, Daniela Rothschild-Rodriguez, Juliet C. Gray, Mark S. Cragg, Kirstie L. Cleary, Sally Moore, James Murray, James E. Turner, John P. Campbell, A single bout of vigorous intensity exercise enhances the efficacy of rituximab against human chronic lymphocytic leukaemia B-cells ex vivo, Brain, Behavior, and Immunity, https://doi.org/10.1016/j.bbi.2024.03.023.

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Study explores link between dietary iron intake and diabetic kidney disease in individuals with diabetes

China: In a significant development in diabetes research, a new study sheds light on the association between dietary iron intake and the risk of diabetic kidney disease (DKD) among individuals with diabetes. Published in the Endocrine Journal, the study offers valuable insights into dietary factors influencing kidney health in diabetic patients.

The researchers found a lower risk of diabetic kidney disease with ≥ 12.59 mg of dietary iron, especially in males, younger, have better blood sugar control, heavier weight, and ex-smokers.

Diabetic kidney disease, a common complication of diabetes, poses a significant health burden globally. Despite advancements in diabetes management, the precise mechanisms underlying DKD development remain incompletely understood. Emerging evidence suggests that dietary factors, including iron intake, may play a role in the pathogenesis of DKD.

Against the above background, Yaoming Xue, Southern Medical University, Guangzhou, China, and colleagues aimed to determine the correlation between dietary iron intake and diabetic kidney disease among diabetic adults by conducting a cross-sectional study.

The study enrolled 8118 participants with diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. 24-hour recall interviews were used to obtain dietary iron intake. Diabetic kidney disease was defined as albumin creatinine ratio (ACR) ≥ 30 mg/g or eGFR < 60 mL/min per 1.73 m2.

Three weighted logistic regression models were utilized to investigate the odd ratio (OR) for DKD. Stratified analyses were performed by age, gender, BMI, HbA1c, hypertension status, HbA1c, smoking status, and diabetes types.

The researchers reported the following findings:

· Among 8118 participants (51.6% male, mean age 61.3 years), 40.7% of participants suffered from diabetic kidney disease.

· With the adjustment of potential covariates, we found that ≥ 12.59 mg of dietary iron was related to a lower risk of diabetic kidney disease (OR = 0.78; OR = 0.79).

· In stratified analyses, higher iron intake was negatively related to diabetic kidney disease, especially among those who were male, < 60 years old, those with HbA1c < 7.0%, those with hypertension, and those who were ex-smokers. The result remained robust in sensitivity analyses.

“We found that ≥ 12.59 mg of dietary iron is associated with a lower risk of diabetic kidney disease, especially in males, younger, have better blood sugar control, heavier weight, and those who were ex-smokers,” the researchers wrote.

In conclusion, the study elucidates the association between dietary iron intake and DKD risk among individuals with diabetes. By highlighting the potential impact of dietary factors on kidney health, the findings underscore the importance of holistic approaches to diabetes management that encompass both pharmacological and lifestyle interventions.

Reference:

Wu, Y., Xiao, M., Chen, J. et al. Association of dietary iron intake with diabetic kidney disease among individuals with diabetes. Endocrine (2024). https://doi.org/10.1007/s12020-024-03819-y

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High Coronary artery calcium score and vascular events more frequent in patients with cancer: Study

In a groundbreaking study conducted at the Cleveland Clinic in Florida and Ohio, researchers have unearthed a compelling link between cancer patients and an increased risk of cardiovascular disease (CVD). The study underscores the importance of considering cardiovascular health in cancer patients, and the association between high Coronary artery calcium score (CACS) and cardiovascular events suggesting the need for targeted cardiovascular risk assessment and management in this population.

The study results were published in the journal BMC – CardioOncology.

Also Read: Blood test may detect neuroendocrine prostate cancer through targeted cell-free DNA methylation

The CT coronary calcium score, a highly researched and widely accessible method in cardiovascular medicine, is a well-established predictor of coronary artery disease. ECG-gated Cardiac Multi-Detector Computed Tomography is the recognized ‘standard of care’ diagnostic tool for measuring coronary artery calcium score (CACS). Robust evidence underscores a compelling connection between CACS and significant cardiovascular (CV) events in individuals with no cardiovascular disease symptoms. Notably, cancer patients (C) may face an elevated risk of CV disease compared to their non-cancer counterparts (NC), a risk attributed not only to cancer treatments but also to shared biological factors and pathways. Hence researchers conducted a retrospective cohort analysis to evaluate the use of CACS as a screening tool for the early identification of cardiovascular diseases in cancer patients.

The retrospective cohort analysis involved a meticulous matching of cancer patients to non-cancer counterparts based on age and sex. Cardiovascular events after their initial Coronary Artery Calcium Score (CACS) assessments were contrasted between individuals with a cancer history (C) and those without cancer (NC). Cardiovascular events after their initial Coronary Artery Calcium Score (CACS) assessments were contrasted between individuals with a cancer history (C) and those without cancer (NC).

Also Read: Obesity to Detect Blood Cancer Precursor Finds Study

Findings:

  • One of the key revelations was the significantly higher prevalence of extensive CACS (scores greater than 400) in cancer patients compared to their non-cancer counterparts.
  • The data indicates that cancer patients, despite having fewer traditional cardiovascular risk factors, exhibited a noteworthy increase in high CACS, suggesting an independent association between cancer and cardiovascular health.
  • Intriguingly, even after conducting a propensity-matched analysis to account for potential confounders, cancer patients (14.8%) continued to display a higher prevalence of CACS greater than 400 underscoring the importance of recognizing cancer as a potential independent risk factor for cardiovascular disease.
  • Despite cancer patients having fewer traditional cardiovascular risk factors, the study revealed that the occurrence of cardiovascular events was similar in both cohorts.
  • Digging deeper into the moderate (101–400) and extensive (>400) CACS categories, the study found a notable increase in the prevalence of stroke and peripheral arterial disease in cancer patients.

These findings suggest that the atherosclerotic burden in cancer patients extends beyond the coronary arteries, encompassing a more systemic involvement.

This study has broader implications for clinical practice, emphasizing the need for heightened vigilance in monitoring cardiovascular health in cancer patients. It highlights the importance of considering cancer not only as a disease in isolation but as a condition that may influence cardiovascular risk in unexpected ways. Early detection of high CACS in cancer patients becomes paramount, offering a window of opportunity for proactive cardiovascular risk management in this unique population.

While the study provides valuable insights, it is essential to acknowledge its retrospective nature and the need for further research to explore specific cancer types, treatments, and individual patient characteristics that may contribute to these intriguing connections between cancer and cardiovascular health.

Further reading: Patel, S., Franco, F.X., McDonald, M. et al. Use of computed tomography coronary calcium score for prediction of cardiovascular events in cancer patients: a retrospective cohort analysis. Cardio-Oncology 10, 1 (2024). https://doi.org/10.1186/s40959-023-00196-9

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Anti-interleukin-17 or anti-interleukin-23- Which biologic agent is better for inverse psoriasis?

Researchers have found that long-term anti-IL-23 therapies yield better outcomes for individuals with inverse psoriasis (IP) compared to IL-17 inhibitors, according to a recent study. This study highlights the challenges in defining IP and developing a clear therapeutic strategy for this psoriasis subtype. This study was published in the International Journal Of Dermatology by Mastorino and colleagues.

Inverse psoriasis is a less understood subtype of psoriasis, characterized by lesions in intertriginous areas such as the inguinal, axillary, and breast folds. Current biologic treatments, particularly IL-17 and IL-23 inhibitors, show varying efficacy in treating different forms of psoriasis. However, the response to these treatments in IP patients has not been well-documented.

The research team, led by Luca Mastorino from the University of Turin, conducted a retrospective analysis of patients with psoriasis treated with IL-17 or IL-23 inhibitors at the Dermatology Clinic of Turin University Hospital from January 2017 to September 2022. The study aimed to evaluate the effectiveness of these treatments in IP patients compared to those with psoriasis vulgaris.

Patients were classified as having IP if they had disease involvement in regions such as the inguinal, axillary, breast folds, submammary lines, intergluteal fold, antecubital and popliteal pits, and perianal area. Psoriasis vulgaris patients with concurrent intertriginous involvement were also included. Effectiveness was assessed using the Psoriasis Area and Severity Index (PASI).

  • The study included a higher proportion of females in the IP group. These patients were more commonly treated with IL-17 inhibitors and had a higher rate of treatment discontinuation and alterations (32.1% vs. 18.1%, P=0.002).

  • IP patients treated with IL-17 inhibitors showed slower progression to PASI100 and PASI90 compared to those with psoriasis vulgaris. These patients also had increased joint involvement and a lower median age of onset (P=0.011).

  • Despite slower initial responses, patients on anti-IL-23 therapies showed progressively better outcomes over time compared to those on IL-17 inhibitors.

  • IP patients on anti-IL-23 medications began treatment with a lower mean PASI and showed a slower rate of response initially compared to those on anti-IL-17 treatments.

The findings suggest that while IL-17 inhibitors may offer a faster onset of action, IL-23 inhibitors provide superior long-term efficacy for treating inverse psoriasis. The study underscores the need for more targeted research and a defined therapeutic strategy for IP patients.

Researchers have found that long-term anti-IL-23 therapies are more effective than IL-17 inhibitors for individuals with inverse psoriasis. This study contributes valuable insights into the management of IP, highlighting the need for a clearer therapeutic strategy and more comprehensive research to guide treatment decisions.

Reference:

Mastorino L, Dapavo P, Ribero S, et al. Clinical characteristics and response to biological therapies for inverse psoriasis: a real-life comparison between the therapeutic effects of anti-IL-23 and anti-IL-17 agents. Int J Dermatol. 2024 May 15. doi: 10.1111/ijd.17252. Epub ahead of print. PMID: 38751026.

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Early first seizure attendance associated with reduced rates of subsequent hospital utilization: JAMA

Researchers have found that early attendance at first-seizure clinics (FSCs) is associated with reduced rates of subsequent hospital utilization and mortality. This finding underscores the importance of timely specialist care for patients with new-onset undifferentiated seizure events. First-seizure clinics aim to provide prompt specialist care to patients experiencing their first seizure. However, the impact of FSC attendance on long-term health outcomes has been unclear.

The study was published in the journal JAMA Neurology by Yingtong Li. and colleagues. This study, conducted by examining patient records from two major metropolitan public hospitals in Melbourne, Australia, aimed to determine whether FSC attendance and the timing of such attendance influence subsequent healthcare utilization and mortality rates.

This retrospective cohort study analyzed data from patients who booked appointments at FSCs between 2007 and 2018. Patients’ records were linked to state-wide administrative databases from 2000 to 2021. The study included patients who were successfully linked for analysis, excluding those who only recorded canceled appointments. The primary exposure was FSC attendance, and the main outcomes were subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions.

  • Of 10,162 patients who booked FSC appointments, 9,392 were linked for analysis. The mean follow-up time was 6.9 years. Among these patients, 5,398 were male (57.5%), with a mean age of 59.7 years.

  • FSC attendance was associated with a significant reduction in subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalizations (aIRR, 0.81; 95% CI, 0.75-0.88).

  • Patients who attended their first-scheduled FSC appointment, compared to those who attended a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalizations (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98).

  • Male sex was associated with a higher risk of nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays of more than 14 days between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54).

  • Hospitalization at referral (aRR, 0.80; 95% CI, 0.72-0.90), non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 miles from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89) were associated with reduced nonattendance.

The study demonstrates that early attendance at FSCs significantly reduces subsequent emergency presentations, hospitalizations, and mortality among patients with new-onset seizures. This highlights the critical role of timely specialist care in managing seizure disorders and suggests that FSCs should be adequately resourced to ensure equitable, timely access for all patients.

Researchers concluded that early attendance at first-seizure clinics is crucial in reducing hospital utilization and improving health outcomes for patients with new-onset seizures. These findings may guide clinicians and healthcare policymakers in optimizing the management and resources of FSCs to enhance patient care.

Reference:

Li, Y., Ren, T., Burgess, M., Chen, Z., Carney, P. W., O’Brien, T. J., Kwan, P., & Foster, E. (2024). Early access to first-seizure clinics, subsequent outcomes, and factors associated with attendance. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.1187

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Addition of acetaminophen to ibuprofen fails to improve control of endodontic pain: Study

The addition of acetaminophen to ibuprofen fails to improve control of endodontic pain suggests a study published in the Journal of endodontics

Most pain studies have been based on a postsurgical, third molar model using ibuprofen (IBU)/acetaminophen (APAP). Studies have found quicker onset of pain relief with a newer formulation of IBU – ibuprofen sodium dihydrate (ISD). The purpose of this study was to compare pain reduction of ISD/APAP to ISD in an acute endodontic pain model of untreated patients experiencing moderate to severe pain with symptomatic apical periodontitis. In this double-blind randomized study, 64 adult emergency patients in acute moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and symptomatic apical periodontitis participated. Each patient randomly received either one dose of 768 mg ISD/1000 mg APAP or one dose of 768 mg ISD. Pain intensity scores were recorded every 15 minutes over 240 minutes using the Heft-Parker VAS along with time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief also recorded. The data were analyzed statistically. Results: Both ISD and ISD/APAP groups showed a progressive decrease in pain from baseline to 120 minutes after medication administration. Afterward, a relative plateau was seen in the patients’ pain. There was no difference in the VAS scores between the ISD and ISD/APAP at any given time point, time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief. The addition of APAP to ISD for pain control in an untreated endodontic pain model did not differ significantly from ISD alone.

Reference:

Palya M, Chevere JM, Drum M, Fowler S, Nusstein J, Reader A, Ni A. Pain Reduction of Ibuprofen Sodium Dihydrate Alone and in Combination with Acetaminophen in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation. J Endod. 2024 Apr 23:S0099-2399(24)00231-0. doi: 10.1016/j.joen.2024.04.005. Epub ahead of print. PMID: 38657900.

Keywords:

Addition, acetaminophen, ibuprofen, fails, improve, control, endodontic pain, study, Acetaminophen, endodontic pain, ibuprofen sodium dihydrate, journal of endodontics, Palya M, Chevere JM, Drum M, Fowler S, Nusstein J, Reader A, Ni A

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Ventilatory assistance before umbilical cord clamping fails to improve outcomes for extremely preterm infants: JAMA

USA: In a groundbreaking development in neonatal care, a randomized clinical trial (RCT) has demonstrated the significant benefits of providing ventilatory assistance to extremely preterm infants before umbilical cord clamping. The trial has garnered attention for its potential to revolutionize caring for these vulnerable newborns.

In the randomized clinical trial of 570 infants born at less than 29 weeks gestation published in JAMA Network Open, the researchers found no reduction in intraventricular hemorrhage (IVH) or death with assisting ventilation before cord clamping versus cord clamping followed by standard resuscitation.

“No difference was detected in the primary outcome of IVH on 7- to 10-day head ultrasonography or death before day 7,” the researchers reported.

For extremely preterm infants, it is suggested that providing assisted ventilation during delayed umbilical cord clamping may improve outcomes. Considering this, Karen D. Fairchild, Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, and colleagues aimed to investigate whether assisted ventilation in extremely preterm infants (23 0/7 to 28 6/7 weeks’ gestational age) followed by cord clamping reduces IVH or early death.

For this purpose, the researchers conducted a phase 3, 1:1, parallel-stratified RCT at 12 perinatal centers across the US and Canada from 2016 to 2023. It assessed early death and IVH outcomes of extremely preterm infants randomized to receive 120 seconds of assisted ventilation followed by cord clamping versus delayed cord clamping for 30 to 60 seconds with ventilatory assistance afterward.

Two analysis cohorts, breathing well and not breathing well, were specified a priori based on an assessment of breathing 30 seconds after birth.

If needed, all infants received stimulation and suctioning after birth. From 30 to 120 seconds, infants randomized to the intervention received positive-pressure ventilation if not breathing well or continuous positive airway pressure (CPAP) if breathing well, with cord clamping at 120 seconds. Control infants were given 30 to 60 seconds of delayed cord clamping followed by standard resuscitation.

The primary outcome was any grade intraventricular hemorrhage on head ultrasonography or death before day 7.

The study led to the following findings:

  • Of 1110 women consented to participate, 548 were randomized and delivered infants at GA in less than 29 weeks.
  • Five hundred seventy eligible infants were enrolled (median GA, 26.6 weeks; 52.1% males).
  • Intraventricular hemorrhage or death occurred in 34.9% of infants in the intervention group and 32.5% in the control group (adjusted RR, 1.02).
  • In the prespecified not-breathing-well cohort (47.5%; median GA, 26.0 weeks; 56.1% males), IVH or death occurred in 38.7% of infants in the intervention group and 43.0% in the control group (RR, 0.91).
  • There was no evidence of differences in severe brain injury, death, or major morbidities between the intervention and control groups in either breathing cohort.

The study did not demonstrate that providing assisted ventilation before cord clamping in extremely preterm infants reduces early death or IVH.

“Additional study around safety, feasibility, and efficacy of assisted ventilation before cord clamping may provide additional insight,” the researchers concluded.

Reference:

Fairchild KD, Petroni GR, Varhegyi NE, et al. Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(5):e2411140. doi:10.1001/jamanetworkopen.2024.11140

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Extended Power Cuts: Medinirai Medical College MBBS Students Forced to Study under Phone Lights

Daltonganj: The MBBS students at the Medinirai Medical College (MMC), Pokhraha, are facing difficulties in studying due to the extended power cuts. The situation is such that the medicos are forced to study under their mobile phone torchlight in the Central Library.

Since the college became operational in 2019, it has been dealing with power outage problems. The college, which lacks a dedicated power line, sometimes faces two to eight hours of power cuts.

Expressing their frustration over the situation, an affected MBBS student at the medical college told TOI, “Even a salon has an inverter while we, the would-be professionals of an emergency service, are forced to prepare for the future in mobile torchlight.”

“Even a tea stall is equipped with an inverter, allowing customers to enjoy uninterrupted light and fan facilities. On the other hand, we, the medical college students, miss out on our study hours, not to mention the discomfort,” said another student.

Also Read: Medinirai Medical College students hold protest seeking respite from power, water woes

Meanwhile, commenting on the matter, a senior faculty member at the Community Medicine Department, Dr Nikhil Nishant informed the Times of India that besides the Central Library, the eight departments on the campus- anatomy, physiology, pathology, biochemistry, microbiology, pharmacology, community medicine, and the forensic medicine and toxicology (FMT)- also suffer power cuts.

The principal of the medical college, Dr Kamender Prasad has blamed the situation on the lack of funds. He said, “I will soon request the health department to release funds for purchasing inverters.”

As per the Daily, the inverter facilities cover only the principal’s chamber and the administrative block on the campus, while the rest of the college, including the central library, classrooms, and laboratories remain without a power backup supply.

Medical Dialogues had earlier reported that the students of Medinirai Medical College in Pokhraha, Daltonganj staged a protest earlier this month seeking respite from power cuts and the water crisis.

The Medinirai Municipal Corporation supplies the campus with two water tankers daily, which is insufficient to meet the needs of students and staff. The students claimed that they were struggling daily to access basic amenities like water supply and power while they keep on working long hours.

MMCH, Daltonganj recently came under the National Medical Commission’s (NMC) scanner as the licence of its blood bank expired on September 30, 2020. Directing the institute to renew the licence by July 10, the Apex Medical Education Regulatory Body warned to slap a Rs 6 Lakh penalty on the institute for non-compliance.

Also Read: Medinirai Medical College students hold protest seeking respite from power, water woes

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Longer reproductive period not linked to weak hand grip strength among postmenopausal women: Study

Muscle strength declines post-menopause. Hand grip strength (HGS), reflecting overall strength, is related to health-related quality of life (HRQoL).

According to an original investigation published in MENOPAUSE, Lee et al. and colleagues from Pusan National University Yangsan Hospital have demonstrated an association between menopausal age and reproductive period with handgrip strength in postmenopausal women.

Two thousand three hundred fifty-four postmenopausal women aged 45-75 were analyzed statistically. The reproductive period was divided into thirds, and Hand grip strength (HGS) was divided into four quartiles. Hand grip strength (HGS) was assessed to measure muscle strength. Based on quartile data, binary logistic regression was used to identify significant predictors for the first quartile HGS. Multiple logistic regression examined the relationship between the reproductive period (exposure) and low Hand grip strength (HGS) (outcome).

Menarche and menopause affect muscle strength in women, as measured by handgrip strength. However, it is unclear if the entire reproductive period, which includes both events (both menarche and menopause), affects handgrip strength in postmenopausal women.

The summary from this original investigation includes the following points of consideration:

· Extended reproductive period correlates with lower Hand grip strength (HGS) risk.

· The odds ratio for low absolute HGS was 0.752 in the second tertile reproductive period and 0.683 in the third tertile reproductive period, compared to the first tertile.

· After adjusting for covariates, The odds ratio for low Hand grip strength (HGS) was 0.761 for the second tertile and 0.732 for the third tertile, with the first tertile as the reference.

They said, ” A longer reproductive period is associated with a decreased risk of low hand grip strength in postmenopausal women.”

Reference:

Lee et al. The association between reproductive period and handgrip strength in postmenopausal women: a nationwide cross-sectional study. Menopause ():10.1097/GME.0000000000002283, November 28, 2023.

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Curve Size Predicts Success of Limited Fusion for Congenital Scoliosis, suggests study

In children with congenital scoliosis, the goal of limited fusion is to correct spinal anomalies at a young age-in a single surgery. But is it really a “one and done” procedure?

Not necessarily, says a new study led by Michael Heffernan, MD, at Children’s Hospital Los Angeles. The team found that children with large preoperative curves-greater than 50 degrees-were 21 times more likely to need further spinal surgeries after a limited fusion than those who had smaller curves.

Dr. Heffernan, a pediatric orthopedic surgeon in the Jackie and Gene Autry Orthopedic Center at CHLA, presented the results in November at the 17th International Congress on Early Onset Scoliosis and the Growing Spine. The study will also be presented at the Pediatric Orthopaedic Society of North America annual meeting in May as part of the “Best of Spine” section.

“What these results mean is that if we’re going to use a short-segment strategy and limit the fusion levels, then we need to do so before the curve gets to 50 degrees,” he explains. “We need to intervene earlier.”

Key findings

The retrospective study looked at 36 patients who underwent limited fusion for congenital scoliosis at CHLA. Mean follow-up time was 7.6 years after the initial surgery.

The team found that:

• When preoperative curves were over 50 degrees, 88% of children ended up needing more corrective surgeries later on.

• When curves were less than 50 degrees, only 25% of children needed another operation. Although that is a high reoperation rate compared with adolescent idiopathic scoliosis, treatment of congenital scoliosis is far more complex.

• Overall, 53% of patients needed additional spinal surgery, at a mean time of 5.2 years after the limited fusion.

The researchers also looked at such factors as age, number of levels fused, location of spinal anomalies and medical comorbidities. But only curve magnitude and percentage of curve correction predicted the need for more surgeries.

What it means for surgeons

Although the data showed a clear benefit to performing limited fusion when curves are still small, that approach can come with challenges, Dr. Heffernan notes.

One problem? The screws and implants used for limited fusions are too large for very young children. That’s why orthopedic surgeons generally wait until a child is 3 to 5 years old before performing this operation.

But while waiting, the spinal curve can worsen-making it unlikely that a limited fusion can permanently fix the problem.

So what should surgeons do for a 2-year-old patient with a 35-degree curve? Although it wasn’t part of the study, one possible solution is to use casting or bracing as a way to slow the curve’s progression.

“Historically casting hasn’t been used much in children with congenital scoliosis because it doesn’t fix the underlying issue, which is that the vertebra did not form properly in utero,” Dr. Heffernan says. “But we can use casting as a delay tactic. The idea is to keep the curve small while you’re waiting for the child to grow big enough for surgery.”

He adds that because congenital scoliosis is such a heterogenous and complex condition, care needs to be individualized to each patient. That said, the study results are already changing his own approach to these patients.

“I’m much more likely now to intervene earlier in the process as opposed to watching and waiting,” Dr. Heffernan notes. “That may mean casting or it may mean doing the surgery at a younger age. But we cannot let the curve get out of control if we plan on doing a limited fusion. That is the clear take-home from this study.”

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