Sri Ramachandra Hospital doctors remove LED bulb from 5-year-old’s lung

Chennai: A five year old poor boy had a miraculous save when an LED bulb swallowed a month ago was removed from his lungs through bronchoscopy at Sri Ramachandra Hospital. 

The boy was brought to the medical college hospital OP with refractory cough and breathing difficulty last Friday. The child which had swallowed a foreign object was admitted to another hospital and after two attempts of boronchoscopic removal failed was advised an open chest surgery after two weeks.

Also Read:Newborn makes miraculous recovery after 15 days in Sarvodaya Hospital

Fearing a major surgery the boy was brought to Sri Ramachandra Hospital where HoD paediatric surgery Dr R Madhu and his team took a CT scan and found an LED bulb deposited in the distal breathing tube branch (segmental bronchus). Parents were explained of the plan of removal through bronchoscopy failing which an open chest surgery and postoperative ICU and ventilation.

With excellent anaesthesia support headed by Dr Aruna Parameswari, HoD, Anaesthesia paediatric surgeons removed the LED bulb safely. The child did not require ICU or ventilation and has since been discharged.

Also Read:Tamil Nadu Chapter of Telemedicine Society of India launches learning centre

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People with diabetes at significantly higher risk of developing carpal tunnel syndrome, finds study

People with diabetes are at significantly higher risk of developing carpal tunnel syndrome, according to a study published in PlosOne.

In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject. This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg’s and Egger’s tests.

Results: This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64–2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg’s test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45–1.94; P-value < 0.001). The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant.

Reference:

Sanjari E, Raeisi Shahraki H, G Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach. PLoS One. 2024 Apr 16;19(4):e0299442. doi: 10.1371/journal.pone.0299442. PMID: 38626071; PMCID: PMC11020394.

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Increasing doses of varenicline or nicotine replacement helps persistent smokers quit smoking: JAMA

 For most smokers, quitting on the first attempt is likely to be unsuccessful, but a new study from The University of Texas MD Anderson Cancer Center found patients were more likely to quit if their cessation regimen was altered and doses were increased. Researchers also found that varenicline, a cessation medication, was more effective than combined nicotine replacement therapy (CNRT), such as patches or lozenges.

The study, published  in JAMA, revealed smokers who failed to quit with varenicline in the trial’s first phase were seven times more likely to quit by the end of the second phase if varenicline doses were increased. There also was a nearly two-fold increase in those who successfully quit if they were switched from a CNRT regimen to varenicline. These results are favorable compared to the near zero chance of abstinence seen in patients who were switched from varenicline to CRNT or left on the same treatment plans.

“These data indicate that sticking to the same medication isn’t effective for smokers who are unable to quit in the first six weeks of treatment,” said lead researcher Paul Cinciripini, Ph.D., chair of Behavioral Science. “Our study should encourage doctors to check in on patients early in their cessation journey and, if patients are struggling, to try a new approach, such as increasing medication dosage.”

The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those unable to quit were re-randomized to continue, switch or increase medication dose for an additional six weeks. Initial treatment included 2 mg of varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were re-randomized either continued the same varenicline or CNRT dose, switched between varenicline and CNRT, or were given an increased dose of 3 mg of varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.

Of the patients who received varenicline and had their doses increased, 20% were still abstaining six weeks later. Meanwhile, the abstinence rate was 14% among patients who switched from CRNT to varenicline or who had their CRNT doses increased. However, varenicline patients who switched to CNRT saw a 0% quit rate. After six months, only those who had their doses increased remained continuously abstinent.

Tobacco use remains the leading preventable cause of death and disease in the U.S. Each year, about 480,000 Americans die from tobacco-related illnesses. Currently, more than 16 million Americans suffer from at least one disease caused by smoking, including cancer. Quitting tobacco can improve the chances of survival by 30-40% for cancer patients who smoke. Since the average smoker makes several attempts to quit before successfully beating the addiction, MD Anderson tackles the barriers to cessation at an individual and population level, factoring in cost, access to cessation services, and knowledge gaps among health care providers on treating tobacco addiction.

In a larger ongoing trial, researchers are testing several different medication combinations as an alternative for those unable to quit on their initial doses of varenicline or CNRT.

Reference:

Cinciripini PM, Green CE, Shete S, et al. Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement: A Randomized Clinical Trial. JAMA. Published online May 02, 2024. doi:10.1001/jama.2024.4183.

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New study challenges one-size-fits-all approach to vitamin D supplementation guidelines

A new study from Trinity College Dublin scientists, sheds light on the complexities of achieving optimal vitamin D status across diverse populations. Despite substantial research on the determinants of vitamin D, levels of vitamin D deficiency remain high. The study was recently published in the journal Clinical Nutrition .

Dr Margaret M. Brennan, Research Assistant, Department of Public Health and Primary Care, School of Medicine, Trinity College and first author, said:

“We hope this work can highlight the significant differences in vitamin D levels among different ethnic groups at northern latitudes and contribute to efforts to address the long-standing population health issue of vitamin D deficiency.”

The authors analysed data from half a million participants from the United Kingdom (UK,) and for each person, they calculated the individualized estimate of ambient ultraviolet-B (UVB) level, which is the wavelength of sunlight that induces vitamin D synthesis in the skin.

A comprehensive analysis of key determinants of vitamin D and their interactions revealed novel insights. The first key insight is that ambient UVB emerges as a critical predictor of vitamin D status, even in a place like the UK, which receives relatively little sunlight. The second is that age, sex, body mass index (BMI), cholesterol level, and vitamin D supplementation significantly influence how individuals respond to UVB. For example, as BMI and age increase, the amount of vitamin D produced in response to UVB decreases.

Professor Lina Zgaga, Associate Professor of Epidemiology, Department of Public Health and Primary Care, School of Medicine, Trinity College and the principal investigator, said:

“We believe our findings have significant implications for the development of tailored recommendations for vitamin D supplementation. Our study underscores the need to move away from a one-size-fits-all approach towards personalized strategies for optimizing vitamin D status.”

Rasha Shraim, PhD candidate, Department of Public Health and Primary Care, School of Medicine, Trinity College, and co-principal investigator on this study said:

“Our study also highlights the effect that natural environmental factors, like sunlight, can have on our health. We hope that our approach encourages future researchers and public health bodies to integrate these factors into their health and disease work.”

The authors hope that their manuscript will contribute to the ongoing discourse on vitamin D supplementation guidelines.

Reference:

Brennan MM, van Geffen J, van Weele M, Zgaga L, Shraim R. Ambient ultraviolet-B radiation, supplements and other factors interact to impact vitamin D status differently depending on ethnicity: A cross-sectional study. Clin Nutr. 2024 Apr 12;43(6):1308-1317. doi: 10.1016/j.clnu.2024.04.006.

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Implant failure rate and risk of sinusitis low for implants penetrating floor of maxillary sinus, reveals study

Implant failure rate and risk of sinusitis low for implants penetrating in the floor of the maxillary sinus reveals a study published in the Journal of Clinical Medicine.

The aim of the present systematic review was to investigate the clinical outcomes after the perforation of the maxillary sinus by dental implants, or after maxillary sinus membrane perforation during sinus lift procedure. Twenty-nine publications were included. Failure rates of implants in cases where perforation of sinus floor had happened (11 studies) was generally low, and only one case of transient sinusitis was reported. The estimated failure rate of these implants was 2.1% (SE 1.0%, p = 0.035). There were 1817 implants (73 failures) placed in augmented sinuses in which the sinus membrane was perforated and 5043 implants (274 failures) placed in sinuses with no perforated membrane, from 18 studies.

The odds of implant failure difference between the groups were not significant (OR 1.347, p = 0.197). log OR of implant failure between perforated and non-perforated membrane groups did not significantly change with the follow-up time (−0.004/month; p = 0.500). In conclusion, implant failure rate is generally low either for implants penetrating in the floor of the maxillary sinus or implants placed in augmented sinuses in which the sinus membrane was perforated. The prevalence of postoperative infection/sinusitis is low, and it may depend either on the dimensions of the perforation or on the anatomical predisposition.

Reference:

Sala YM, Lu H, Chrcanovic BR. Clinical Outcomes of Maxillary Sinus Floor Perforation by Dental Implants and Sinus Membrane Perforation during Sinus Augmentation: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2024; 13(5):1253. https://doi.org/10.3390/jcm13051253

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Obesity Linked to Increased severity of Atopic Dermatitis: Study

Researchers have found that obesity is associated with clinician- and patient-assessed severity of atopic dermatitis (AD), although the effect sizes suggest limited clinical relevance. This conclusion comes from a prospective, observational cohort study known as TREATgermany, led by Dr. Stephan Traidl from Hannover Medical School’s Department of Dermatology and Allergy. The study was published in the Journal Of the European Academy Of Dermatology and Venereology.

The relationship between obesity and the severity of atopic dermatitis has been debated in epidemiological studies, with some European findings contradicting American research on the topic. The TREATgermany study was designed to investigate the associations between obesity and subjective and objective measures of disease severity, as well as comorbidities in patients with atopic dermatitis. The study’s data come from one of the largest AD registries worldwide.

TREATgermany is a prospective observational cohort study involving subjects with moderate-to-severe atopic dermatitis. By 2023, the cohort had recruited more than 1,800 individuals across 69 centers. The research team used UK Working Party criteria for diagnosing atopic dermatitis and enrolled adults who had undergone systemic therapy for AD within the previous 24 months.

Participants were stratified into three groups based on Body Mass Index (BMI): underweight (<18.5 kg/m²), normal weight/overweight non-obese (18.5-29.9 kg/m²), and obese (≥30 kg/m²). Researchers assessed participants’ baseline characteristics, including educational background, age, sex, smoking habits, employment and marital status, and disease severity. The team also looked at Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (oSCORAD), and Investigator’s Global Assessment (IGA) scores, as well as allergic comorbidities.

The key findings of the study were:

  • The study involved 1,416 participants, 16.5% of whom were classified as obese (BMI ≥30 kg/m²).

  • Obese participants had lower education levels and higher rates of smoking.

  • An increase in BMI was associated with increased oSCORAD (adjusted β: 1.24, 95% CI: 1.05–1.46, P = 0.013) and Patient-Oriented Eczema Measure (POEM) scores (adjusted β: 1.09, 95% CI: 1.01–1.17, P = 0.038).

  • Allergic comorbidities were similar across all groups, except for asthma, which was more common in obese individuals (P < 0.001).

The study’s main limitation was the low number of underweight participants, which prevented in-depth analysis of this subgroup. Despite this, the large sample size allowed for a thorough investigation of obese patients with AD.

The findings suggest that obesity is associated with increased severity of atopic dermatitis as assessed by both clinicians and patients. However, the effect sizes indicate limited clinical relevance, suggesting that while there is a link, it may not be a major factor in the management of AD.

Reference:

Traidl S, Hollstein MM, Kroeger N, Fischer S, Heratizadeh A, Heinrich L, et al. Obesity is linked to disease severity in moderate to severe atopic dermatitis—Data from the prospective observational TREATgermany registry. J Eur Acad Dermatol Venereol. 2024; 00: 1–9. https://doi.org/10.1111/jdv.20042.

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Needle-based gastrocnemius lengthening: Novel ultrasound-guided non invasive technique

Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure.

Iborra et al conducted a study to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. This has been published in “Journal of Orthopaedic Surgery and Research.”

The authors performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible fat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. The authors used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. The authors evaluated pre- and post operative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.

Key findings of the study were:

• Ankle dorsiflexion increased on average by 17.89°.

• The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months.

• The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.

The authors concluded – “Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist’s office, with a very basic instrument set and local anesthesia, thus reducing expenses.”

Further reading:

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique: part II—clinical results

Iborra et al.

Journal of Orthopaedic Surgery and Research (2024) 19:203

https://doi.org/10.1186/s13018-024-04685-0

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Low oxygen during sleep and sleep apnea linked to epilepsy in older adults: Study

Sleep apnea and low oxygen levels while sleeping are associated with epilepsy that first occurs after 60 years of age, known as late-onset epilepsy, according to a new study funded by the National Institutes of Health (NIH) and published in Low oxygen during sleep and sleep apnea linked to epilepsy in older adults. The link was independent of other known risk factors for late-onset epilepsy and sleep apnea including hypertension and stroke. The findings may help to better understand the relationship between sleep disorders and late-onset epilepsy, as well as identify potential targets for treatment.

“There’s increasing evidence that late-onset epilepsy may be indicative of underlying vascular disease, or neurodegenerative disease, even potentially as a preclinical marker of neurodegenerative disease,” said Rebecca Gottesman, M.D., Ph.D., chief of the Stroke Branch at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS), and an author on the study. “Compared to other age groups, older adults have the highest incidence of new cases of epilepsy-up to half of which have no clear cause. Sleep apnea is common among people with epilepsy, but the association is not well understood.”

Researchers, led by Christopher Carosella, M.D., assistant professor of neurology at Johns Hopkins University, Baltimore, identified cases of late-onset epilepsy using Medicare claims and analyzed sleep data from more than 1,300 participants in a study of sleep-disordered breathing and cardiovascular disease. They found that people whose oxygen saturation fell below 80% during sleep, a condition known as nocturnal hypoxia, were three times more likely to develop late-onset epilepsy compared to those who did not have similarly low oxygen levels. In addition, participants with self-reported sleep apnea in later life were twice as likely to develop late-onset epilepsy as those without the sleep disorder.

The degree of hypoxia during sleep was associated with late-onset epilepsy, independent of other co-occurring medical issues and demographic factors. The authors note that the study did not detect an association between the apnea-hypopnea index, a traditional measure of sleep apnea severity.

Sleep apnea is known to be a risk factor for poor brain health in other ways, including risk of stroke and dementia, but an association with epilepsy had not been described previously. The link to hypoxia suggests that repeated chronic exposure to low oxygen levels overnight might lead to brain changes that ultimately lead to risk of epilepsy. The study can’t determine whether treating or preventing sleep apnea might reduce the risk of epilepsy, but it does suggest that this may be an important potential target for reducing risk of late-onset epilepsy.

“Discovering a reversible cause for the development of any type of idiopathic epilepsy is an aspirational goal for epilepsy researchers or clinician,” said Dr. Carosella. “We hope this study might be a small first step in that direction and also an encouragement to evaluate and treat sleep disorders in patients with epilepsy.”

Because sleep apnea can have cardiovascular and brain health-related effects, the findings may also ultimately help to identify individuals at risk for some of these other conditions, providing a potential opportunity for treatment and prevention.

Future studies are needed to assess whether treating sleep apnea in patients at risk for late-onset epilepsy may help prevent the onset of the disease.  

Reference:

Christopher M Carosella, Rebecca F Gottesman, Anna Kucharska-Newton, Pamela L Lutsey, Adam P Spira, Naresh M Punjabi, Andrea L C Schneider, Kelsie M Full, Emily L Johnson, Sleep apnea, hypoxia, and late-onset epilepsy: the Atherosclerosis Risk in Communities study, Sleep, 2023;, zsad233, https://doi.org/10.1093/sleep/zsad233.

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Endoscopic Bile Reflux Strongly Associated with Barrett’s Esophagus, finds study

Researchers have found that endoscopic evidence of bile reflux is strongly associated with the presence of Barrett’s esophagus. This finding comes from a retrospective analysis of a prospectively maintained database of consecutive patients who underwent screening esophagogastroduodenoscopy. This study was published in the journal Digestive and Liver Disease by Yugo I. and colleagues.

Barrett’s esophagus is a condition in which the lining of the esophagus changes, potentially increasing the risk of esophageal cancer. Although bile reflux is known to play a role in the development of Barrett’s esophagus, the relationship between endoscopic evidence of bile reflux and the condition remains unclear. This study sought to evaluate whether endoscopic evidence of bile reflux is associated with the presence of Barrett’s esophagus.

The researchers conducted a retrospective analysis of a database comprising consecutive patients who underwent screening esophagogastroduodenoscopy. Endoscopic evidence of bile reflux was defined as the presence of bile-stained fluid in the gastric fundus. Multivariate analysis was performed to identify predictive factors that differed significantly between patients with and without Barrett’s esophagus.

The key findings of the study were:

  • The study involved 4,021 patients, of whom 922 (23%) had Barrett’s esophagus, and 1,000 (25%) showed endoscopic findings of bile reflux.

  • Multivariate analysis revealed endoscopic evidence of bile reflux as the strongest independent factor associated with the presence of Barrett’s esophagus (odds ratio [OR] 5.65, 95% confidence interval [CI] 4.71–6.76).

  • The analysis also found that hiatal hernia (OR 3.30, 95% CI 2.70–4.04) and male gender (OR 1.54, 95% CI 1.24–1.91) were significantly associated with the presence of Barrett’s esophagus.

The study’s findings suggest that endoscopic evidence of bile reflux may serve as a strong predictor for Barrett’s esophagus. This could help identify patients at future risk of developing the condition and who might benefit from increased endoscopic surveillance.

The research provides compelling evidence that endoscopic bile reflux is an independent factor associated with Barrett’s esophagus. This finding emphasizes the importance of monitoring bile reflux during endoscopy to identify patients who may be at increased risk of Barrett’s esophagus.

Reference:

Iwaya, Y., Goda, K., Kako, S., Hattori, H., Miyazawa, T., Hara, D., Hashigami, K., Hirayama, A., Okamura, T., Nagaya, T., & Umemura, T. (2024). Association between endoscopic evidence of bile reflux and Barrett’s esophagus: A large-scale case-control study. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 56(4), 622–627. https://doi.org/10.1016/j.dld.2023.11.042

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Prophylactic use of urokinase in children with Primary nephrotic syndrome can prevent VTE: Study

Prophylactic use of urokinase in children with Primary nephrotic syndrome can prevent VTE suggests a new study published in the BMC Nephrology.

A study was done to analyze the clinical effect of urokinase on the prevention of thrombosis in children with primary nephrotic syndrome. A total of 370 children diagnosed with primary nephrotic syndrome (PNS) in the Children’s Hospital of Soochow University and Zibo Maternal and Child Health Hospital from January 2018 to December 2022 were selected as the research objects. The patients were divided into a urokinase adjuvant therapy group and a non-urokinase adjuvant therapy group according to the application of drugs. The clinical data of the children were collected, including sex, age, drug application, bleeding during treatment, and telephone follow-up, to record whether thromboembolism occurred in the acute stage and remission stage. The clinical pattern of PNS, renal biopsy, histopathological type, and related laboratory indexes before and after treatment were recorded. Results: A total of 313 patients were treated with urokinase and 57 patients were not. More thrombotic events were observed in the non-urokinase group compared to the urokinase group(2 versus 0 episodes, p = 0.02). The thrombotic events observed included one patient who had a pulmonary embolism combined with right ventricular thrombosis and another who had intracranial venous thrombosis. More minor bleeding events occurred in the urokinase group compared to the non-urokinase group(7 versus 1 episode, p = 1.0). No major bleeding events occurred in either group. The rational prophylactic use of urokinase anticoagulation in children with PNS can prevent the formation of thromboembolism and has good safety.

Reference:

Wang, Z., Wang, N., Chen, R. et al. Urokinase prophylactic anticoagulation in children with nephrotic syndrome: a multicenter retrospective cohort study. BMC Nephrol 25, 68 (2024). https://doi.org/10.1186/s12882-024-03502-4

Keywords:

Prophylactic use, urokinase, children, Primary nephrotic syndrome, VTE, BMC Nephrology, Wang, Z., Wang, N., Chen, R, Thromboembolism

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