Observational Study Highlights Postinflammatory Hyperpigmentation after Mohs Micrographic Surgery

USA: Mohs Micrographic Surgery (MMS) is a widely recognized and effective technique for treating certain types of skin cancer, known for its high cure rates and tissue-sparing approach. However, a recent observational study has shed light on a common but often overlooked complication associated with this procedure: postinflammatory hyperpigmentation (PIH).

The study found that individuals with skin of color (Fitzpatrick skin types IV to V) are more likely to develop postinflammatory hyperpigmentation following Mohs micrographic surgery (MMS). Granulation and grafts lead to PIH more often than linear repairs and flaps.

“Postoperative complications significantly increase PIH risk,” the researchers wrote in the Journal of Drugs in Dermatology. “Surgeons should consider these risk factors during surgical planning to mitigate PIH in the skin of color individuals.”

Postinflammatory hyperpigmentation refers to the darkening of the skin that occurs following inflammation or injury, such as surgical procedures. While typically benign, PIH can have significant cosmetic and psychological implications for patients, leading to concerns about scarring and changes in skin pigmentation.

Cosmetic and functional outcomes following MMS are studied poorly in individuals with skin of color. Postinflammatory hyperpigmentation may be highly distressing and long-lasting. SOC individuals are particularly susceptible to PIH following procedures. Considering this, Onjona B. Hossain, Albert Einstein College of Medicine, Department of Medicine, Division of Dermatology, Bronx, NY, and colleagues aimed to characterize factors contributing to the PIH development following MMS in SOC.

For this purpose, the researchers conducted a retrospective study comprising 72 SOC individuals with 83 cases of keratinocyte carcinoma treated with MMS between August 2020 and August 2021 at a single medical center in the Bronx, New York.

The study led to the following findings:

  • Postinflammatory hyperpigmentation following Mohs micrographic surgery was more common in Fitzpatrick skin types (FST) IV to V (48.0%) compared to FST I to III (18.2%).
  • Grafts and granulation resulted in higher rates of PIH compared to linear repairs and flaps (87.5% versus 30.7%).
  • Cases with postoperative complications resulted in higher rates of PIH compared to cases without (81.8% versus 29.2%).
  • In a subset analysis of linear repairs, polyglactin 910 as a subcutaneous suture produced a higher PIH rate than poliglecaprone 25 (46.2% versus 7.1%).

“Surgeons should consider these risk factors during surgical planning for patients with skin of color to best minimize postinflammatory hyperpigmentation,” the researchers wrote. There is a need for studies with larger sample sizes.

In conclusion, the observational study underscores the importance of vigilance and proactive management of postinflammatory hyperpigmentation following Mohs Micrographic Surgery. By identifying risk factors and implementing preventive measures, dermatologic surgeons can mitigate the impact of this complication and optimize outcomes for patients undergoing skin cancer treatment.

Reference:

Hossain OB, Labiak A, Mieczkowska K, Srikantha R, Ciocon DH, Williams RF. Postinflammatory Hyperpigmentation Following Mohs Micrographic Surgery: An Observational Study. J Drugs Dermatol. 2024 May 1;23(5):316-321. doi: 10.36849/JDD.8146. PMID: 38709696.

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Size of person’s fat cells may hold clues to their future weight status, suggests study

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) suggests that it is possible to predict if someone is going to gain weight based on their size of their fat cells.

Individuals with large fat cells tend to lose weight over time, while those with small fat cells gain weight, the Swedish study found.

The size and number of fat cells are known to determine fat mass – how much body fat someone has. But their impact on long-term changes in body weight are unknown.

To explore this further, Professor Peter Arner, of the Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Dr Daniel P Andersson, Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm, and colleagues measured cell volume (FCV, the size of the fat cells) and fat cell number (FCN) in abdominal fat of 260 subjects (30% men) with an average age of 44 years and an average BMI of 32 kg/m².

An average of 15 years (range 5-28 years) later, the participants were seen again and body weight (BW), BMI and total body fat (BF) measured. Individuals undergoing bariatric surgery or receiving anti-obesity drugs (n=69) were excluded from the analysis.

Initial fat cell volume and fat cell number were significantly related to changes in all three measures over time – BW, BMI and BF.

Having a high number of fat cells that were large was associated with decreases in the three measures, while having few, but small, fat cells correlated with increases in weight, BMI and body fat. This was the case whether or not individuals were living with obesity.

The effects of FCV and FCN were additive and together explained 32-35% of the variations in changes over time in BW/BMI/BF.

The associations between FCV and changes in BW, BMI and BF was still significant when initial age, physical activity, length of follow-up and sex were taken into account. In other words, large cells were linked to future weight loss and small cells to future weight gain.

Professor Arner says: “We can only speculate as to why the size of a person’s fat cells seems to predict their future weight. Body weight decreases when energy expenditure exceeds intake and the body burns off fat to compensate. Our results suggest that the loss of large fat cells makes more of an impact on weight than the loss of small ones.

“It is a bit like having a room filled to the top by few large balloons or many small ones. It is easier to make empty space in the room by letting out air from the big rather than the small balloons.”

As to why having small cells might make it easier to gain weight, Professor Arner says: “Conversely it is easier to fill up the room if many small balloons increase their volume a bit, as compared with having few large balloons and filling them up just a bit.”

The researchers conclude that FCV has a strong influence on long-term changes in body weight. Thus, measuring FCV early in life could be important for weight management later in life.

Professor Arner adds: “It could be of great clinical value to have information about fat cell size before starting a weight management programme. If it is the case that those with large fat cells find it easier to lose weight, those with smaller cells could be given extra support.

“Unfortunately, there isn’t an easy way of measuring fat cell size at present – but it is something we are working on and we’re close to coming up with a solution.”

There are advantages, however, to having small fat cells. Professor Arner says: “It is well known that people with small fat cells have a better metabolic profile than people who are the same weight but have large fat cells.

“This means that if someone with small fat cells does gain weight, it may not raise their risk of conditions such as type 2 diabetes and high blood pressure as much as if they had large fat cells.”

Reference:

Size of a person’s fat cells may hold clues to their future weight, European Association for the Study of Obesity, Meeting: European Congress on Obesity (ECO2024)

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Arm fat may reveal women and men at risk of spinal fracture,reveals study

Measuring the total mass of fat in the arms could potentially predict which women and men over 50 are at risk of spinal fracture, according to research presented at the 26th European Congress of Endocrinology in Stockholm. The findings may help identify high-risk individuals with a more simple and inexpensive method and influence the design of their exercise plans.

Osteoporosis is a common disease among older people, but is also among the most undiagnosed and untreated medical conditions in the world. Many people do not have noticeable symptoms of osteoporosis until they experience an injury or fracture, which most often occurs in the spine-known as spinal or vertebrae fractures. Imaging techniques, such as dual-energy X-ray absorptiometry (DXA), are used to measure bone mineral density (BMD), while trabecular bone score (TBS) assesses the quality of bone and predicts new fractures independently of BMD. However, the effect body fat has on bone health is still unclear.

To investigate this, researchers from the National and Kapodistrian University of Athens in Greece examined 14 men and 101 women, without osteoporosis and with an average age of about 62, and found that those with excess body fat-irrespective of their body mass index (BMI)-had low bone quality (low TBS) in their spine. What’s more, the more belly fat located deep inside the abdomen and around internal organs, the lower the quality of the spine’s spongy bone (or trabecular bone). The researchers then looked at the distribution of body fat under the skin and discovered that individuals with higher fat mass in the arms were more likely to have lower bone quality and strength in the spine.

“Surprisingly, we identified, for the first time, that the body composition of the arms-in particular, the fat mass of the arms-is negatively associated with the bone quality and strength of the vertebrae”, said senior author Professor Eva Kassi.

“This could mean that the arm’s subcutaneous fat, which can be easily estimated even by the simple and inexpensive skin-fold calliper method, may emerge as a useful index of bone quality of the spine, possibly predicting the vertebrae fracture risk.”

She added: “It should be noted that visceral fat-which we found to be strongly correlated with low bone quality-is the hormonally more active component of the total body fat. It produces molecules called adipocytokines that provoke a low-grade inflammation, so the increased inflammatory status plausibly poses a negative impact on bone quality.”

Professor Kassi acknowledges that larger studies are needed to confirm the link between arm fat and spinal fracture risk. “Although our results remain robust after controlling for age and weight, we will now increase the number of participants and expand the age range by including younger adults between the ages of 30 and 50 years old, as well as more men”, she said.

“Moreover, using the loss of arm fat mass as a marker, we will try to determine the most effective physical exercise routine that not only targets the visceral fat but also focuses on the upper part of the body so that these higher-risk adults lose arm fat and achieve a favourable effect on vertebrae bone quality.”

Reference:

Arm fat may reveal women and men at risk of spinal fracture, European Society of Endocrinology, Meeting: European Congress of Endocrinology.

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Nivolumab with chemotherapy improve outcomes in resectable non-small-cell lung cancer: NEJM

A new phase 3 clinical trial revealed that standard treatment with neoadjuvant nivolumab in combination with chemotherapy significantly improved the outcomes for patients with resectable non-small-cell lung cancer (NSCLC). The key findings of this study were published in the recent issue of The New England Journal of Medicine.

This comprehensive study included adults with resectable stage IIA to IIIB NSCLC and randomly assigned participants to receive either neoadjuvant nivolumab plus chemotherapy or neoadjuvant chemotherapy plus a placebo. The treatments were administered every three weeks for four cycles. Following surgery, the patients received either adjuvant nivolumab or placebo every four weeks for one year. The primary aim of this study was to evaluate event-free survival based on a blinded independent review.

The interim analysis was conducted at a median follow-up of 25.4 months that demonstrated a substantial improvement in event-free survival for the patients treated with nivolumab. The 18-month event-free survival rate was 70.2% in the nivolumab group when compared to 50.0% in the chemotherapy group. This translated to a hazard ratio for disease progression, recurrence, abandoned surgery or death of 0.58 (97.36% confidence interval [CI], 0.42 to 0.81; P<0.001) that indicated a 42% reduction in the risk of these events for the patients receiving nivolumab.

A pathological complete response was observed in 25.3% of patients in the nivolumab group when compared to just 4.7% in the chemotherapy group (odds ratio, 6.64; 95% CI, 3.40 to 12.97). Also, a major pathological response occurred in 35.4% of patients who received nivolumab against the 12.1% in the chemotherapy group (odds ratio, 4.01; 95% CI, 2.48 to 6.49). While treatment-related adverse events of grade 3 or 4 were somewhat higher in the nivolumab group (32.5%) when compared to the chemotherapy group (25.2%), the overall safety profile was consistent with previous studies, with no new safety concerns observed.

These findings illuminate the potential of perioperative treatment with nivolumab to significantly improve the clinical outcomes for patients with resectable NSCLC. The notable improvement in event-free survival, coupled with higher rates of pathological complete and major pathological responses, positions nivolumab as a formidable addition to the current standard of care for lung cancer.

Reference:

Cascone, T., Awad, M. M., Spicer, J. D., He, J., Lu, S., Sepesi, B., Tanaka, F., Taube, J. M., Cornelissen, R., Havel, L., Karaseva, N., Kuzdzal, J., Petruzelka, L. B., Wu, L., Pujol, J.-L., Ito, H., Ciuleanu, T.-E., de Oliveira Muniz Koch, L., Janssens, A., … Provencio Pulla, M. (2024). Perioperative Nivolumab in Resectable Lung Cancer. In New England Journal of Medicine (Vol. 390, Issue 19, pp. 1756–1769). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2311926

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Validating QoR-40 Questionnaire in Hindi for Assessing Recovery after Cancer Surgery – study

Recent study aimed to translate and culturally adapt the Quality of Recovery (QoR)-40 score into Hindi and assess its validity and reliability in patients undergoing cancer surgery. The translation of the QoR-40 questionnaire was based on forward and backward translation methods. The questionnaire was completed by 350 patients, and the reliability of the translated version was checked for internal consistency, test-retest reliability, and split-half reliability. Construct validity was assessed with correlation coefficient values, and content validity was evaluated for feasibility and understanding. The average time to complete the questionnaire was 3.8 minutes, and most respondents found it easy to understand and related the questions to their recovery. The translated QoR-40 questionnaire was found to be a valid and reliable version for assessing the quality of recovery in Hindi-speaking patients after cancer surgery.

Study Design and Reliability of Translated QoR-40

The study was conducted in a tertiary care teaching hospital for one and a half years, and ethical approval and informed consent were obtained. The translation of the QoR-40 questionnaire was based on the methods provided by Beaton et al. and Tsang et al. The translation process went through several steps, including forward translation, backward translation, expert committee review, prefinal questionnaire application, and final version development. The patients completed the translated version of the QoR-40 preoperatively and on the third postoperative day in the morning and evening. The reliability of the translated questionnaire was checked for internal consistency, test-retest reliability, and split-half reliability. The construct and content validity of the translated questionnaire were also evaluated, and the results demonstrated satisfactory reliability, validity, and responsiveness of the translated QoR-40 questionnaire in patients undergoing cancer surgery.

Patient Responses and Validity Assessment

The study included 400 patients, and the results were derived from responses of 350 patients who completed the questionnaire on the third postoperative day. The reliability assessment revealed good internal consistency, and the validity assessment showed a negative statistical correlation between the total QoR-40 score with the VAS score on POD3 and the total duration of hospital stay, indicating good construct validity. The acceptability results of the translated version demonstrated good feasibility and understanding, with most patients finding the questionnaire simple and easy to answer. The results showed that the Hindi translation of the QoR-40 questionnaire is a valid, reliable, and acceptable version for assessing the quality of recovery in Hindi-speaking patients after surgery.

Key Points

– Translation and Cultural Adaptation of QoR-40 Score into Hindi: The study focused on translating and culturally adapting the Quality of Recovery (QoR)-40 score into Hindi and assessing its validity and reliability in patients undergoing cancer surgery. The translation process followed forward and backward translation methods and involved 350 patients. The translated version demonstrated satisfactory reliability, validity, and responsiveness, with an average completion time of 3.8 minutes. Most respondents found the questionnaire easy to understand and related the questions to their recovery, indicating its effectiveness in assessing the quality of recovery in Hindi-speaking patients after cancer surgery.

– Study Design and Reliability of Translated QoR-40: The study was conducted in a tertiary care teaching hospital over one and a half years, with ethical approval and informed consent obtained. The translation process followed specific steps, including forward translation, backward translation, expert committee review, prefinal questionnaire application, and final version development. The reliability of the translated questionnaire was assessed for internal consistency, test-retest reliability, and split-half reliability. The construct and content validity of the translated questionnaire were also evaluated, demonstrating satisfactory reliability, validity, and responsiveness in patients undergoing cancer surgery.

– Patient Responses and Validity Assessment: The study included 400 patients, and the results were derived from the responses of 350 patients who completed the questionnaire on the third postoperative day. The assessment revealed good internal consistency and negative statistical correlation between the total QoR-40 score with the VAS score on POD3 and the total duration of hospital stay, indicating good construct validity. The acceptability results of the translated version demonstrated good feasibility and understanding, with most patients finding the questionnaire simple and easy to answer. Overall, the study confirmed that the Hindi translation of the QoR-40 questionnaire is a valid, reliable, and acceptable version for assessing the quality of recovery in Hindi-speaking patients after surgery.

Reference –

Govil N, Rathore R, Tiwari A, Garg PK, Parag K, Mishra P. Hindi translation and cultural adaptation of the quality of recovery score-40 (QoR 40 score): A validation study. Indian J Anaesth 2024;68:533-9.

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Severe obesity in childhood can halve life expectancy, global modelling study finds

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) has, for the first time, quantified the impact of different aspects of childhood obesity on long-term health and life expectancy.

The modelling by stradoo GmbH, a life sciences consultancy in Munich, Germany, initiated and supported by Rhythm Pharmaceuticals and presented by Dr Urs Wiedemann, of stradoo, and colleagues at universities and hospitals in the UK, Netherlands, France, Sweden, Spain, USA and Germany found that age of onset, severity and duration of obesity all take their toll on life expectancy.

The development of obesity at a very young age was found to have a particularly profound effect.

For example, a child living with severe obesity (BMI Z-score of 3.5) at the age of four, who doesn’t subsequently lose weight, has a life expectancy of 39 years – about half of the average life expectancy.

Dr Wiedemann says: “While it’s widely accepted that childhood obesity increases the risk of cardiovascular disease and related conditions such as type 2 diabetes (T2D), and that it can reduce life expectancy, evidence on the size of the impact is patchy.

“A better understanding of the precise magnitude of the long-term consequences and the factors that drive them could help inform prevention policies and approaches to treatment, as well as improve health and lengthen life.”

To learn more, the researchers created an early onset obesity model that allowed them to estimate the effect of childhood obesity on cardiovascular disease and related conditions such as type 2 diabetes (TD2), as well as life expectancy.

Four key variables were included: age of obesity onset, obesity duration, irreversible risk accumulation (a measure of irreversible risks of obesity – health effects that remain even after weight loss) and severity of obesity.

Severity of obesity was based on BMI Z-scores. A widely used measure of weight in childhood and adolescence, BMI Z-scores indicate how strongly an individual’s BMI deviates from the normal BMI for their age and sex, with higher values representing higher weight.

For example, a 4-year-old boy with an average height of 103 cm and a “normal” weight of about 16.5 kg (2st 8lb) will have a BMI Z-score of 0. A boy of the same age and height who weighs 19.5 kg (3st 1lb) will have a BMI Z-score of 2, which is just in the obese range, and one who weighs 22.7 kg (3st 8lb) will have a BMI Z-score of 3.5, which indicates severe obesity.

Data came from 50 existing clinical studies on obesity and obesity-related comorbidities, such as type 2 diabetes, cardiovascular events and fatty liver. The studies included more than 10 million participants from countries around the world, approx. 2.7 million of whom were aged between 2 and 29 years.

The model shows that earlier onset and more severe obesity increase the likelihood of developing related comorbidities.

For example, an individual with a BMI Z-score of 3.5 (which indicates severe obesity) at age 4 and who doesn’t go on to lose weight has a 27% likelihood of developing T2D by the age of 25 and a 45% chance of developing T2D by the age of 35.

In contrast, an individual with a BMI Z-score of 2 at age 4 will have a 6.5% chance of T2D by the age of 25 and 22% chance by the age of 35.

The early onset obesity model also shows that a higher BMI Z-score at an early age leads to a lower life expectancy.

For example, a BMI Z-score of 2 at age 4 without subsequent weight reduction decreases average life expectancy from approx. 80 to 65 years. Life expectancy is further reduced to 50 years for a BMI Z-score of 2.5 and 39 years for a BMI Z-score of 3.5.

In contrast, a BMI Z-score of 3.5 at age 12 without subsequent weight reduction yields an average life expectancy of 42 years.

Comparisons with data from studies not included as input for the model and the opinions of leading experts confirmed the model’s accuracy.

It was also possible to model the effect of weight loss on life expectancy and long-term health. For example, an individual living with severe early onset obesity (BMI Z-score of 4 at age 4) who doesn’t subsequently lose weight has a life expectancy of 37 years and a 55% risk of developing type 2 diabetes at age of 35. Weight loss that results in a BMI Z-score of 2 (just in the obese range) at age of 6, will increase the life expectancy to 64 and reduce the risk of type 2 diabetes to 29%.

The modelling also shows that earlier weight loss returns more years of life than later weight loss.

Dr Wiedemann says: “The early onset obesity model shows that weight reduction has a striking effect on life expectancy and comorbidity risk, especially when weight is lost early in life.”

The model’s limitations include not taking into account the cause of obesity, genetic risk factors, ethnic or sex differences, as well as not factoring in how different co-morbidities interact with each other.

Dr Wiedemann concludes: “The impact of childhood obesity on life expectancy is profound.

“It is clear that childhood obesity should be considered a life-threatening disease. It is vital that treatment isn’t put off until the development of type 2 diabetes, high blood pressure or other ‘warning signs’ but starts early. “Early diagnosis should and can improve quality and length of life.”

Reference:

Severe obesity in childhood can halve life expectancy, global modelling study finds, European Association for the Study of Obesity, Meeting: European Congress on Obesity (ECO2024).

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Azithromycin Addition to TMP-SMX Fails to Reduce Malaria and STI Risk in Pregnant Women with HIV: Study

Researchers have found that adding azithromycin (AZ) to the standard daily trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis does not reduce the risk of malaria or bacterial sexually transmitted infections (STIs) at delivery among pregnant women with HIV in Cameroon. This study, conducted between March 2018 and August 2020, aimed to test a novel regimen to prevent these infections, but the results suggest no significant benefit from the addition of azithromycin. This study was published in the journal Open Forum Infectious Diseases by Dionne and colleagues.

Malaria and sexually transmitted infections pose significant health risks to pregnant women, particularly those living with HIV. The standard prophylactic regimen involves daily TMP-SMX, which has shown efficacy in reducing certain infections. This study hypothesized that the addition of azithromycin, known for its broad-spectrum antibiotic properties, would further reduce the rates of malaria and bacterial STIs at delivery.

This randomized, controlled trial enrolled 308 pregnant women with HIV, all under 28 weeks of gestation. Participants were randomized into two groups: 155 women received TMP-SMX with monthly azithromycin (1 gram daily for three days), and 153 women received TMP-SMX with a placebo. The primary outcomes were the presence of peripheral malaria infection (detected by microscopy or PCR) and a composite measure of bacterial genital STIs (including C. trachomatis, N. gonorrhoeae, and syphilis) at delivery. Statistical analysis involved estimating relative risks (RR) and 95% confidence intervals (CI) using 2 × 2 tables, with significance set at p < 0.05.

Results:

  • A total of 308 women were enrolled, with a loss to follow-up rate of 3.2%. The baseline characteristics of the groups were similar.

  • At delivery, 16.3% of women in the TMP-SMX-AZ group had malaria, compared to 13.2% in the TMP-SMX group (RR 1.24, 95% CI 0.71-2.16, p=0.12).

  • The incidence of bacterial STIs was 4.2% in the TMP-SMX-AZ group versus 5.8% in the TMP-SMX group (RR 0.72, 95% CI 0.26-2.03, p=0.28).

  • There were no significant differences in adverse birth outcomes. Preterm delivery occurred in 6.7% of the TMP-SMX-AZ group and 10.7% of the TMP-SMX group (p=0.3).

  • Low birth weight was observed in 3.4% of the TMP-SMX-AZ group and 5.4% of the TMP-SMX group (p=0.6)

The study’s findings indicate that the addition of azithromycin to the standard TMP-SMX regimen does not provide additional protection against malaria or bacterial STIs at delivery for pregnant women with HIV. These results align with previous research that has shown mixed outcomes for azithromycin in similar contexts.

The trial concluded that adding monthly azithromycin to daily TMP-SMX prophylaxis does not significantly reduce the risk of malaria or bacterial STIs at delivery in pregnant women with HIV in Cameroon. Future research should explore alternative strategies to enhance infection prevention in this high-risk population.

Reference:

Dionne, J. A., Anchang-Kimbi, J., Hao, J., Long, D., Apinjoh, T., Tih, P., Mbah, R., Ngah, E. N., Juliano, J. J., Kahn, M., Bruxvoort, K., Van Der Pol, B., Tita, A. T. N., Marrazzo, J., & Achidi, E. (2024). Trimethoprim-sulfamethoxazole plus azithromycin to prevent malaria and sexually transmitted infections in pregnant women with HIV (PREMISE): A randomized, double-masked, placebo-controlled, phase IIB clinical trial. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofae274

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Blue-Light Filtering Intraocular Lenses Slow Progression in AMD Patients: Study

A recent retrospective clinical cohort study investigated the impact of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in patients suffering from neovascular age-related macular degeneration (nAMD). The key findings were published in the recent issue American Journal of Ophthalmology.

The study focused on patients who received anti-vascular endothelial growth factor (VEGF) injections and underwent cataract surgery from 2007 to 2018 with follow-up extending until June 2023. The research included 373 eyes of 373 patients with an average age of 78.6 years at the time of surgery. Of these, a total of 206 eyes were implanted with BLF IOLs while 167 received non-BLF IOLs. Both groups had comparable follow-up durations and baseline parameters, including age, gender, corrected distance visual acuity, macular thickness and the number of anti-VEGF injections.

A total of 86 cases of MA were identified which comprised 9 pre-existing and 77 new-onset cases. The distribution of new-onset MA was similar between the BLF and non-BLF groups showed no significant difference (P=0.399). Also, univariate Kaplan-Meier and multivariate Cox regression analyses were adjusted for age and gender, indicated no significant difference in the hazard of developing new-onset MA between the two types of IOLs (HR 1.236, 95% CI 0.784-1.949, P=0.363).

The study found that BLF IOLs did not significantly prevent the onset of MA but they were associated with a slower progression of the condition over time. At the final visit, the mean area of MA was significantly smaller in the BLF IOL group (5.14±4.71 mm²) when compared to the non-BLF IOL group (8.56±9.17 mm², P=0.028). Also, the annual increase in the MA area was also lower in the BLF IOL group (0.78±0.84 mm²) against the non-BLF IOL group (1.26±1.32 mm², P=0.042).

These findings of this study suggest that while BLF IOLs may not prevent the initial development of macular atrophy, they could play a role in reducing the progression of the disease. This could have significant implications for the long-term management of patients with neovascular age-related macular degeneration. Further research and studies are imperative to fully understand the mechanisms behind this effect and to validate these findings in larger and more diverse populations.

Reference:

Achiron, A., Trivizki, O., Knyazer, B., Elbaz, U., Hecht, I., Jeon, S., Kanclerz, P., & Tuuminen, R. (2024). The effect of blue-light filtering intraocular lenses on the development and progression of macular atrophy in eyes with nAMD. In American Journal of Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ajo.2024.04.018

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Study Reveals Lack of Counseling on Marijuana Use During Pregnancy Despite Reported Usage: ACOG annual meeting

USA: As marijuana legalization continues to expand across the globe, concerns about its potential impact on maternal and fetal health have become increasingly prominent. In a recent study, researchers have uncovered a troubling trend, despite a significant number of pregnant women reporting marijuana use, few receive adequate counseling on the potential risks during pregnancy.

The study revealed that women who used marijuana during pregnancy were significantly less likely to view it as risky, even in a state where it was not legalized. However, most of those women had not received any counseling about stopping its use, and more than half wanted more information about its impact on pregnancy complications.

The findings were presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

An estimated 3%-30% of pregnant women use marijuana, depending on the population, but there has been an increase in prevalence as more states legalize its use. Yet research has shown an association between marijuana use during pregnancy and multiple neonatal complications, including low birth weight and fetal growth restriction.

During the prenatal visits, pregnant women at a single center in Arkansas were invited to complete a 35-question, anonymous survey electronically or on paper. Of the 460 approaches, 88.7% completed the survey, and 11.8% of those women reported marijuana use during pregnancy. Among those who used it while pregnant, 50% reported using it 2-3 times a week, 18.8% reported using it daily, and 27% reported using it once weekly.

The other questions asked respondents on a 5-point Likert scale how much they disagreed or agreed with several statements related to perceptions of marijuana, its use during pregnancy, and its risks.

The following were the key findings of the study:

· The women who used it while pregnant were less likely to have a college degree, and half (50%) were aged 18-24, with use declining with increasing age.

· More than half of the women (52.7%) who used marijuana during pregnancy reported that there had not been any discussion about substance use during pregnancy at the prenatal visit, and 82.4% said they had not received any counseling about stopping its use during pregnancy. Yet 54% of them wanted more information about pregnancy complications linked to cannabis use.

· Most respondents strongly agreed that “marijuana isn’t as bad as other drugs like heroin, cocaine or meth,” but the average agreement was higher among those who used marijuana (4.88) than those who didn’t (4.02).

· Respondents largely neither agreed nor disagreed with its being okay to use marijuana during pregnancy with a prescription, but agreement was still higher among those who used it (3.68) than didn’t use it (2.82).

· Those who used marijuana were more likely to agree that it’s “a natural substance and not a drug” (4.67 versus 3.38); to believe “marijuana has minimal health risks during and outside of pregnancy” (4.15 versus 2.96), and to believe “marijuana has less risk for treating symptoms in pregnancy than prescription medication from my provider” (4.19 versus 3.01).

In a separate poster, Sarah Dzubay, BS, of Oregon Health & Science University, Portland, presented data examining potential associations between cannabis use and fertility. Previous research has suggested an association, but the cross-sectional analysis by Ms. Dzubay identified only a nonsignificant trend toward an association.

The researchers analyzed data from the 2013-2018 National Health and Nutrition Examination Study (NHANES) for women aged 20-49 based on self-reported use of cannabis. Among 3166 women, 51% reported never using cannabis, 29% reported irregular use, and 20% reported regular use at least monthly.

“Women reporting regular use were younger, of lower income and educational attainment, and more likely to be single,” Ms. Dzubay reported. Those reporting irregular use, meanwhile, were more likely to be college graduates.

More of the women who used cannabis regularly (15.4%) reported an inability to conceive within one year than women who used cannabis irregularly (10.8%) or never (12.6%). The higher odds ratio of infertility among those using cannabis regularly (OR 1.47) compared to never using it was not statistically significant, however, nor was the reduced odds ratio among those using it irregularly (OR 0.83).

Because the results were not significant, the possibility of a link to infertility is “something to keep in mind,” Ms. Dzubay said, but “a lot more data has to be collected about this question before we can definitively say there’s a risk.”

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Night-time heat significantly increases risk of stroke, claims study

In a recent study, researchers from Helmholtz Munich and the Augsburg University Hospital show that nocturnal heat significantly increases the risk of stroke. The findings can contribute to the development of preventive measures: With them, the population can better protect themselves against the risks of climate change with increasingly frequent hot nights. In addition, knowledge of the consequences of hot nights can improve patient care.

Climate change is resulting in more and more extreme weather events. These include extremely hot, so-called tropical nights. The research team led by Dr. Alexandra Schneider investigated the effects of night-time heat on the risk of stroke. “We wanted to understand the extent to which high night-time temperatures pose a health risk,” says the head of the working group Environmental Risks at Helmholtz Munich. “This is important because climate change is causing night-time temperatures to rise much faster than daytime temperatures.”

Data on 11,000 strokes from 15 years

In their study, the researchers analyzed data from Augsburg University Hospital. Its Department of Neurology has collected data on around 11,000 strokes over 15 years. The analysis shows that extreme heat at night increases the risk of stroke by seven percent. “Elderly people and women are particularly at risk, and it is mainly strokes with mild symptoms that are diagnosed in clinics after hot nights,” says the study’s lead author, Dr. Cheng He: “Our results make it clear that adjustments in urban planning and the healthcare system are extremely important to reduce the risks posed by rising night-time temperatures.” This is all the more true as “we were able to show that the risk of stroke associated with high night-time temperatures increased significantly in the period 2013 to 2020 compared to the period 2006 to 2012,” as Prof. Michael Ertl, head of the Stroke Unit and the neurovascular working group at Augsburg University Hospital, emphasizes. From 2006 to 2012, hot nights resulted in two additional strokes per year in the study area; from 2013 to 2020, there were 33 additional cases per year.

Recommendations for adaptation strategies and urban planning

The researchers plan to make their findings applicable in practical settings. To this end, they are working on recommendations for public adaptation strategies and urban planning, such as reducing the intensity of urban heat islands. The aim is to better protect the population from the effects of night-time heat. The study will also serve as a basis for further research to develop targeted preventive measures against stroke-promoting factors. “The earlier these preventive measures are implemented, the better,” says Alexandra Schneider. The results of the study are also of great importance for hospitals. They will be able to better adapt to the frequency of strokes in the future: If the weather forecast predicts a hot night, it can be expected that more cases will come to the clinics. This allows clinics to provide more staff to care for patients as a precaution, explains Prof. Markus Naumann, Director of the Neurological University Hospital in Augsburg.

Background: What are tropical nights?

“Tropical nights” are defined using the so-called “Hot Night Excess Index” (HNE). It measures how much temperatures rise above a certain threshold value at night. The threshold value is the temperature that is only exceeded on the five percent warmest nights during the entire study period. In this study, this value is 14.6 °C. If temperatures rise above this value at night, this is categorized as a tropical night. The HNE index adds up how many degrees the temperatures are above this threshold during the night hours to determine the intensity of the heat.

Reference:

Cheng He, Susanne Breitner, Siqi Zhang, Veronika Huber, Markus Naumann, Claudia Traidl-Hoffmann, Gertrud Hammel, Annette Peters, Michael Ertl, Alexandra Schneider, Nocturnal heat exposure and stroke risk, European Heart Journal, 2024;, ehae277, https://doi.org/10.1093/eurheartj/ehae277.

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