Krill Oil Ineffective for Knee Osteoarthritis Pain Relief, finds JAMA Study

Researchers have found that krill oil supplementation does not improve knee pain in people with knee osteoarthritis. Knee osteoarthritis is a common and disabling condition with limited effective treatments. Krill oil, rich in omega-3 fatty acids, has been suggested as a potential therapeutic option due to its anti-inflammatory properties. However, its efficacy in reducing knee pain associated with osteoarthritis remains uncertain. Despite preliminary evidence suggesting potential benefits, a recent comprehensive study indicates no significant difference between krill oil and placebo in alleviating knee pain. This study was published in JAMA by Laura L. and colleagues.

The study aimed to evaluate the efficacy of krill oil supplementation compared with placebo on knee pain in individuals with knee osteoarthritis who experience significant knee pain and effusion-synovitis. This multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted across five Australian cities. Participants included individuals with clinical knee osteoarthritis, significant knee pain, and effusion-synovitis confirmed by magnetic resonance imaging (MRI). Enrollment occurred from December 2016 to June 2019, with the final follow-up on February 7, 2020.

Participants were randomized to receive either 2 grams per day of krill oil (n = 130) or a matching placebo (n = 132) for 24 weeks. The primary outcome was the change in knee pain assessed by the visual analog scale (VAS) over 24 weeks.

  • Of the 262 participants randomized (mean age 61.6 years, 53% women), 222 (85%) completed the trial.

  • The study found no significant improvement in knee pain with krill oil compared to placebo.

  • The mean change in VAS score was −19.9 for the krill oil group and −20.2 for the placebo group, resulting in a between-group mean difference of −0.3 (95% CI, −6.9 to 6.4).

  • Adverse events were reported by 51% of participants in the krill oil group (67/130) and 54% in the placebo group (71/132).

  • The most common adverse events were musculoskeletal and connective tissue disorders, occurring 32 times in the krill oil group and 42 times in the placebo group, including knee pain (10 with krill oil; 9 with placebo), lower extremity pain (1 with krill oil; 5 with placebo), and hip pain (3 with krill oil; 2 with placebo).

Among individuals with knee osteoarthritis experiencing significant knee pain and effusion-synovitis, 2 grams daily of krill oil supplementation did not improve knee pain over 24 weeks compared with placebo. These findings do not support the use of krill oil for treating knee pain in this population.

Reference:

Laslett, L. L., Scheepers, L. E. J. M., Antony, B., Wluka, A. E., Cai, G., Hill, C. L., March, L., Keen, H. I., Otahal, P., Cicuttini, F. M., & Jones, G. (2024). Krill oil for knee osteoarthritis: A randomized clinical trial. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2024.6063

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Higher dose of super-bioavailable itraconazole not required for obese patients with dermatophytosis, new study claims

India: A recent study published in the Indian Dermatology Online Journal sought to compare the safety and efficacy of once-daily super-bioavailable itraconazole (SITZ)-130 mg in obese and non-obese patients of glabrous tinea.

The researchers revealed that once daily, SITZ-130 mg achieved a similar and desired clinical response in obese as in non-obese patients suffering from dermatophytosis, and hence, a higher dose may not be needed in obesity.

Dermatophytosis has epidemic proportions in India, with an astonishing prevalence rate of 37–74% and an increase in resistant cases. Obesity has been recognized as one of the major risk factors for this transformation. These modifications have led to the evaluation of the present care of dermatophytosis into a combination therapy that includes itraconazole, the most widely prescribed systemic antifungal drug along with topical antifungal.

The Central Drugs Standard Control Organisation (CDSCO) in India recently approved a more recent itraconazole formulation (ITZ), super-bioavailable itraconazole due to pharmacokinetic challenges of conventional formulation of itraconazole, such as the need for an acidic environment for optimal absorption and food dependency. There have been mixed opinions regarding the dosing of systemic antifungals for dermatophytosis management in obese patients.

Dhiraj Dhoot, Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India, and colleagues, therefore, aimed to compare the safety and efficacy of SITZ-130 mg once daily in glabrous tinea or dermatophytosis in obese and non-obese patients for a total duration of 10 weeks on 87 eligible patients.

Safety and efficacy assessments were done at weeks 3 and 6 with follow-up at week 10 for relapse. The primary objective of the clinical study was to assess the proportion of patients achieving complete cure at week 6, with the assessment of clinical, safety, and mycological cure rates as secondary objectives. Out of 87 eligible patients, 80 were considered for analysis.

The researchers led to the following findings:

  • At week 6, 63% and 73% of patients in obese and non-obese groups were completely cured.
  • There was no statistically significant difference in mycological and clinical cure in both groups.
  • Four patients in the obese group (18% completely cured), while one patient in the non-obese group (3% completely cured), relapsed within 4 weeks of completion of treatment.
  • The therapy was well tolerated by both groups, with only one patient in the non-obese group experiencing pruritus.

“From the results, it can be concluded that obesity posed one of the risk factors for dermatophytosis,” the researchers wrote. “Additionally, SITZ-130 mg once daily achieved similar and desired clinical response in obese patients and non-obese patients suffering from dermatophytosis, and hence, a higher dose may not be required in obesity.”

The small sample size and duration of treatment were the limitations of the study. Hence, the authors warrant a comparative clinical study with a larger sample size and for a longer duration.

Reference:

Shenoy, Manjunath; De, Abhishek1; Shah, Bela2; Das, Anupam3; Saraswat, Abir4; Lahiri, Koushik1; Dhoot, Dhiraj5. Comparative Efficacy and Safety of Super-Bioavailable Itraconazole-130 mg Once Daily in Obese and Non-Obese Patients of Glabrous Tinea. Indian Dermatology Online Journal 14(6):p 839-843, Nov–Dec 2023. | DOI: 10.4103/idoj.idoj_120_23

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Ultrasounds can help predict risk of preterm births, new research shows

Researchers have developed a way to use ultrasound to predict whether a pregnant person is at risk of delivering a baby prematurely, which occurs in upward of 10% of pregnancies in the U.S.

The new method-the result of more than 20 years of collaboration between researchers in nursing and engineering at University of Illinois Chicago and University of Illinois Urbana-Champaign-measures microstructural changes in a woman’s cervix using quantitative ultrasound. The ultrasound method works as early as 23 weeks into a pregnancy, according to the research, which is published in the American Journal of Obstetrics & Gynecology Maternal Fetal Medicine.

The current method for assessing a woman’s risk of preterm birth is based solely on whether she has previously given birth prematurely. This means there has been no way to assess risk in a first-time pregnancy.

“Today, clinicians wait for signs and symptoms of a preterm birth,” such as a ruptured membrane, explained lead author Barbara McFarlin, a professor emeritus of nursing at UIC. “Our technique would be helpful in making decisions based on the tissue and not just on symptoms.”

In a study of 429 women who gave birth without induction at the University of Illinois Hospital, the new method was effective at predicting the risk of preterm births during first-time pregnancies. And for women who were having a subsequent pregnancy, combing the data from quantitative ultrasound with the woman’s delivery history was more effective at assessing risk than just using her history.

The new approach differs from a traditional ultrasound where a picture is produced from the data received. In quantitative ultrasound, a traditional ultrasound is performed but the radio frequency data itself is read and analyzed to determine tissue characteristics.

The study is the culmination of a research partnership that began in 2001 when McFarlin was a nursing PhD student at UIC. Having previously worked as a nurse midwife and sonographer, she had noticed that there were differences in the appearance of the cervix in women who went on to deliver preterm. She was interested in quantifying this and discovered that “no one was looking at it.”

She was put in touch with Bill O’Brien, a UIUC professor of electrical and computer engineering, who was studying ways to use quantitative ultrasound data in health research. Together, over the past 22 years, they established that quantitative ultrasound could detect changes in the cervix and, as McFarlin had suspected long ago, that those changes help predict the risk of preterm delivery.

The preterm birth rate hovers around 10-15% of pregnancies, O’Brien said. “That’s a very, very high percentage to not know what is happening,” he said.

If a clinician could know at 23 weeks that there was a risk of preterm birth, they would likely conduct extra appointments to keep an eye on the fetus, the researchers said. But since there had previously been no routine way to assess preterm birth risk this early, there have been no studies to show what sort of interventions would be helpful in delaying labor. This study, O’Brien explains, will allow other researchers to “start studying processes by which you might be able to prevent or delay preterm birth.” 

Reference:

Barbara L MCFARLIN, Michelle VILLEGAS-DOWNS, Mehrdad MOHAMMADI, Aiguo HAN, Douglas G. SIMPSON, William D. O’BRIEN Jr., Enhanced Identification of At-Risk Women for Preterm Birth via Quantitative Ultrasound: A Prospective Cohort Study, American Journal of Obstetrics & Gynecology Maternal Fetal Medicine, https://doi.org/10.1016/j.ajogmf.2023.101250.

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Wearable ultrasound patch may enable continuous, non-invasive monitoring of cerebral blood flow, concludes research

Engineers at the University of California San Diego have developed a wearable ultrasound patch that can offer continuous, non-invasive monitoring of blood flow in the brain. The soft and stretchy patch can be comfortably worn on the temple to provide three-dimensional data on cerebral blood flow-a first in wearable technology.

A team of researchers led by Sheng Xu, a professor in the Aiiso Yufeng Li Family Department of Chemical and Nano Engineering at the UC San Diego Jacobs School of Engineering, published their new technology in Nature.

The wearable ultrasound patch marks a significant leap from the current clinical standard, called transcranial Doppler ultrasound. This method requires a trained technician to hold an ultrasound probe against a patient’s head. The process has its downsides, however. It is operator-dependent, so the accuracy of the measurement can vary based on the operator’s skill. It is also impractical for long-term use.

Xu’s team developed a device that overcomes these hurdles. Their wearable ultrasound patch offers a hands-free, consistent and comfortable solution that can be worn continuously during a patient’s hospital stay.

“The continuous monitoring capability of the patch addresses a critical gap in current clinical practices,” said study co-first author Sai Zhou, a materials science and engineering Ph.D. candidate in Xu’s lab. “Typically, cerebral blood flow is monitored at specific times each day, and those measurements do not necessarily reflect what may happen during the rest of the day. There can be undetected fluctuations between measurements. If a patient is about to experience an onset of stroke in the middle of the night, this device could offer information that is crucial for timely intervention.”

Patients who are undergoing and recovering from brain surgery can also benefit from this technology, noted Geonho Park, another co-first author of this study who is a chemical and nano engineering Ph.D. student in Xu’s lab.

The patch, roughly the size of a postage stamp, is constructed from a silicone elastomer embedded with several layers of stretchy electronics. One layer consists of an array of small piezoelectric transducers, which produce ultrasound waves when electrically stimulated and receive ultrasound waves reflected from the brain. Another key component is a copper mesh layer-made of spring-shaped wires-that enhances signal quality by minimizing interference from the wearer’s body and environment. The rest of the layers consist of stretchable electrodes.

During use, the patch is connected through cables to a power source and computer. To achieve 3D monitoring, the researchers integrated ultrafast ultrasound imaging into the system. Unlike standard ultrasound, which captures about 30 images per second, ultrafast imaging captures thousands of images per second. This high frame rate is necessary for collecting robust data from the piezoelectric transducers in the patch, which would otherwise suffer from low signal intensity due to the strong reflection of the skull.

The data are then post-processed using custom algorithms to reconstruct 3D information such as the size, angle and position of the brain’s major arteries.

“The cerebral vasculature is a complex structure with multiple branching vessels. You need a device capable of capturing this three-dimensional information to get the whole picture and obtain more accurate measurements,” said Xinyi Yang, another co-first author of this study and materials science and engineering Ph.D. student in Xu’s lab.

In this study, the patch was tested on 36 healthy volunteers for its ability to measure blood flow velocities-peak systolic, mean flow and end diastolic velocities-in the brain’s major arteries. Participants engaged in activities affecting blood flow, such as hand-gripping, breath-holding and reading. The patch’s measurements closely matched those obtained with a conventional ultrasound probe.

Reference:

Zhou, S., Gao, X., Park, G. et al. Transcranial volumetric imaging using a conformal ultrasound patch. Nature 629, 810–818 (2024). https://doi.org/10.1038/s41586-024-07381-5.

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Plant-Based Diets Linked to Reduced Risk of CKD Progression and Mortality, CRIC Study Finds

USA: In a significant stride towards understanding the impact of dietary choices on kidney health, the Chronic Renal Insufficiency Cohort (CRIC) Study has unveiled compelling evidence supporting the benefits of plant-based diets in reducing the risk of chronic kidney disease (CKD) progression and all-cause mortality. Published in the renowned American Journal of Kidney Diseases, the findings underscore the potential of dietary interventions in improving outcomes for individuals with CKD.

The researchers revealed that following an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among patients with chronic kidney disease. By contrast, an unhealthy plant-based diet was associated with an increased risk of CKD progression and all-cause mortality.

“These results suggest the importance of quality of plant-based diets for CKD management,” the researchers wrote.

Previous studies have shown that plant-based diets are healthful dietary patterns linked to a lower risk of chronic diseases. However, the effect of plant-based diets on clinical outcomes in CKD patients is not well-established. Considering this, Saira Amir, Johns Hopkins University, Baltimore, Maryland, and colleagues examined the prospective associations of adherence to three different types of plant-based diets with the risks of CKD progression and all-cause mortality in 2,539 individuals with CKD.

Scores for the healthy plant-based diet index, overall plant-based diet index, and unhealthy plant-based diet index were calculated using Diet History Questionnaire responses. Outcomes were CKD progression defined as a decline in ≥50% estimated glomerular filtration rate (eGFR) from baseline or kidney replacement therapy (dialysis, transplant), and (2) all-cause mortality.

The study led to the following findings:

· There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively.

· Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74) and 21% (HR, 0.79) lower risks of all-cause mortality, respectively.

· Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14) and all-cause mortality (HR, 1.11).

The main limitation is that self-reported diet may be subject to measurement error.

In conclusion, higher adherence to an overall plant-based diet and a healthy plant-based diet was linked with a lowered risk of all-cause mortality but not CKD progression or incident cardiovascular disease in a population of kidney disease patients. Per 10-point higher in unhealthy plant-based diets was associated with a higher risk of all-cause mortality, CKD progression, and incident cardiovascular disease.

The researchers suggest that adhering to a plant-based diet may prolong life. There is no clarity on whether overall and healthy plant-based diets can delay CKD progression once kidney disease becomes overt, however, unhealthy plant-based diets may be detrimental to kidney health.

“Efforts to increase high-quality plant-based diet consumption should be facilitated by promoting equitable access to healthy plant foods in individuals with CKD,” they wrote.

Reference:

Amir S, Kim H, Hu EA, Ricardo AC, Mills KT, He J, Fischer MJ, Pradhan N, Tan TC, Navaneethan SD, Dobre M, Anderson CAM, Appel LJ, Rebholz CM; CRIC Study Investigators. Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2024 May;83(5):624-635. doi: 10.1053/j.ajkd.2023.09.020. Epub 2023 Dec 14. PMID: 38103719; PMCID: PMC11034716.

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One in eight pregnant people have a disability, but report shows gaps exist in the provision of accessible care

People with disabilities account for 13% of all pregnancies in Ontario, but a new report shows that this population was more likely to experience pregnancy complications such as emergency department visits, hospitalizations, and preterm birth.

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Research says pomegranates could offer a solution to fatty liver disease

Researchers at Edith Cowan University (ECU) are investigating the effects ellagic acid, an antioxidant found in some fruits and vegetables, could have on halting and potentially reversing the damage caused by fatty liver disease.

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US Food and Drug Administration approves artificial pancreas system

An artificial pancreas developed by researchers at the University of Cambridge has been granted approval by the U.S. Food and Drug Administration (FDA) for use by individuals with type 1 diabetes aged 2 and older, including during pregnancy.

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Alzheimer’s report highlights immense caregiver burden—and potential ways forward

Some 7 million Americans live with Alzheimer’s, and about 11 million provide unpaid care for them.

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Artificial intelligence could alleviate loneliness, says expert

Artificial Intelligence (AI) technology could offer companionship to lonely people amid an international epidemic of loneliness, says a robotics expert.

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