MCH Hospital Gandhi Nagar to get milk bank at cost of Rs 42.7 lakh

Jammu: The Ministry of Health and Family Welfare (MoHFW), Government of India, has given its approval for the establishment of first of its kind ‘Milk Bank ‘-a (Comprehensive Lactation Management Centre) at Maternity Hospital (MCH), Gandhinagar, Govt Medical College Jammu at cost of Rs 42.70 lakhs.    

As per GMC officials, the ‘Milk Bank’ worth Rs 42.70 lakhs has been sanctioned by the Ministry of Health and Family Welfare, Government of India at Maternity Hospital, Gandhi Nagar, Govt Medical College Jammu, news agency UNI reported.   

Also Read:Delhi : MCD’s first milk bank set up at Swami Dayanand Hospital

“It has been sanctioned after many years efforts,” they said and added that the maternity hospital Gandhi Nagar is already running State-of-the-Art 150 bedded NICU and taking load of SMGS Hospital as well as periphery to manage all sick neonates in addition to the Department of Gynaecology and Obstetrics also operating simultaneously.  

As per a media report in the Daily Excelsior, While Rs 16.61 lakh has been sanctioned by the Government for infrastructure of the CLMC, Rs 30.59 lakh has been sanctioned for the procurement of equipment for the Centre. The project has been sanctioned with the continuous efforts of Dr Ashutosh Gupta, Principal and Dean, GMC Jammu and Dr Ghanshyam Saini (HoD Paediatrics) under over all supervision of Dr Syed Abid Rasheed Shah (Administrative Secretary), who is also chairman of NHM J&K.  

Medical Dialogues team had earlier reported that in a move aimed to bolster healthcare infrastructure in Jammu and Kashmir, Oil and Natural Gas Corporation (ONGC) has constructed permanent 100-bed hospitals at Baltal in Ganderbal district and Chandanwari in Anantnag district. Oil and Natural Gas Corporation (ONGC) has partnered with the Department of Health and Medical Education, Government of Jammu and Kashmir.    

Also Read:TN: GMC Kanyakumari Kickstarts its first breast milk bank

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Precision in Practice: Machine Learning Redefines Familial Hypercholesterolemia Detection in new study

UK: In healthcare diagnostics, the quest for early detection of genetic disorders is increasingly turning towards innovative technologies. One such area of focus is Familial Hypercholesterolemia (FH), a genetic condition characterized by high levels of cholesterol in the blood, which significantly increases the risk of heart disease from a young age if left untreated.

New findings indicate that machine learning could play a role in enhancing the detection of potential cases of familial hypercholesterolemia. A machine learning–derived model provided a higher pretest probability in identifying individuals with a molecular diagnosis of FH than current approaches.

“This provides a cost‐effective, promising scalable tool for implementation into electronic health records to prioritize potential FH cases for genetic confirmation,” the researchers wrote in the Journal of the American Heart Association. 

Familial hypercholesterolemia, while highly prevalent, is a significantly underdiagnosed monogenic disorder. Recently, medical researchers and technology experts have been exploring the potential of machine learning algorithms in improving the identification and management of FH cases. FH is often underdiagnosed, partly due to its asymptomatic nature until complications arise, such as premature heart disease. Identifying individuals with FH early on can lead to timely interventions, potentially preventing severe cardiovascular events.

Against the above background, Christophe A. T. Stevens, Imperial College London, London, United Kingdom, and colleagues aimed to assess whether machine learning algorithms outperform clinical diagnostic criteria (history, signs, and biomarkers) and the recommended screening criteria in the United Kingdom to identify individuals with FH‐causing variants, presenting a scalable screening criteria for general populations.

The analysis included UK Biobank participants with whole exome sequencing; they were classified as having FH when (likely) pathogenic variants were detected in their LDLR, APOB, or PCSK9 genes. Data were stratified into three data sets for (1) deriving state‐of‐the‐art statistical and machine learning models; (2) feature importance analysis; (3) evaluating models’ predictive performance against clinical diagnostic and screening criteria: Simon Broome, Dutch Lipid Clinic Network, Familial Case Ascertainment Tool, and Make Early Diagnosis to Prevent Early Death.

The following were the key findings of the study:

  • One thousand and three of 454,710 participants were classified as having FH.
  • A Stacking Ensemble model yielded the best predictive performance (precision, 0.61%; sensitivity, 74.93%; accuracy, 72.80%, area under the receiver operating characteristic curve, 79.12%) and outperformed clinical diagnostic criteria and the recommended screening criteria in identifying FH variant carriers within the validation data set (figures for Familial Case Ascertainment Tool, the best baseline model, were 69.55%, 0.44%, 65.43%, and 71.12%, respectively).
  • Our model decreased the number needed to screen compared with the Familial Case Ascertainment Tool (164 versus 227).

Investigators noted that incorporating models derived from machine learning into electronic health records could improve the prioritization of genetic confirmation of FH, providing a more effective and efficient approach to identifying FH across diverse clinical settings and adult populations. They suggested that implementing screening criteria based on machine learning could enhance early identification and management, potentially decreasing instances of acute myocardial infarctions, revascularizations, and cardiovascular deaths associated with undetected cases.

Reference:

Stevens CAT, Vallejo-Vaz AJ, Chora JR, et al. Improving the Detection of Potential Cases of Familial Hypercholesterolemia: Could Machine Learning Be Part of the Solution?. J Am Heart Assoc. 2024;13(12):e034434. doi:10.1161/JAHA.123.034434

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Pemvidutide Shows Promise: Significant Weight Loss and Muscle Mass Preservation in MOMENTUM Trial

USA: Data from the phase 2 MOMENTUM trial indicate that pemvidutide, a dual GLP-1/Glucagon receptor agonist developed by Altimmune, achieved an average weight reduction of 15.6% in patients with overweight or obesity.

Presented at the 84th American Diabetes Association (ADA) Scientific Sessions, the study findings reveal that pemvidutide led to significant decreases in total body weight, with a unique emphasis on preserving muscle mass. Specifically, the weight loss was attributed to 21.9% lean mass and 78.1% fat reduction.
Dr. Louis J. Aronne, primary investigator from Weill Cornell Medicine’s Comprehensive Weight Control Center, highlighted the implications of these results: “Obesity requires diverse treatment options tailored to individual needs and health conditions. Pemvidutide’s ability to induce substantial weight loss and preserve lean mass is particularly promising.”
These findings were presented in full after an initial 24-week interim analysis by Altimmune in March 2023, where pemvidutide demonstrated dose-dependent weight reductions: 7.3% for 1.2 mg, 9.4% for 1.8 mg, and 10.7% for 2.4 mg, compared to 1.0% in the placebo group.
The MOMENTUM trial enrolled 391 participants with overweight or obesity, excluding those with type 2 diabetes, who had a mean age of 50 years and a mean BMI of 37 kg/m² at baseline. Participants were randomly assigned to receive pemvidutide doses of 1.2 mg, 1.8 mg, 2.4 mg, or placebo over 48 weeks, with dose titration for the 2.4 mg group.
At the end of 48 weeks, pemvidutide demonstrated mean weight reductions of 10.3% for 1.2 mg, 11.2% for 1.8 mg, and 15.6% for 2.4 mg, compared to 2.2% in the placebo group. Notably, 20% or greater weight loss was achieved by 2.0% (placebo), 10.0% (1.2 mg), 9.5% (1.8 mg), and 32.1% (2.4 mg) of participants.
Moreover, pemvidutide was associated with significant reductions in triglyceride levels across all doses: -21.7% for 1.2 mg, -22.3% for 1.8 mg, and -34.9% for 2.4 mg, contrasting with a 7.3% increase in the placebo group.
Dr. Aronne also presented MRI-based body composition analyses, revealing that pemvidutide users experienced a mean loss of 21.9% lean mass, predominantly from fat reduction (78.1%).
“With its promising safety profile and potential to improve conditions like dyslipidemia and hypertension associated with obesity, pemvidutide could offer a valuable long-term treatment option for diverse segments of the obese population,” Dr. Aronne concluded.
The study authors are gearing up for larger Phase 3 trials to validate the safety and clinical effectiveness of pemvidutide for managing weight. Additionally, given that obesity can contribute to excess liver fat accumulation and nonalcoholic steatohepatitis (NASH), they are investigating pemvidutide’s potential benefits in patients with these conditions.
Reference:
Aronne LJ, Harris MS, Roberts MS, et al. Pemvidutide, a GLP-1/Glucagon Dual Receptor Agonist, in Subjects with Overweight or Obesity—A 48-Week, Placebo-Controlled, Phase 2 (MOMENTUM) Trial. Presented at: American Diabetes Association (ADA) 84th Scientific Sessions. June 21 – 24, 2024. Orlando, FL.

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Exercise combined with GLP-1RA outperforms liraglutide alone in Optimizing weight loss and bone health: JAMA

Denmark: A recent secondary analysis of a randomized clinical trial including 195 adults with obesity has provided valuable insights into the impact of different treatments—exercise alone, GLP-1 receptor agonist treatment, or a combination of both—on bone health. The study, which examined outcomes related to bone mineral density (BMD) and bone turnover markers, offers new perspectives on strategies to promote skeletal health.

The findings, published in JAMA Network Open, suggest that adding exercise to glucagon-like peptide-1 receptor agonists (GLP-1RAs) treatment is an effective weight loss strategy while preserving bone health.

“The combination of exercise and GLP-1 RA preserved spine, hip, and forearm BMD despite larger weight loss. GLP-1 RA treatment alone reduced spine and hip BMD compared with placebo or exercise alone,” the researchers reported.

Concomitant bone loss is a major concern with weight loss. Exercise and GLP-1RAs represent weight loss strategies that may protect bone mass despite weight loss. Considering this, Simon Birk Kjær Jensen, University of Copenhagen, Copenhagen, Denmark, and colleagues aimed to investigate bone health at clinically relevant sites (forearm, spine, and hip) after diet-induced weight loss followed by a 1-year intervention with exercise, liraglutide, or both combined.

For this purpose, the researchers conducted a predefined secondary analysis of a randomized clinical trial between 2016 and 2019 at the University of Copenhagen and Hvidovre Hospital in Denmark. Eligible participants were adults aged 18 to 65 years, with obesity (body mass index of 32-43) and without diabetes. Data analysis took place from March to April 2023, with supplementary analysis conducted in February 2024 during the revision phase.

Following an 8-week low-calorie diet (800 kcal/day), participants were randomly assigned to one of four groups for 52 weeks: a moderate- to vigorous-intensity exercise program (exercise alone), daily administration of 3.0 mg of the GLP-1 receptor agonist liraglutide (liraglutide alone), the combined intervention, or placebo.

The main focus was to assess changes in BMD at specific sites—hip, lumbar spine, and distal forearm—from a pre-low-calorie diet to the conclusion of treatment, evaluated using dual-energy x-ray absorptiometry in the intention-to-treat population.

The following were the key findings of the study:

  • 195 participants (mean age, 42.84 years; 64% females; mean BMI, 37.00) were randomized, with 48 participants in the exercise group, 49 participants in the liraglutide group, 49 participants in the combination group, and 49 participants in the placebo group.
  • The total estimated mean change in weight losses during the study was 7.03 kg in the placebo group, 11.19 kg in the exercise group, 13.74 kg in the liraglutide group, and 16.88 kg in the combination group.
  • In the combination group, BMD was unchanged compared with the placebo group at the hip (mean change, −0.006 g/cm2) and lumbar spine (−0.010 g/cm2).
  • Compared with the exercise group, BMD decreased for the liraglutide group at the hip (mean change, −0.013 g/cm2) and spine (mean change, −0.016 g/cm2).

The findings showed that combining exercise and GLP-1RA (liraglutide) was the most effective weight loss strategy while preserving bone health. Liraglutide treatment alone reduced bone mineral density at clinically relevant sites more than exercise alone, despite similar weight loss.

In conclusion, the secondary analysis of this randomized clinical trial provides compelling evidence regarding the effects of exercise, GLP-1 receptor agonists, and their combination on bone health markers. As further research unfolds, these findings hold promise for advancing therapeutic approaches aimed at preserving and enhancing skeletal integrity across different patient demographics.

Reference:

Jensen SBK, Sørensen V, Sandsdal RM, et al. Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2416775. doi:10.1001/jamanetworkopen.2024.16775

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Dr Anita Vig Kohli appointed as new HOD Anaesthesiology at GMC Jammu

Jammu: Dr Anita Vig Kohli has been appointed as the new professor and Head of the Department (HOD) of Anaesthesiology at Government Medical College (GMC) Jammu.

As per media reports, she took charge of the new position of Professor and Head of the Postgraduate Department of Anesthesia and Critical Care at the GMC Jammu after Prof Anju Jamwal’s retirement.  

Also Read: GMC Jammu begins cancer genetic testing on NGS technology

As per an order issued by the Principal and Dean GMC Jammu and consequent upon superannuation of Prof Anju Jamwal, Dr Anita took over as Prof and Head of the Postgraduate Department of Anesthesia and Critical Care at GMC Jammu as reported by Daily Excelsior.    

Dr Anita is an aluminous of GMC Jammu and has been the President Of the Anesthesia Society of India (Jammu). She has been associated with various training programs like the Emergency trauma course. Basic life support at GMC Jammu and Advanced life support is on the anvil. She intends to take the department forward in fields of Critical Care, Pain Management Palliative Care and Emergency resuscitations (code blue).   

Also read- Padma Shri Dr Mahesh Verma Reappointed As Vice Chancellor Of GGSIP University

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Allowing patients to eat and drink before coronary procedures as safe as traditional fasting and enhances patient comfort: Study

France: The debate over whether patients should fast before interventional coronary procedures has been a longstanding topic in cardiovascular medicine. The recently concluded TONIC trial, a randomized controlled study, sought to clarify this by comparing outcomes between patients who fasted and those who did not before such procedures.

The study, published in JACC: Cardiovascular Interventions, showed that a nonfasting strategy is noninferior to the usual fasting strategy for coronary procedures regarding safety while improving the comfort of the patients.

These findings indicate that permitting patients to consume food and beverages before coronary procedures is equally safe compared to traditional fasting practices and contributes to enhanced patient comfort. It is recommended that clinicians revise procedural protocols to incorporate nonfasting approaches, potentially improving the overall patient experience without raising the risk of adverse events.

Traditionally, patients undergoing procedures like percutaneous coronary intervention (PCI) or coronary angiography are required to fast overnight. However, growing evidence suggests that fasting may not be necessary and could even lead to discomfort and potential complications. Considering this, Madjid Boukantar, Interventional Cardiology, Henri Mondor Hospital, Créteil, France, and colleagues conducted the TONIC inferiority trial to investigate the safety and comfort of a nonfasting strategy (ad libitum food and drinks) vs traditional fasting (>6 hours for solid food and liquids) before coronary procedures.

The researchers conducted a monocentric, prospective, single-blind randomized controlled trial, including 739 patients undergoing coronary procedures, and randomized to a fasting or a nonfasting strategy. Emergency procedures were excluded.

The primary outcome measure included a combination of vasovagal reactions, hypoglycemia (defined as blood sugar ≤0.7 g/L), and isolated incidents of nausea and vomiting. A noninferiority margin of 4% was applied. Secondary endpoints comprised contrast-induced nephropathy and patient-reported satisfaction levels.

The following were the key findings of the study:

  • Among the 739 procedures (697 elective and 42 semiurgent), 517 angiographies, and 222 angioplasties (including complex and high-risk procedures) were performed.
  • The primary endpoint occurred in 8.2% nonfasting patients vs 9.9% fasting patients, demonstrating noninferiority (absolute between-group difference, −1.7%).
  • No food-related adverse event occurred, and contrast-related acute kidney injuries were similar between groups.
  • Procedure satisfaction and perceived pain were similar in both groups, but nonfasting patients reported less hunger and thirst.
  • In the case of redo coronary procedures, most patients (79%) would choose a nonfasting strategy.

The TONIC trial showed noninferiority regarding the safety of a nonfasting strategy to the routine fasting strategy for all patients undergoing elective or semi-urgent coronary procedures, with no food-related adverse event.

“A nonfasting strategy could improve patients’ comfort and catheterization laboratories efficiency,” the researchers wrote.

Reference:

Boukantar, M., Chiaroni, P., Gallet, R., Zamora, P., Truong, T., Mangiameli, A., Rostain, L., Tuffreau-Martin, A., Natella, P., Oubaya, N., & Teiger, E. (2024). A Randomized Controlled Trial of Nonfasting vs Fasting Before Interventional Coronary Procedures: The TONIC Trial. JACC: Cardiovascular Interventions, 17(10), 1200-1210. https://doi.org/10.1016/j.jcin.2024.03.033

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Maternal BMI Linked to Increased Risk of Sleep Apnea in Offspring: Study

Researchers have found that maternal overweight and obesity during early pregnancy are associated with an increased risk of sleep apnea in their offspring. This conclusion comes from a comprehensive nationwide cohort study conducted in Sweden, which analyzed data from over 3 million singleton live births between 1983 and 2015. The study was recently published in Journal of Clinical Sleep Medicine by Mia Q Zhu and colleagues.

Sleep apnea, a serious sleep disorder characterized by repeated interruptions in breathing, has significant health implications for affected individuals. Previous research has suggested that early-life factors may play a role in the development of sleep apnea. This study aimed to investigate the association between maternal early pregnancy body mass index (BMI) and the risk of sleep apnea in offspring, providing crucial insights into potential early predictors of this condition.

The study included 3,281,803 singleton live births in Sweden, born between 1983 and 2015. Researchers utilized national registers with prospectively recorded information to follow participants for a sleep apnea diagnosis from the age of 2 up to 35 years. Sleep apnea risks were compared across different maternal early pregnancy BMI categories using hazard ratios (HR) with 95% confidence intervals (CI) derived from adjusted Cox models. To address potential confounding by factors shared within families, sibling-controlled analyses were also conducted.

During the study period, 17,830 individuals were diagnosed with sleep apnea. Maternal early pregnancy BMI was positively associated with offspring sleep apnea risk.

Compared with women with normal BMI (18.5-24.9), the adjusted HR (95% CI) of offspring sleep apnea for maternal BMI categories were:

• Overweight (BMI 25.0-29.9): HR 1.14 (1.09, 1.19)

• Obesity Class I (BMI 30.0-34.9): HR 1.28 (1.20, 1.36)

• Obesity Class II or III (BMI ≥35.0): HR 1.40 (1.27, 1.54)

Sibling-Controlled Analyses: Representing risk changes for maternal BMI differences between pregnancies, the HR (95% CI) were:

• Overweight: HR 1.13 (1.01, 1.26)

• Obesity Class I: HR 1.17 (0.97, 1.42)

• Obesity Class II or III: HR 1.32 (0.97, 1.80)

• The HR by siblings’ maternal BMI were attenuated, suggesting a weak role for shared familial factors in the association.

• Other pregnancy, birth, and neonatal complications were also associated with offspring sleep apnea risk but did not substantially mediate the association with maternal obesity.

The findings from this extensive cohort study underscore the importance of maternal health during early pregnancy. The dose-response relationship between maternal BMI and offspring sleep apnea risk suggests that higher maternal BMI is a significant risk factor. This information could be crucial for healthcare providers in counseling and managing expectant mothers, particularly those with higher BMI, to mitigate potential long-term health risks for their children.

This landmark study reveals that maternal overweight and obesity during early pregnancy are associated with an increased risk of sleep apnea in offspring. These findings highlight the need for early intervention and targeted strategies to manage maternal BMI, potentially reducing the risk of sleep apnea and improving health outcomes for future generations.

Reference:

Zhu, M. Q., Cnattingius, S., O’Brien, L. M., & Villamor, E. (2024). Maternal early pregnancy body mass index and risk of sleep apnea in the offspring. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine. https://doi.org/10.5664/jcsm.11228

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Early Vitrectomy may Improve Vision and Retinal Health in Open Globe Injuries: Study

Mexico: In the realm of ophthalmic trauma management, a recent systematic review and meta-analysis have compared the outcomes of early versus delayed vitrectomy in cases of open globe injuries (OGIs), shedding light on optimal treatment timelines for improved patient outcomes.

The study, published in Clinical Ophthalmology, showed better postoperative visual acuity, a greater proportion of retinal reattachment, and a decreased incidence of proliferative vitreoretinopathy (PVR) with early vitrectomy (within seven days) compared to delayed surgery (8-14 days).

“Patients who received early intervention showed a 3.42-fold increase in the odds of retinal reattachment and were 2.4 times more likely to achieve visual acuity ≥ 5/200,” the researchers reported. “Delayed surgery led to a higher incidence of proliferative vitreoretinopathy and often required multiple vitrectomies.”

Open globe injuries, characterized by a full-thickness wound of the eye resulting from trauma, pose significant challenges in ophthalmology due to the potential for severe complications such as retinal detachment and endophthalmitis. Vitrectomy, a surgical procedure involving the removal of vitreous gel from the eye, is often employed to repair these injuries and restore visual function. However, there is a lack of consensus concerning the optimal timing of vitrectomy for maximizing visual outcomes.

To fill this knowledge gap, Miguel A Quiroz-Reyes, Retina Department. Oftalmologia Integral ABC, Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Mexico City, Mexico, and colleagues aimed to investigate whether early or delayed vitrectomy improves outcomes in patients with OGIs.

For this purpose, the researchers conducted a review based on PRISMA guidelines. They searched the online databases and included clinical studies that used vitrectomy to manage OGIs as early (within seven days) or delayed (8– 14 days) interventions. Randomized controlled trials (RCTs) were evaluated using the Cochrane risk of bias tool, while non-RCTs underwent assessment with the JBI tool.

The researchers reported the following findings:

  • Eleven studies met the inclusion criteria and were included in the quantitative analyses. 235 patients with OGIs received early intervention, and 211 received delayed intervention.
  • The retina was reattached in 91% and 76% of the patients after early and delayed intervention, respectively.
  • Traumatic PVR was present in 9% and 41% of the patients in the early and delayed groups, respectively.
  • The odds of retinal reattachment after vitrectomy were greater in the early group (OR = 3.42), and the odds of visual acuity ≥ 5/200 were 2.4 times greater in the early group.
  • The incidence of PVR was significantly greater in the delayed surgery group (OR = 0.16), which also required more than one vitrectomy surgery.

In conclusion, the systematic review and meta-analysis comparing early versus delayed vitrectomy for open globe injuries provide compelling evidence supporting the benefits of early surgical intervention. By elucidating optimal treatment timelines, the study underscores the importance of timely vitrectomy in preserving visual function and improving overall patient prognosis in cases of ocular trauma.

“More RCTs are needed to overcome the limitations of this review,” the researchers wrote.

Reference:

Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gómez V. Early versus Delayed Vitrectomy for Open Globe Injuries: A Systematic Review and Meta-Analysis. Clin Ophthalmol. 2024;18:1889-1900. https://doi.org/10.2147/OPTH.S466144

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Physical exercise may prevent nerve damage during chemotherapy: Study

Cancer treatments often cause nerve damage that can lead to long-lasting symptoms. Medication has proven ineffective in these cases. A sports scientist at the University of Basel, together with an interdisciplinary team from Germany, has now shown that simple exercises can prevent nerve damage.

Cancer therapies have improved over the years. It is no longer just about sheer survival: quality of life after recovery is gaining more importance.

Unfortunately, many cancer medications, from chemotherapy to modern immunotherapies, attack the nerves as well as the tumor cells. Some therapies, such as oxaliplatin or vinca alkaloids, leave 70 to 90 percent of patients complaining of pain, balance issues, or feelings of numbness, burning or tingling. These symptoms can be very debilitating. They can disappear following cancer treatment, but in around 50 percent they become chronic. Specialists call it chemotherapy-induced peripheral neuropathy, or CIPN for short.

A research team led by sports scientist Dr. Fiona Streckmann from the University of Basel and the German Sport University Cologne has now shown that specific exercise, concomitant to cancer therapy, can prevent nerve damage in many cases. The researchers have reported their findings in the journal JAMA Internal Medicine.

Exercise alongside chemo

The study involved 158 cancer patients, both male and female, who were receiving treatment either with oxaliplatin or vinca-alkaloids. The researchers divided the patients at random into three groups. The first was a control group, whose members received standard care. The other two groups completed exercise sessions twice a week for the duration of their chemotherapy, with each session lasting between 15 and 30 minutes. One of these groups carried out exercises that focused primarily on balancing on an increasingly unstable surface. The other group trained on a vibration plate.

Regular examinations over the next five years showed that in the control group around twice as many participants developed CIPN as in either of the exercise groups. In other words, the exercises undertaken alongside chemotherapy were able to reduce the incidence of nerve damage by 50 to 70 percent. In addition, they increased the patients’ subjectively perceived quality of life, made it less necessary to reduce their dose of cancer medications, and reduced mortality in the five years following chemotherapy.

The participants receiving vinca-alkaloids and performing sensorimotor training, had the largest benefit.

Ineffective medications

A lot of money has been invested over the years in reducing the incidence of CIPN, explains Streckmann. “This side effect has a direct influence on clinical treatment: for example, patients may not be able to receive the planned number of chemotherapy cycles that they actually need, the dosage of neurotoxic agents in the chemotherapy may have to be reduced, or their treatment may have to be terminated.”

Despite the investments made, there is no effective pharmacological treatment to date: various studies have shown that medications can neither prevent nor reverse this nerve damage. However, according to the latest estimates, USD 17,000 are spent per patient every year in the USA on treating nerve damage associated with chemotherapy. Streckmann’s assumption is that “doctors prescribe medications despite everything, because patients’ level of suffering is so high.”

Study ongoing in children’s hospitals

In contrast, the sports scientist emphasizes, the positive effect of exercise has been substantiated, and this treatment is very cheap in comparison. At the moment she and her team are working on guidelines for hospitals, so that they can integrate the exercises into clinical practice as supportive therapy. In addition, since 2023 a study has been ongoing in six children’s hospitals in Germany and Switzerland (PrepAIR), which is intended prevent sensory and motor dysfunctions in children receiving neurotoxic chemotherapy.

“The potential of physical activity is hugely underestimated,” says Fiona Streckmann. She very much hopes that the results of the newly published study will lead to more sports therapists being employed in hospitals, in order to better exploit this potential.

Reference:

Streckmann F, Elter T, Lehmann HC, et al. Preventive Effect of Neuromuscular Training on Chemotherapy-Induced Neuropathy: A Randomized Clinical Trial. JAMA Intern Med. Published online July 01, 2024. doi:10.1001/jamainternmed.2024.2354.

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Metallic element mixtures in first trimester linked to increased preterm birth risk: Vanadium identified as key factor in new study

China: The impact of environmental factors on pregnancy outcomes continues to be a critical area of research, with a recent study shedding light on the effects of exposure to multiple metallic elements during the first trimester. Conducted by a team of researchers, the study aimed to investigate whether prenatal exposure to various metals influences the risk of preterm birth.

Exposure to metallic elements mixtures consisting of vanadium (V), arsenic (As), cobalt, nickel (Ni), manganese, and chromium in the first trimester was associated with an increased risk of preterm birth (PTB), and V was considered the most important factor in the mixtures in promoting PTB incidence. The findings were published online in Maternal & Child Nutrition on June 24, 2024. 

During pregnancy, exposure to metallic elements such as lead, mercury, cadmium, and arsenic can occur through various sources, including contaminated water, air pollution, and dietary intake. These elements are known to have toxic effects on human health and can potentially affect fetal development. However, limited studies focused on the effects of other metal mixtures.

To fill this knowledge gap, Yan-Ting Wu, Fudan University, Shanghai, China, and colleagues aimed to explore the relationship between maternal exposure level of the abovementioned six metallic elements detected in maternal plasma before 14 weeks of pregnancy and PTB risk in Shanghai, China by using four statistical methods. They also illustrated the non-linear relationship between metallic element exposure and gestational age.

For this purpose, the researchers performed a nested case-control study that enrolled 94 PTB cases and 282 controls. Metallic elements in maternal plasma collected during the first trimester were identified using inductively coupled plasma‒mass spectrometry. Researchers employed logistic regression, least absolute shrinkage and selection operator (LASSO), restricted cubic spline (RCS), quantile g computation (QGC), and Bayesian kernel machine regression (BKMR) to assess how maternal exposure influences the risk of preterm birth.

The study led to the following findings:

  • Arsenic (As) and vanadium (V) were positively associated with PTB risk in the logistic model, and V remains positively associated in the multi-exposure logistic model. QGC analysis determined V (69.42%) and nickel (Ni) (70.30%) as the maximum positive and negative contributors to the PTB risk, respectively.
  • BKMR models further demonstrated a positive relationship between the exposure levels of the mixtures and PTB risk, and V was identified as the most important independent variable among the elements.
  • RCS analysis showed an inverted U-shape effect of V and gestational age, and plasma V more than 2.18 μg/L was considered a risk factor for shortened gestation length.

The study revealed the significantly positive joint effect metal mixture comprising As, V, Ni, Co, Cr, and Mn on preterm birth by applying different statistical methods.

“We further confirmed that vanadium was the most important risk factor for PTB among the metal mixture, and maternal plasma concentration of V above 2.18 μg/L was considered a risk factor for shortened gestation length,” the researchers wrote.

“Further study is warranted to explore the underlying mechanism of V act on PTB occurrence,” they concluded.

Reference:

Wu, T., Luo, C., Li, T., Zhang, C., Chen, X., Mao, T., Wu, T., & Huang, F. Effects of exposure to multiple metallic elements in the first trimester of pregnancy on the risk of preterm birth. Maternal & Child Nutrition, e13682. https://doi.org/10.1111/mcn.13682

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