Bone Marrow Stimulation Does Not Improve Outcomes in Rotator Cuff Repair, reveals study

Researchers have found that adding bone marrow stimulation (BMS) to arthroscopic rotator cuff repair (ARCR) does not significantly improve clinical or structural outcomes. A recent comprehensive study involving 204 patients aimed to determine whether BMS offers any advantage over ARCR alone for treating small, medium, and large full-thickness rotator cuff tears. This study was published in the Journal of Shoulder and Elbow Surgery by Keun-Bae Hong and colleagues.

Bone marrow stimulation, a procedure that creates multiple channels in the greater tuberosity, is often performed to enhance healing during ARCR. However, its actual benefits in improving postoperative outcomes remain unclear. This study compared patients undergoing ARCR with and without BMS to assess its impact on recovery and tendon integrity.

The study randomized 204 patients into two groups: 103 patients received both BMS and ARCR (BMS group), while 101 patients underwent only ARCR (control group). Clinical and functional outcomes were measured using range of motion, American Shoulder and Elbow Surgeons (ASES) scores, constant scores, and visual analog scale (VAS) scores at baseline and 3 months, 6 months, 1 year, and 2 years post-surgery. Tendon integrity was evaluated via ultrasound at 6 months and 2 years.

• No significant differences in range of motion, ASES scores, constant scores, or VAS scores between groups over 2 years (all p>0.05).

• Similar rotator cuff retear rates between BMS and control groups at 6 months and 2 years post-surgery (all p>0.05).

• Both groups showed similar improvements over the 2-year follow-up period. There were no significant differences between the BMS and control groups in range of motion, ASES scores, constant scores, or VAS scores (all p>0.05).

• Ultrasound assessments revealed no significant difference in the rotator cuff retear rate between the two groups at 6 months and 2 years post-surgery (all p>0.05).

The study’s findings indicate that BMS does not offer additional benefits when combined with ARCR in terms of clinical and structural outcomes. Despite theoretical advantages, the practical impact of BMS on postoperative recovery appears minimal.

The inclusion of BMS in ARCR for patients with small to large rotator cuff tears does not significantly affect postoperative outcomes. Therefore, BMS may not be necessary for improving clinical and functional recovery in these patients.

Reference:

Hong, K.-B., Lee, T.-H., Park, H.-K., Lee, J.-H., Chung, S.-W., & Park, J.-Y. (2024). The impact of bone marrow stimulation on arthroscopic rotator cuff repair for small to large rotator cuff tears: A randomized controlled trial. Et al [Journal of Shoulder and Elbow Surgery]. https://doi.org/10.1016/j.jse.2024.03.048

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FDA approves red light LED lamp for patients with actinic keratosis

The US food and Drug Administration has approved red light LED lamp for patients with actinic keratosis.The new device was is recommend to be used in combination with aminolevulinic acid hydrochloride topical gel, 10% (Ameluz) as photodynamic therapy (PDT) for individuals with actinic keratoses of mild-to-moderate severity on the face and scalp. 

This innovative device represents a significant advancement in the treatment of PDT with state-of-the-art engineering, robust but sleek construction and an intuitive user interface. It is designed to be simple to maneuver and able to accommodate various patient treatment positions in order to optimize ease of use.

Biofrontera’s PDT drug, Ameluz®, is approved by the FDA in combination with either member of the RhodoLED lamp family. The introduction of the RhodoLED XL provides the option to illuminate a larger area in a single on-label Ameluz PDT treatment.

“We are delighted to introduce the RhodoLED XL lamp to the dermatology community in the US,” said Dr. Hermann Luebbert, CEO of Biofrontera Inc. “This new device underscores our commitment to innovation and excellence, providing dermatologists with a powerful tool to deliver superior patient care. The XL lamp’s advanced features and user-friendly design will undoubtedly set a new standard in photodynamic therapy.”

In comparison to Biofrontera’s existing lamp, the RhodoLED XL offers a larger illumination area with five panels compared to one, and additional features such as positioning sensors to ensure the patient receives the optimal energy delivery from the LED array.

Dr. Luebbert continued “I’m pleased to say we have already shipped three of these new devices to customers in our first week of launch and the response from dermatology organizations across the US has been very encouraging.”

Cleaver Dermatology, a renowned practice with offices in Missouri and Georgia, was the first to have the RhodoLED XL lamp installed.

“We are honored to be the first to integrate the XL lamp into our practice,” said Dr. David Cleaver. “The advanced features and versatility of this device represent a considerable upgrade on what has been available until now and will allow us to provide our patients with the highest standard of care. In addition, we have been very pleased with the level of customer service that the team at Biofrontera has delivered.”

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Unlocking Heart Health: New Guidelines on Sodium and Fluid Intake in Heart Failure Released by ESC

Belgium: In a pivotal move towards refining management strategies for heart failure patients, the Heart Failure Association of the European Society of Cardiology (ESC) has issued a clinical consensus statement emphasizing the critical role of dietary sodium and fluid intake. This guidance represents a unified effort by leading experts to address a longstanding challenge in cardiovascular care: optimizing nutrition to improve patient outcomes.

Heart failure (HF), a chronic condition affecting millions worldwide, imposes significant demands on healthcare systems and individuals alike. The delicate balance of sodium and fluid intake is central to its management, which directly influences cardiovascular function and symptom severity. The guideline, published in the European Journal of Heart Failure, underscores the need for tailored dietary approaches, acknowledging that individualized strategies are pivotal in mitigating symptoms and reducing hospitalizations.

For these guidelines, individuals with acute HF are those who, during the uptitration phase of guideline-recommended HF therapy (GDMT), have residual congestion and require maintenance on loop diuretics. Patients with chronic HF are those with chronic stable HF who are receiving GDMT and don’t have congestion signs/symptoms, and who have no or minimal loop diuretic requirements.

The ESC advises limiting salt intake to no more than 5 g/day in HF patients and restricting fluids to 1.5-2 L/day only in select patients with HF.

Sodium Intake

Normal sodium intake is generally considered 1.5 to 4 g/day (equivalent to 3.75-10 g of salt daily); a more liberal sodium intake is over 4 g/day; and a more restrictive salt intake is limited to less than 1-1.5 g/day.

In acute HF, a liberal sodium intake may not be tolerated; thus, the ESC indicates that a normal sodium intake is likely the best strategy, provided that the overall net sodium balance (intake vs output) remains negative during the acute decongestion phase. Avoid extreme salt restriction (<1-1.5 L/day) as it may be harmful in most clinical settings.

In chronic HF, the ESC suggests a normal sodium intake, with a more liberal intake allowed up to 5 g/day.

Fluid Intake

Currently, no convincing evidence exists for a clear benefit of hypertonic saline addition during the treatment of acute decompensated HF.

Avoid large volumes of fluid intake for all HF patients. Normal fluid intake is generally considered to be 1.5 to 2.5 L/day (corresponding to 15-30 mL/kg/day); a more liberal fluid policy is over 2.5-3.0 L/day; and a restrictive fluid policy is typically one that is less than 1-1.5 L/day.

The ESC suggests a normal fluid intake in acute and chronic HF, mainly using a sense of thirst and environmental factors to guide intake.

Intensive Care Unit Patients

Use similar principles as those above for managing HF patients who are not able to eat and drink independently and are receiving sodium and fluids via intravenous lines or a gastric tube. In clinically stable patients, the goal is to achieve a daily intake like a normal sodium and fluid regimen. When febrile or acutely ill, individuals on ventilation may have more fluid intake requirements.

It is crucial to consider concurrently administered fluids with medications and flushes (fluid creep) and extravascular volume collections. Monitor diuresis and track the net effect over several days, adjusting as required.

In conclusion, the clinical consensus statement on dietary sodium and fluid intake in heart failure represents a landmark initiative aimed at refining therapeutic approaches and improving the outcomes of patients. With a focus on evidence-based recommendations and individualized care, the statement sets a new standard in cardiovascular management, underscoring the commitment of ESC to advancing patient-centered care in heart failure.

Reference:

Mullens, W., Damman, K., Dhont, S., Banerjee, D., Bayes-Genis, A., Cannata, A., Chioncel, O., Cikes, M., Ezekowitz, J., Flammer, A. J., Martens, P., Mebazaa, A., Mentz, R. J., Miró, Ò., Moura, B., Nunez, J., Ter Maaten, J. M., Testani, J., Verbrugge, F. H., . . . Filippatos, G. (2024). Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. European Journal of Heart Failure, 26(4), 730-741. https://doi.org/10.1002/ejhf.3244

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Risk Rises: Low-grade fever in prolonged rupture of membranes linked to maternal and neonatal morbidity, study reveals

Israel: In a recent retrospective cohort study published in the American Journal of Obstetrics and Gynecology, researchers have uncovered a concerning association between prolonged rupture of membranes (PROM) exceeding 12 hours at term and increased infectious outcomes characterized by low-grade fever. The findings highlight potential risks for mothers in this clinical scenario.

In women with rupture of membranes (ROM) (>12h) at term, the researchers reported higher neonatal and maternal morbidity among those with low-grade fever versus normal body temperature. Low-grade fever was associated with a higher Enterobacteriaceae isolates risk in chorioamniotic membrane cultures and might be the initial presentation of peripartum infection.

“In term pregnancies with PROM (>12h), women with low-grade fever experienced higher rates of adverse events, including puerperal endometritis (OR 9.0), cesarean delivery, surgical site infections, umbilical cord pH<7.2 & NICU admissions (OR 3.2),” the researchers wrote.

Intrapartum fever (>38°C) is associated with adverse neonatal and maternal outcomes. However, the correlation between low-grade fever (37.5-37.9°C) and adverse perinatal outcomes is controversial. Considering this, Raneen ABU SHQARA, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel, and colleagues aimed to compare neonatal and maternal outcomes of women with prolonged rupture of membranes at term, between those with low-grade fever and those with normal body temperature.

For this purpose, the researchers conducted a retrospective study comprising women hospitalized in a tertiary university-affiliated hospital between 2021 and 2023, with singleton term and ROM>12h. Women were categorized as having normal body temperature (<37.5°C) or intrapartum low-grade fever (37.5°-37.9°C).

The co-primary outcomes: postpartum endometritis and neonatal intensive care unit admission (NICU) rates were compared between these groups.

Secondary maternal outcomes were cesarean delivery rate, intrapartum leukocytosis (>15,000/mm2), postpartum hemorrhage, postpartum fever, postpartum length of stay, and surgical site infection. Secondary neonatal outcomes were early-onset sepsis, umbilical artery cord pH<7.2 and pH<7.05, NICU length of stay, 5-minute Apgar score <7, and respiratory distress.

The study led to the following findings:

· Included were 687 women with ROM 12-18h and 1109 with ROM>18h.

· In both latency groups, among those with low-grade fever versus normal body temperature, the rates were higher for cesarean delivery, surgical site infections, endometritis, umbilical cord pH<7.2, NICU admission, and sepsis work-up.

· Among those with low-grade fever, the positive likelihood ratios were 12.7 and 3.2 for puerperal endometritis and NICU admission, respectively.

· Among women with ROM>18h, the rates were higher of Enterobacteriaceae isolates in chorioamniotic membrane cultures for those with low-grade fever vs. normal intrapartum temperature (22.0% versus 11.0%).

· Low-grade fever (odds ratio (OR) 9.0), AROM (OR 4.2), and cesarean delivery (OR 5.4) were independently associated with puerperal endometritis.

· Low-grade fever (OR 3.2) and cesarean delivery (OR 1.9) were independently associated with NICU admission.

As research continues to evolve, the implications of this study serve as a poignant reminder of the complexities involved in managing PROM at term. By prioritizing thorough assessment and evidence-based interventions, healthcare providers can strive towards better outcomes for mothers and newborns in obstetric practice.

Reference:

Abu Shqara R, Nakhleh Francis Y, Lowenstein L, Frank Wolf M. The relation between low-grade fever during prolonged rupture of membranes (>12 hours) at term and infectious outcomes: a retrospective cohort study. Am J Obstet Gynecol. 2024 Jun 11:S0002-9378(24)00665-3. doi: 10.1016/j.ajog.2024.05.054. Epub ahead of print. PMID: 38871240.

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Study Links Elevated Serum Hepatic Transaminases to Apical Periodontitis

Chile: A recent study has brought to light a concerning association between elevated serum hepatic transaminases and apical periodontitis, a common dental condition affecting the root tip of a tooth. The study aimed to explore potential connections between oral health and liver function markers.

Apical periodontitis (AP) is associated with higher serum hepatic transaminases alanine aminotransferase (ALT) and aspartate aminotransferase (AST), potentially contributing to nonalcoholic fatty liver disease (NAFLD) physiopathology in young adults, the study stated. The findings were published in the International Endodontic Journal. 

Apical periodontitis occurs when bacteria infect the dental pulp and spread to the root tip, leading to inflammation and possible infection in the surrounding tissues. The condition is prevalent among adults and can cause significant discomfort if left untreated. Whilst AP has been linked with noncommunicable diseases and systemic inflammation, its potential association with NAFLD is unknown. Considering this, Marcela Hernández, Universidad de Chile, Santiago, Chile, and colleagues aimed to evaluate the serum ALT and AST levels as surrogate markers of hepatic injury, and the systemic inflammatory burden in otherwise healthy individuals with and without AP diagnosis.

For this purpose, the researchers recruited individuals with AP (n = 30) and healthy controls (n = 29) in a cross-sectional study. The mean diameter (mm), number, and periapical index of the apical lesions of endodontic origin (ALEO) were assessed. AST and ALT levels (pg/mL) were measured through enzyme-linked immunosorbent assays. 

The serum TNF-α, IL-9, IL-4, IL-10, IL-22, and IL-17A levels were evaluated by Multiplex assay. Inferential analysis was performed using t-test or Mann–Whitney tests as per the data distribution and linear regression models. 

The following
were the key findings of the study:

  • ALT and AST levels were significantly higher in
    individuals with AP compared to controls.
  • Serum inflammatory biomarkers showed no
    significant differences between the study groups.
  • Bivariate and multivariate analyses confirmed
    that AP diagnosis was independently associated with ALT and AST elevations.
  • The number of ALEO positively influenced AST
    levels.
  • IL-22 on the other hand, was associated with
    reduced ALT levels.

In conclusion, young patients with apical periodontitis exhibited significantly higher serum levels of aspartate aminotransferase and alanine aminotransferase compared to controls, suggesting possible liver injury. Moreover, more severe apical lesions of endodontic origin were associated with higher AST levels.

“Despite comparable serum inflammatory markers between AP patients & controls, AP diagnosis was independently linked to increased AST & ALT levels,” the researchers wrote. The study represents a significant step toward elucidating the complex interactions between oral health and systemic conditions like liver function.

Reference:

Bordagaray, M. J., Pellegrini, E., Garrido, M., Hernández-Ríos, P., Villalobos, T., Fernández, A., & Hernández, M. Elevated serum hepatic transaminases in apical periodontitis individuals. International Endodontic Journal. https://doi.org/10.1111/iej.14109

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Thulium fiber laser equally effective as holmium laser for benign prostatic obstruction, suggests study

A recent study demonstrated that thulium fiber laser (TFL) enucleation of the prostate (ThuFLEP) is just as effective as the current standard, holmium laser enucleation of the prostate (HoLEP), for treating benign prostatic obstruction (BPO). This significant finding offers a promising alternative for the patients who undergo prostate surgery, regardless of prostate size.

The study was conducted from October 2021 to October 2022 and involved a total of 150 male patients diagnosed with BPO. These patients were randomly assigned to undergo either the ThuFLEP or HoLEP procedure. The research adhered strictly to the CONSORT guidelines for randomized trials by ensuring robust and reliable results. The primary focus was to compare the improvement in symptoms and quality of life three months post-surgery. Secondary measures included evaluating complications, peak urine flow rate, residual urine volume, and the duration of the surgical procedure.

The patients who underwent ThuFLEP and HoLEP procedures underwent remarkable improvements in their symptoms. The International Prostate Symptom Score (IPSS) which gauges the severity of symptoms, dropped from an average of 21 to 8. Quality of life scores also improved significantly, from 4 to 1.5 which indicated substantial relief and patient satisfaction post-treatment.

A detailed analysis revealed no significant differences between the two groups in the primary outcomes. The median postoperative IPSS was 8.5 for the ThuFLEP group and 7 for the HoLEP group, while the quality of life scores were 1 for ThuFLEP and 2 for HoLEP. Both differences were statistically insignificant that reinforced the non-inferiority of ThuFLEP.

The safety profile of the ThuFLEP procedure was comparable to that of HoLEP. The rate of major complications was nearly identical, with 5.3% for ThuFLEP and 5.4% for HoLEP. Also, the laser hemostasis times were close which averaged 3 minutes for ThuFLEP and 2 minutes for HoLEP. Use of additional electric coagulation was slightly lower in the ThuFLEP group (74% vs. 87%), although this difference was not statistically significant.

Other secondary outcomes, such as peak urine flow and residual urine volume, also showed no significant differences.  The patients in both groups demonstrated similar improvements which further validated the efficacy of ThuFLEP. Overall, the results of this study highlight ThuFLEP as a critical and effective alternative to HoLEP for treating BPO. With comparable improvements in symptoms, quality of life and a similar safety profile, ThuFLEP stands out as a promising new option for patients.

Source:

Kosiba, M., Filzmayer, M., Welte, M. N., Hügenell, L., Keller, A. C., Traumann, M. I., Müller, M. J., Kluth, L. A., Mandel, P. C., Chun, F. K.-H., & Becker, A. (2024). Thulium fiber laser vs. holmium laser enucleation of the prostate: results of a prospective randomized non-inferiority trial. In World Journal of Urology (Vol. 42, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1007/s00345-023-04748-7

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Thyroid eye disease patients report maintained improvement 2 years after teprotumumab infusions, reveals research

Most patients with thyroid eye disease treated with teprotumumab didn’t require additional treatments nearly 2 years later, according to industry-supported research being presented Sunday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass., and published in the journal Thyroid.

“Thyroid eye disease is a lifelong autoimmune disease that can worsen or flare, regardless of how it has been treated. This is the case for many autoimmune diseases,” said George Kahaly, M.D., Ph.D., professor of medicine and endocrinology at Johannes Gutenberg University Medical Center in Mainz, Germany. “Given the enduring nature of thyroid eye disease, it is important to understand whether patients who are treated with a full course of teprotumumab (eight infusions) can expect to experience lasting improvements in signs and symptoms, like eye bulging and double vision.”

Due to the longevity of thyroid eye disease, Kahaly added, it was important to look at longer-term results after treating patients with teprotumumab. Kahaly and colleagues sought to answer whether or not patients with thyroid eye disease would see sustained improvements in eye bulging (proptosis) and double vision (diplopia).

The study was sponsored by Amgen, which manufactures teprotumumab.

The researchers analyzed pooled clinical trial data beyond the 24-week treatment period for patients in phase 2, OPTIC, and OPTIC-X studies who received a full course of teprotumumab, up to week 72 (51 weeks post-final teprotumumab infusion). They also investigated whether or not patients received additional therapy from week 24 through week 120 (99 weeks post-therapy) as a measure of persistent benefit.

The data revealed patients who received teprotumumab mostly maintained efficacy 51 weeks after the final infusion at week 72.

Nearly two years after the treatment period was complete, 82% of patients did not need further treatment for thyroid eye disease. Of the 106 reporting patients, 18% (19/106) received additional medication, either systemic steroids or teprotumumab, and/or remedial periocular surgery as of 99 weeks post-therapy.

“As physicians consider treatment approaches for their thyroid eye disease patients, they now have longer-term data to support the use of teprotumumab in appropriate patients,” Kahaly said.

Reference:

Thyroid eye disease patients report maintained improvement 2 years after teprotumumab infusions, The Endocrine Society, Meeting: ENDO 2024.

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Chest CT scans offer critical insights into the lung function of sarcoidosis patients, reveals research

A recent study published in the CHEST journal highlighted the lung function assessment in sarcoidosis patients by suggesting that chest CT scans could provide more comprehensive insights than the traditional Scadding staging system.

The research was a part of the NHLBI Genomics Research in Alpha-1 Anti-Trypsin Deficiency and Sarcoidosis (GRADS) and analyzed sarcoidosis cases to compare demographic features, Scadding stage and CT findings. The primary research question was to determine whether a standardized CT assessment offers additional understanding of lung function beyond the Scadding stage and demographic data. The study included a total of 351 sarcoidosis patients who had both Scadding stage assessments and standardized chest CT scans. A single chest radiologist scored all CT scans using a visual scoring system and a subset of these scans was independently reviewed by another radiologist to evaluate the consistency.

The study then compared demographic features, Scadding stage and CT findings. The research also analyzed the correlations between these measures and lung function, using spirometry and DLCO (diffusing capacity for carbon monoxide) results from 318 patients.

One of the significant findings of the study was that CT features did not always align with Scadding stage classifications with inconsistencies observed in approximately 40% of cases. Also, most CT features assessed were negatively associated with lung function. This means that certain abnormalities detected via CT scans correlated with poorer lung function outcomes.

Even after adjusting for Scadding stage, the CT features maintained their associations with FEV1 (forced expiratory volume in one second) and DLCO. However, some associations between CT features and FVC (forced vital capacity) became insignificant upon this adjustment. The Scadding stage itself was primarily linked to FEV1, but incorporating CT features into the analysis reduced the significance of the association between Scadding stage and lung function.

Both Scadding stage and various CT measures were found to explain lung function variability through multivariable regression modeling. Moreover, Scadding stage contributed significantly to models explaining FEV1 and FEV1/FVC ratios and marginally for DLCO. The study illuminated moderate to poor agreement between the radiologists in evaluating the presence, absence and degree of CT abnormalities that suggests the need for more standardized CT assessment protocols.

This research indicates that chest CT scans offer valuable additional insights into lung function in sarcoidosis patients beyond what is provided by the Scadding stage. Further investigations are imperative to assess the potential of CT scans to enhance patient management and treatment outcomes.

Source:

Benn, B. S., Lippitt, W., Cortopassi, I., G.K, B., Barbosa, E. M., Jr., Drake, W. P., Herzog, E., Gibson, K., Chen, E. S., Koth, L. L., Fuhrman, C., Lynch, D. A., Kaminski, N., Wisniewski, S. R., Carlson, N. E., & Maier, L. A. (2024). Chest computed tomography provides more information than chest X-ray alone in determining extent of physiologic impairment in pulmonary sarcoidosis. In CHEST. Elsevier BV. https://doi.org/10.1016/j.chest.2024.04.031

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Frailty tied to poorer one-year survival among ICU patients after cardiac arrest: Study

Australia: In the realm of critical care medicine, the role of frailty in determining patient outcomes has emerged as a critical area of study. A recent research study has shed new light on how frailty impacts survival times among patients admitted to the intensive care unit (ICU) following in-hospital cardiac arrest.

The retrospective multicentre study, published in the Journal of Critical Care, revealed that frailty is associated with poorer one-year survival in patients admitted to Australian ICUs following an in-hospital cardiac arrest (IHCA).

“In critically ill adults who experienced IHCA, frail individuals faced significantly shorter median survival times (19 days versus 302 days) and worse overall one-year mortality than their non-frail counterparts (64.8% versus 36.4%),” the researchers reported. “Alarmingly, each unit increase in Clinical Frail Scale (CFS) associated with a 22% worse survival outcome, adjusted hazard ratio = 1.22.”

In-hospital cardiac arrest is a serious medical emergency. When IHCA occurs in frail patients, short-term survival is poor. However, the effect of frailty on long-term survival is unknown. To fill this knowledge gap, Ryo Ueno, Intensive Care Medicine, Eastern Health, Victoria, Australia, and colleagues aimed to assess the association between frailty and one-year survival in IHCA patients admitted to ICU in Australia.

For this purpose, the researchers performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian ICU between 2018 and 2022. It included all patients with an IHCA within the 24 hours before ICU admission with a documented Clinical Frail Scale (CFS).

The primary outcome was median survival up to one year after ICU admission. The effect of frailty on one-year survival was evaluated using a Cox proportional hazards model, adjusting for sex, age comorbidities, hospital type, and sequential organ failure assessment (SOFA) score.

The researchers reported the following findings:

  • 3769 patients were examined, of whom 30.8% (n = 1160) were frail (CFS ≥ 5).
  • The median survival was significantly shorter for patients with frailty (median days 19 versus 302).
  • The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% versus 36.4%).
  • Each unit increment in the CFS was associated with a 22% worse survival outcome (adjusted Hazard ratio = 1.22) after adjustment for confounders.
  • The survival trend was similar among patients who survived the hospitalization.

“Early recognition of frailty may provide individualized patient-centered intervention for such patients with frailty admitted to ICUs and guide goals of care discussions,” the researchers concluded.

Reference:

Ueno, R., Reddy, M. P., Jones, D., Pilcher, D., & Subramaniam, A. (2024). The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest. Journal of Critical Care, 83, 154842. https://doi.org/10.1016/j.jcrc.2024.154842

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Maternal serum alpha-fetoprotein levels higher in Black than White pregnant women, reveals research

USA: In the realm of prenatal care, the quest for equitable screening methods remains paramount, particularly in detecting fetal anomalies such as open neural tube defects (ONTDs). A recent study has spotlighted the significance of maternal race and weight in optimizing the performance of serum screening for ONTDs, offering promising insights into enhancing prenatal diagnostic accuracy while addressing disparities in healthcare access and outcomes.

The study, published in Clinical Chemistry, found higher maternal serum alpha-fetoprotein (AFP) levels in Black than White pregnant women, supporting the use of accounting for these differences in prenatal ONTD screening.

“AFP levels for pregnancies were higher in Black than White individuals (6 to 11 percent depending on gestational age),” the researchers reported.

“Similar screen-positive rates were observed for self-reported White and Black individuals in race-specific gestation age and maternal weight analyses at 0.74 versus 1.00 percent, respectively. However, the screen-positive rate was 2.4 times higher in Black than White individuals in race-agnostic analyses.”

Maternal serum AFP levels are used in screening for open neural tube defects. Historical reports show that AFP levels and maternal weights are higher in self-reported Black than White individuals, however, recent studies question the need to account for these variables in screening. Glenn E Palomaki, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, United States, and colleagues compared screening performance with and without accounting for race.

For this purpose, the researchers performed a retrospective analysis on deidentified prenatal screening records, including maternal weight and self-reported race of White or Black. For each group, gestational age-specific medians and weight-adjusted multiples of the median levels were separately calculated using a race-agnostic analysis. Outcome measures included the proportion of screen-positive results.

The following were the key findings of the study:

  • Records for analysis (n = 13 316) had an ultrasound confirmed gestational age between 15 and 21 completed weeks, singleton pregnancy, and self-reported race. Race was Black for 26.3%.
  • AFP levels for pregnancies in Black individuals were higher than in White individuals: 6% to 11%, depending on gestational age.
  • Race-specific gestational age and maternal weight analyses resulted in similar screen-positive rates for self-reported White and Black individuals at 0.74% versus 1.00%, respectively.
  • The use of race-agnostic analyses resulted in a screen-positive rate that was 2.4 times higher in Black than White individuals.

These findings show that the historical method of accounting for maternal weight and race in prenatal screening for ONTD provides equitable performance. Using a race-agnostic methodology leads to an increased screen-positive rate and a disproportionate rate of required follow-up care for individuals who self-identify as Black.

“Our results, together with existing professional recommendations and other current publications, endorse the continued self-reported race use in prenatal serum screening,” the researchers concluded.

Reference:

Messerlian, G., Strickland, S. W., Willbur, J., Vaughan, C., Koenig, S., Wright, T., & Palomaki, G. E. Use of Maternal Race and Weight Provides Equitable Performance in Serum Screening for Open Neural Tube Defects. Clinical Chemistry. https://doi.org/10.1093/clinchem/hvae053

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