Ventricular tachyarrhythmias might be most common cardiac arrhythmia after Acute MI: Study

A recent comprehensive analysis found the coexistence of cardiac arrhythmias in patients with acute myocardial infarction (AMI), the findings from the China Acute Myocardial Infarction (CAMI) registry unveiled significant implications for patient outcomes. The study published in the recent issue of BMC Cardiovascular Disorders included data from a total of 23,825 consecutive AMI patients across 108 hospitals and offered crucial insights into the prevalence and impact of arrhythmias in this population.

According to the findings, cardiac arrhythmias were detected in 8.35% of AMI patients where ventricular tachyarrhythmias emerged as the most common type, followed by bradyarrhythmias, atrial tachyarrhythmias and combinations of multiple arrhythmias. The patients with arrhythmias were more frequently associated with ST-segment elevation myocardial infarction, fibrinolysis and a history of heart failure which underlines the complex interplay between these conditions.

The study highlights the substantial burden of arrhythmias on in-hospital outcomes, with patients experiencing arrhythmias expressing significantly higher rates of adverse events such as all-cause mortality, cardiogenic shock, re-infarction, stroke or heart failure. The incidence of in-hospital outcomes was markedly higher in patients with any form of arrhythmia when compared to the individuals without. This emphasizes the detrimental impact of arrhythmias on the prognosis of these patients.

The independent association between arrhythmias and high risks of hospitalization outcomes and in-hospital mortality further illuminates the urgent need for targeted interventions and management strategies in AMI patients with concurrent arrhythmias. With odds ratios indicating substantially increased risks across all types of arrhythmias, from ventricular tachyarrhythmias to atrial tachyarrhythmias, the study underscores the imperative for heightened vigilance and tailored therapeutic approaches in this vulnerable patient population.

The comprehensive analysis highlighted the significant prevalence of cardiac arrhythmias in AMI patients and their strong impact on clinical outcomes. These findings underline the importance of early detection and management of arrhythmias in AMI and also emphasize the imperative for further research to unveil the optimal therapeutic strategies and improve patient outcomes in this high-risk population. Overall, the implications of this research prompts intensified efforts towards multidisciplinary approaches in reducing the adverse effects of arrhythmias in AMI patients and ultimately enhancing the quality of care and patient outcomes in this critical setting.

Reference:

Xu, X., Wang, Z., Yang, J., Fan, X., & Yang, Y. (2024). Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. In BMC Cardiovascular Disorders (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12872-024-03889-w

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Metformin effectively reduce viral load in COVID-19 patients, finds study

A recent study published in the Clinical Infectious Diseases journal uncovered the potential of metformin which is commonly used to treat type 2 diabetes to manage COVID-19. This research was conducted as part of the COVID-OUT trial and unveiled strong evidence of antiviral activity of metformin against the RNA viruses, including the SARS-CoV-2.

This comprehensive highlights that metformin exerts its antiviral effects by targeting the host mechanistic target of rapamycin pathway which in turn suppresses the protein translation that is crucial for viral replication. The implications of this mechanism extend beyond diabetes management which could offer a new avenue for tackling infectious diseases.

This rigorous randomized, placebo-controlled, double-blind COVID-OUT trial evaluated the efficacy of metformin along with other potential treatments for COVID-19, including fluvoxamine and ivermectin. The results were striking: metformin demonstrated remarkable effectiveness in reducing the odds of hospitalizations, deaths, and even the onset of long COVID.

The participants who received metformin underwent a sharp 58% reduction in the risk of hospitalizations or death within 28 days. Also, the medication decreased the likelihood of emergency department visits, hospitalizations or death by 42% within 14 days and reduced the incidence of long COVID by 42% over a span of 10 months.

The trial involved a total of 999 participants who self-collected anterior nasal swabs at specified intervals. The analysis of viral load using reverse-transcription quantitative polymerase chain reaction revealed a significant 3.6-fold reduction in SARS-CoV-2 viral load with metformin when compared to placebo. Also, metformin recipients were also less likely to express detectable viral loads on subsequent days that indicates sustained antiviral activity.

This study highlighted the consistency of metformin’s effect across the various subgroups and its progressive improvement over time. Notably, neither ivermectin nor fluvoxamine demonstrated discernible benefits over placebo which points to the unique potency of metformin in the context of COVID-19 treatment. Overall, metformin offers clinical benefits and opens new avenues for exploring its pleiotropic actions against COVID-19 pathophysiology by significantly reducing the viral load. 

Reference:

Bramante, C. T., Beckman, K. B., Mehta, T., Karger, A. B., Odde, D. J., Tignanelli, C. J., Buse, J. B., Johnson, D. M., Watson, R. H. B., Daniel, J. J., Liebovitz, D. M., Nicklas, J. M., Cohen, K., Puskarich, M. A., Belani, H. K., Siegel, L. K., Klatt, N. R., Anderson, B., … Hartman, K. M. (2024). Favorable Antiviral Effect of Metformin on Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load in a Randomized, Placebo-Controlled Clinical Trial of Coronavirus Disease 2019. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciae159

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Pre-antibiotic use tied to higher risk of secondary stroke after acute ischemic and hemorrhagic stroke: Study

South Korea: In a significant breakthrough in stroke research, a longitudinal study utilizing the Korean National Health Insurance Service (NHIS) database has uncovered the effects of pre-antibiotic use before the first stroke incidence on recurrence and mortality rates. The findings shed new light on the intricate relationship between antibiotic usage and stroke outcomes, offering valuable insights into stroke prevention and management strategies. 

“In a study involving over 200,000 adults aged 55 and older with acute hemorrhagic stroke (AHS) or acute ischemic stroke (AIS), pre-antibiotic use within a year before the stroke event was linked to increased risks of secondary stroke in both groups (aHR of 1.03 for AIS and 1.08 for AHS),” the researchers reported in the International Journal of General Medicine. However, pre-antibiotic use in the AIS group was tied to a reduced mortality risk (aHR 0.95).

Dougho Park, Medical Research Institute, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea, and colleagues conducted the study to investigate the effects of pre-antibiotic use before a stroke event on secondary outcomes using a longitudinal population-level database.

For this purpose, the researchers conducted a retrospective cohort study comprising adults aged 55 years or older diagnosed with acute hemorrhagic stroke and acute ischemic stroke between 2004 and 2007. Patients were followed up until the end of 2019, and the target outcomes included secondary AIS, AHS, and all-cause mortality.

Multivariable Cox regression analyses were applied, and the researchers adjusted covariates such as sex, age, socioeconomic status, hypertension, dyslipidemia, and diabetes. Pre-antibiotic use was identified from 7 days to 1 year before the acute stroke event.

The study led to the following findings:

  • 159,181 patients with AIS (AIS group) and 49,077 patients with AHS (AHS group) were included.
  • Pre-antibiotic use significantly increased the risk of secondary AIS in the AIS group (adjusted hazard ratio [aHR], 1.03) and secondary AHS in the AHS group (aHR, 1.08).
  • Furthermore, pre-antibiotic use in the AIS group was associated with a lower risk of mortality (aHR, 0.95).

This study elucidated the effect of pre-antibiotic use during a specific period before the first incidence of stroke on long-term secondary outcomes. As an observational, longitudinal study using a population-level database, the study confirmed that pre-antibiotic use was significantly associated with the risk of secondary stroke.

“Our population-based longitudinal study showed that pre-antibiotic use was associated with a higher risk of secondary stroke and a lower risk of mortality in the AIS and AHS groups,” the researchers wrote. “There is a need for further studies to understand the relationship between dysbiosis and stroke outcomes.”

Reference:

Park D, Kim HS, Kim JH. Effect of Pre-Antibiotic Use Before First Stroke Incidence on Recurrence and Mortality: A Longitudinal Study Using the Korean National Health Insurance Service Database. Int J Gen Med. 2024;17:1625-1633

https://doi.org/10.2147/IJGM.S456925

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Dengue fever infections have negative impacts on infant health for three years-study

Dengue infections in pregnant women may have a negative impact on the first years of children’s lives, new research has found.

Dengue fever is the most prevalent mosquito-borne disease globally and poses a threat to half of the world’s population. There has been a dramatic rise in cases over recent years, with cases in the Americas reaching more than three million cases in 2023. Since January 2024, Brazil has reported more than 3.5 million cases, marking the largest dengue outbreak on record.

The paper, co-authored by Dr Livia Menezes from the University of Birmingham and Dr Martin Foureaux Koppensteiner from the University of Surrey, has been published in the American Economic Journal: Applied Economics.

The study looks at a large data set of dengue fever infections in expectant mothers from Minas Gerais, Brazil, and the resulting birth outcomes. It finds that babies born to women who were infected with dengue fever during their pregnancy had lower birth weights, increasing the risk of newborns being classed as having a very and extremely low birth weight by 67% and 133%, respectively.

Dr Livia Menezes, Assistant Professor in Economics at the University of Birmingham and co-author of the study said: “Even though dengue is a very common mosquito-borne disease, there has not been much attention given to the impact it has on birth outcomes and as a result, what can be done to improve them and protect pregnant women and their children.

“This paper sets out robust research which shows that being infected with dengue fever, even with a mild case, whilst pregnant can have a significant impact on the health of the child once born. These birth outcomes can even have longer-term impacts, for example, previous research has shown that low birth weight can negatively affect socio-economic outcomes and health in adulthood.”

The researchers also found that children whose mothers were infected with dengue fever whilst pregnant had a 27% increased risk of being hospitalised from birth to age three. The highest risk of hospitalisation for these children comes in their second year of life, where there is a 76% increase.

Dr Martin Foureaux Koppensteiner, Associate Professor in Economics at the University of Surrey said: “These negative birth outcomes are not only limited to the health of individual children and mothers, but they have a much wider impact for communities where dengue fever is common. Hospitalisations and ongoing health issues resulting from maternal infections all have a cost, and one that could be avoided, or at least minimised with increased awareness and improved policy.

“We strongly suggest that dengue fever should be considered alongside the TORCH infections to manage and avoid when pregnant, which currently include Toxoplasmosis, Rubella, HIV, syphilis, chicken pox, Zika, and influenza among others.”

The study also highlights the possible consequences of climate change expanding the reach of dengue fever. While the disease has historically been limited to tropical and subtropical regions, it now has an established presence in over 120 countries. Aedes mosquitoes, which carry and transmit dengue, have found breeding grounds in countries previously unaffected, including Croatia, France, Portugal, and the southern states of the USA.

Dr Menezes concludes: “As the planet heats, we can expect to see dengue fever become even more common in countries that have previously not had high infection rates. This is a problem that needs to be taken seriously, and quickly.

“Policy changes and things like vector control, updated risk communication with key groups and vaccine adoption can all reduce the risk of pregnant women being infected with dengue. Action needs to be taken by governments and health organisations to provide better protection for pregnant women and their children.”

Reference:

Koppensteiner, Martin Foureaux, and Lívia Menezes. 2024. “Maternal Dengue and Health Outcomes of Children.” American Economic Journal: Applied Economics, 16 (2): 530-53, DOI: 10.1257/app.20210656

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Antioxidant-Rich Diets Linked to Improved Quality of Life for Young Women Battling Acne Vulgaris, Study Finds

Poland: Acne vulgaris, a common skin condition affecting millions worldwide, often affects physical appearance and mental well-being. In a promising development, a recent study published in Nutrients Journal suggests that the antioxidant properties of certain diets could offer relief and enhance the quality of life for young women grappling with acne vulgaris.

The study showed that the quality of life (QoL) of young women with acne vulgaris (AV) was impaired. However, there was a reduction in the risk of AV impact on the QoL by approximately 30–32% and the risk of depression by 33% with greater adherence to an antioxidant diet. The dietary antioxidant quality index (DAQI) may be used as a new indicator of diet quality in acne vulgaris.

The DAQI included the following elements: antioxidant vitamins, carotenoids, minerals, phytosterols, polyphenols, lignans, and the total antioxidant capacity of the diet.

Acne vulgaris significantly reduces the QoL of young people, so it becomes critical to look for factors that can improve their QoL. Kinga Zujko-Kowalska, Medical University of Białystok, Białystok, Poland, and colleagues aimed to assess the relationship between dietary antioxidants measured using the new DAQI index and QoL measured using standardized tests.

The study comprised 165 young women with acne vulgaris, mainly students. A self-report survey was used for basic data collection on their anthropometric information, sociodemographic status, and lifestyle.

“Acne vulgaris pathogenesis is not fully known. However, the determination of oxidative stress biomarkers, especially lipid peroxidation in acne patients, confirms the important role of oxidative stress,” the researchers wrote.

They added, “Inflammation caused by oxidative stress of the pilosebaceous unit and oxidation of sebum initiates the development of acne. A well-composed diet is a source of various antioxidants (vitamins, minerals, polyphenols) that may support the treatment of acne and improve quality of life.”

The energy value of the diet and the content of minerals, vitamins, and carotenoids with the diet’s antioxidant activity were estimated using 3-day food diaries and the Diet 6.0 program. The diet’s antioxidant potential and the content of phytosterols, polyphenols, lignans, and selenium were calculated based on individual food product consumption and available databases.

While conventional acne treatments focus primarily on topical and systemic medications, integrating dietary modifications can offer patients additional avenues for symptom management. The study underscores the importance of considering lifestyle factors in holistic acne management approaches.

This study has some limitations. First, food intake was assessed based on 3-day food diaries, which did not consider usual eating habits. Second, the available databases on dietary antioxidant potential, polyphenols, selenium, lignans, and phytosterols did not include all foods and dishes, so similar products were used to calculate any missing data.

Reference:

Jankowska, B., & Zujko, M. E. (2023). The Antioxidant Power of a Diet May Improve the Quality of Life of Young Women with Acne Vulgaris. Nutrients, 16(9), 1270. https://doi.org/10.3390/nu16091270

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Eye ultrasounds may assist with detecting brain shunt failure in children: Study

Use of an eye ultrasound may quickly and safely identify children with brain drainage tube failure in the emergency department, according to a new study. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto.

A ventricular shunt is a surgically implanted thin, plastic tube that drains extra fluid and relieves pressure on the brain. Children receive ventricular shunts for hydrocephalus, a condition where brain fluid doesn’t drain or reabsorb properly from brain bleeds, tumors, or other causes. Nearly 30% of shunts break, are displaced, or become blocked within two years of placement, and another 5% fail each year after that, experts say.

When a patient visits the emergency department for potential shunt failure, their symptoms are often nonspecific, including headache, vomiting, and fatigue, according to researchers. Shunt failure is life threatening, and children with shunts typically undergo multiple computed tomography and magnetic resonance imaging scans per year, exposing them to excessive radiation and sedation. A backup of fluid causes the optic nerve sheath to swell, which researchers can measure with eye ultrasound.

The study found that comparing the diameter of the optic nerve when a patient is symptomatic to the diameter when they are well can help determine if a shunt is blocked.

“The research team is interested in finding ways to lessen radiation exposure and expedite diagnosing shunt failure in the emergency department,” said Adrienne L. Davis, MD, MSc, FRCPC, pediatric emergency medicine research director at The Hospital for Sick Children (SickKids) and presenting author. “The study uses patients as their own controls by measuring the optic nerve when well and sick—a strategy that individualizes this test for every patient and recognizes that every patient with a shunt has a unique degree of shunt dependence and ability to tolerate high brain pressures.”

The researchers studied 76 pairs of eye ultrasounds of nearly 60 children presenting to the Toronto hospital’s emergency department with potential shunt failure. Researchers note that while findings are promising, results require further confirmation in a larger population of children with shunts across North America.

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Intranasal esketamine may improve symptoms of Treatment-resistant depression and fibromyalgia, reports study

Intranasal esketamine may improve symptoms of Treatment-resistant depression and fibromyalgia, reports a paper presented at American Psychiatric Association (APA) 2024 Annual Meeting.

Treatment-resistant depression with intranasal esketamine was linked to improvements in major depressive disorder (MDD) symptoms and fibromyalgia pain, a patient case showed. The US Food and Drug Administration approved esketamine (Spravato) for treatment-resistant depression and depressive symptoms in adults with MDD who had acute suicidal ideation in 2019. Since then, the FDA warned using a compounded ketamine nasal spray to treat psychiatric disorders puts patients at risk. Esketamine may be derived from racemic ketamine, but it is safe to treaty psychiatric disorders. Although esketamine is approved for treatment-resistant depression, research suggests it can help other conditions, too. After intranasal esketamine, a 40-year-old female on intranasal esketamine had incident improvements for both MDD and chronic fibromyalgia pain. She wasn’t the first patient to experience pain relief after esketamine. Another patient with treatment-resistant depression the investigators studied received remission for their chronic migraine headaches through 6 months of treatment. Other patients with treatment-resistant depression on esketamine experienced pain relief from pain syndromes such as diabetic peripheral neuropathy, lower back pain, and sciatica, on the day of dosing.

A study earlier this year found low dose esketamine improves acute postoperative pain in patients undergoing thoracoscopic surgery without increasing adverse events. Investigators of the study suggest the underlying mechanism may be linked to postoperative inflammation. In this study, the esketamine group had no decreased depression scores after the surgery. However, for fibromyalgia pain, intranasal esketamine demonstrated to lessen the discomfort, as demonstrated by one patient’s case presented at the annual American Psychiatric Association (APA) 2024 conference. The patient had treatment-resistant depression, as well as anxiety, irritable bowel syndrome (IBS), dysesthesia, poor concentration, low energy, and weight gain. She tried many oral antidepressants and augmentation agents to alleviate depressive symptoms. Antidepressants helped symptoms a bit, but they were still inadequate. Before her esketamine treatment, she took bupropion extended-release 450 mg and venlafaxine extended-release 225 mg daily. Her esketamine regimen started with an initial 56 mg dose on the first day to establish tolerability. Afterward, she received esketamine 84 mg intranasal twice weekly for 4 weeks and followed by once weekly for 4 weeks. The patient’s depressive symptoms improved within days of beginning esketamine. The treatment also improved her sleep. Since depressive symptoms returned after switching to a biweekly dosing, she returned to weekly dosing. Along with reducing depressive symptoms, esketamine provided pain relief from fibromyalgia pain. She rated her baseline pain as 7 – 8 daily on a 10-point scale with aggravations to 9 or 10. After esketamine, she rated her pain as 2 – 3, except for a score of 4 on day 6 and a score of 7 on the 1-week inter-dose interval. The response lasted over a 10-month course of treatment. When doses were 11 or 9 days a part, the patient rated her breakthrough pain as 6 – 7.

Reference:
Fichtner, Christopher. Incident Pain Relief with Esketamine for Depression: Sustained Benefit in Fibromyalgia and Migraine. Paper presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4-8, 2024.

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Second-generation supraglottic airway device effective intubation tool even for emergency airway management: Study

Recently published study aimed to assess the Ambu® Aura-i™ as an independent ventilatory device and conduit for fiberoptic-guided endotracheal intubation in adults. The Ambu® Aura-i™ is designed as a second-generation supraglottic airway device and is compatible with standard cuffed tracheal tubes, phthalate-free, and MRI-compatible. A descriptive observational study was conducted with 80 patients to evaluate the efficiency of the Ambu® Aura-i™ in various aspects.

Following the induction of general anesthesia, the Ambu® Aura-i™ was inserted, and fiberoptic examination of the glottis was conducted. The ease of insertion, time for insertion, glottic view grading, ease of intubation, success rate, time for fiberoptic-guided intubation, and removal duration were recorded. The Ambu® Aura-i™ was found to be easy to insert, with negligible variation in insertion and intubation times between different patient groups.

Comparison of Insertion and Intubation

Both groups experienced similar ease of insertion, with average insertion times being around 13-14 seconds and fiberoptic-guided intubation times averaging about 14 seconds. The success rate for the first attempt intubation was around 75-87.5% in both groups, and the removal duration of the Ambu® Aura-i™ from the tracheal tube was comparable in both groups.

Study Findings and Conclusion

No significant adverse events were reported, and the device was found to be suitable for various age groups and compatible with MRI machines. The study concluded that the Ambu® Aura-i™ is an effective and appealing ventilatory device and intubation tool for both normal and emergency airway management.

Overall Assessment and Limitation

Overall, the study demonstrated that the Ambu® Aura-i™ is an efficient and cost-effective ventilatory device and intubation tool, making it both anesthetist- and patient-friendly, and has potential use in fiberoptic-guided airway management in both operating theaters and the ICU. However, a limitation of the study was the restriction to only sizes 3 and 4 of the Ambu® Aura-i™, limiting its use to patients weighing up to 70 kg.

Key Points

– The study assessed the Ambu® Aura-i™ as a ventilatory device and conduit for fiberoptic-guided endotracheal intubation in adults, concluding that the device is easy to insert, with negligible variation in insertion and intubation times between different patient groups. The average insertion times were around 13-14 seconds, and fiberoptic-guided intubation times averaged about 14 seconds. The success rate for the first attempt intubation was around 75-87.5% in both groups, and the removal duration of the Ambu® Aura-i™ from the tracheal tube was comparable in both groups.

– The study found no significant adverse events and concluded that the Ambu® Aura-i™ is an effective and appealing ventilatory device and intubation tool for both normal and emergency airway management. It is considered suitable for various age groups and compatible with MRI machines. The research suggests that the device is efficient, cost-effective, anesthetist- and patient-friendly, and has potential use in fiberoptic-guided airway management in operating theaters and the ICU.

Reference –

Mishra N, Sinha N, Kharwar R K, et al. (April 20, 2024) Clinical Assessment of the Ambu® Aura-i™ as an Independent Ventilatory Device and Conduit for Fiberoptic-Guided Endotracheal Intubation in Adults. Cureus 16(4): e58629. DOI 10.7759/cureus.58629

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Multi-Ingredient Supplement Shows Promising Results for Dry Eye Disease in Clinical Trial

USA: Dry eye disease (DED) affects millions worldwide, causing discomfort and impairing vision quality. However, a glimmer of hope emerges from the latest research findings published in the Frontiers in Ophthalmology. A novel multi-ingredient supplement has demonstrated remarkable efficacy in alleviating ocular symptoms and improving tear production among patients with DED, according to results from a rigorous randomized, placebo-controlled clinical trial.

The study showed that a novel nutritional supplement of lutein, zeaxanthin isomers, curcumin, and vitamin D3 (LCD) demonstrated therapeutic potential as a once-daily treatment for patients with dry eye disease.

“Once-daily LCD supplementation significantly improved tear production, quality and stability, improved participants’ symptoms, and reduced ocular surface damage and inflammation,” the researchers reported. They suggested that LCD supplementation could offer a useful adjunct to artificial tears for patients with DED.

The multi-ingredient supplement is formulated with a synergistic blend of nutrients and compounds that support ocular health, including omega-3 fatty acids, antioxidants, and essential vitamins. This unique combination targets multiple pathways involved in DED pathogenesis, providing comprehensive relief from symptoms and promoting long-term eye health.

While artificial tears are the traditional mainstay of treatment for DED, addressing the underlying pathophysiology could relieve symptoms and prevent progression. Considering this, Neda Gioia, Integrative Vision Corp, Shrewsbury, NJ, United States, and colleagues evaluated the safety and efficacy of a proprietary blend of lutein, zeaxanthin isomers, curcumin, and vitamin D3 as a daily supplement in adult participants with DED.

The study Participants were randomized to receive one LCD supplement capsule (zeaxanthin isomers 4 mg, lutein 20 mg, curcumin 200 mg curcuminoids, and vitamin D3 600 IU) or placebo per day for eight weeks (LCD, n=77; placebo, n=78). Primary outcomes were changes in ocular symptoms (Ocular Surface Disease Index [OSDI] and tear volume (Schirmer’s test).

The following were the study’s key findings:

  • The study met its primary endpoints: the LCD group demonstrated significantly better Schirmer’s test scores, and improvement in overall OSDI score, versus placebo, at Day 56.
  • Scores for total OSDI, and symptoms and vision domains, significantly improved by Day 14 for LCD versus placebo, and were maintained to Day 56.
  • In addition, the LCD group demonstrated significantly improved tear film break-up time (TBUT) and tear film osmolarity, versus placebo, by Day 56, along with significant improvements in corneal and conjunctival staining, and inflammation (matrix metalloproteinase-9).
  • Total Standard Patient Evaluation of Eye Dryness (SPEED) score, and scores for the frequency and severity domains were significantly improved by Day 14 for LCD versus placebo and maintained to Day 56.
  • There was no difference between groups for artificial tear usage. The supplement was well-tolerated.

In conclusion, the trial highlights the benefits to patients with DED of anti-inflammatory and antioxidant nutritional support with this proprietary supplement by addressing the characteristic loss of tear homeostasis, improving their experience of symptoms, and ameliorating the ocular inflammation and damage that are the basis of DED pathophysiology.

Reference:

Gioia N, Gerson J, Ryan R, Barbour K, Poteet J, Jennings B, Sharp M, Lowery R, Wilson J, Morde A, Rai D, Padigaru M and Periman LM (2024) A novel multi-ingredient supplement significantly improves ocular symptom severity and tear production in patients with dry eye disease: results from a randomized, placebo-controlled clinical trial. Front. Ophthalmol. 4:1362113. doi: 10.3389/fopht.2024.1362113

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Dequalinium Chloride Matches Metronidazole in Efficacy for Treating Bacterial Vaginosis: JAMA

Researchers have found that dequalinium chloride, a broad-spectrum antiseptic, is as effective as oral metronidazole for treating bacterial vaginosis (BV) with better tolerability and fewer adverse events. This phase 4, multicenter, triple-blind, double-dummy, noninferiority randomized clinical trial suggests that dequalinium chloride could be a promising non antibiotic treatment option for BV. This study was published in the journal JAMA Network Open by Raba G. and colleagues.

Bacterial vaginosis is a common cause of vaginal infection, with metronidazole and clindamycin being the first-line treatments. Due to rising concerns about antibiotic resistance, the need for effective non antibiotic treatments is growing. Dequalinium chloride, a broad-spectrum antiseptic, has been examined to determine if it is noninferior to oral metronidazole for treating BV.

The trial, conducted from July 29, 2021, to August 25, 2022, included 147 premenopausal women aged 18 years or older diagnosed with BV from 11 gynecologic practices and one hospital in Poland, Slovakia, and the Czech Republic. Participants were randomized to receive either dequalinium chloride vaginal tablets (10 mg once daily for six days) or oral metronidazole (500 mg twice daily for seven days). Double-dummy medication kits contained both vaginal and oral tablets with either placebo or active medication.

The main outcome was the non-inferiority margin of 15 percentage points in the absolute difference in clinical cure rates between dequalinium chloride and metronidazole 7 to 11 days after starting treatment (visit 1). Noninferiority was achieved if the lower 95% confidence interval for the difference in clinical cure rate was less than 15 percentage points.

The key findings of the study were as follows:

  • At visit 1, the clinical cure rate was 92.8% for dequalinium chloride and 93.2% for metronidazole in the intention-to-treat population.

  • The treatment differences confirmed the noninferiority of dequalinium chloride, with a difference of −0.5 percentage points (95% CI, −10.8 to 9.8 percentage points; P = .002) in the intention-to-treat population and 2.5 percentage points (95% CI, −9.4 to 14.4 percentage points; P = .001) in the per-protocol population.

  • Dequalinium chloride was rated as very good by 60% of patients compared to 38.9% for metronidazole.

  • Three patients in the metronidazole group suspended treatment due to adverse events.

Given the similar high cure rate and improved tolerability, dequalinium chloride could be considered as a first-line treatment for BV, offering an alternative to antibiotics and helping to reduce antibiotic consumption.

The trial demonstrates that dequalinium chloride is noninferior to oral metronidazole for treating bacterial vaginosis. It provides similar efficacy with better tolerability and fewer adverse events, making it a potential first-line treatment option for BV.

Reference:

Raba, G., Ďurkech, A., Malík, T., Bassfeld, D., Grob, P., Hurtado-Chong, A., Botta, S., Sach, A., Golańska – Wróblewska, M., Paškala, M., Romanek-Piva, K., Sládičeková, R., Skřivánek, A., Sudek, P., & Fluomizin Study Group. (2024). Efficacy of dequalinium chloride vs metronidazole for the treatment of bacterial vaginosis: A randomized clinical trial. JAMA Network Open, 7(5), e248661. https://doi.org/10.1001/jamanetworkopen.2024.8661

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