Gastric bypass may reduce CV risk independent of weight loss, suggests JAMA study

Gastric bypass may reduce CV risk independent of weight loss, suggests a study published in the JAMA Surgery. 

Roux-en-Y gastric bypass (RYGB) is associated with reduced cardiovascular (CV) risk factors, morbidity, and mortality. Whether these effects are specifically induced by the surgical procedure or the weight loss is unclear. A study was done to compare 6-week changes in CV risk factors in patients with obesity undergoing matching caloric restriction and weight loss by RYGB or a very low-energy diet (VLED). This nonrandomized controlled study (Impact of Body Weight, Low Calorie Diet, and Gastric Bypass on Drug Bioavailability, Cardiovascular Risk Factors, and Metabolic Biomarkers [COCKTAIL]) was conducted at a tertiary care obesity center in Norway. Participants were individuals with severe obesity preparing for RYGB or a VLED. Recruitment began February 26, 2015; the first patient visit was on March 18, 2015, and the last patient visit (9-week follow-up) was on August 9, 2017. Data were analyzed from April 30, 2021, through June 29, 2023.

Results Among 78 patients included in the analyses, the mean (SD) age was 47.5 (9.7) years; 51 (65%) were women, and 27 (35%) were men. Except for a slightly higher mean (SD) body mass index of 44.5 (6.2) in the RYGB group (n = 41) vs 41.9 (5.4) in the VLED group (n = 37), baseline demographic and clinical characteristics were similar between groups. Major atherogenic blood lipids (low-density lipoprotein cholesterol, non–high-density lipoprotein cholesterol, apolipoprotein B, lipoprotein[a]) were reduced after RYGB in comparison with VLED despite a similar fat mass loss. Mean between-group differences were −17.7 mg/dL (95% CI, −27.9 to −7.5), −17.4 mg/dL (95% CI, −29.8 to −5.0) mg/dL, −9.94 mg/dL (95% CI, −15.75 to −4.14), and geometric mean ratio was 0.55 U/L (95% CI, 0.42 to 0.72), respectively. Changes in glycemic control and blood pressure were similar between groups. This study found that clinically meaningful reductions in major atherogenic blood lipids were demonstrated after RYGB, indicating that RYGB may reduce CV risk independent of weight loss.

Reference:

Karlsson C, Johnson LK, Greasley PJ, et al. Gastric Bypass vs Diet and Cardiovascular Risk Factors: A Nonrandomized Controlled Trial. JAMA Surg. Published online July 03, 2024. doi:10.1001/jamasurg.2024.2162

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Intraoperative use of IV ketamine bests dexmedetomidine for analgesia among those operated under spinal anesthesia: Study

Intravenous sedation administered alongside spinal anesthesia offers benefits such as prolonged spinal anesthesia duration and improved postoperative pain management. In a recent prospective randomized double-blind controlled trial, the study aimed to compare the effect of intravenous bolus and infusion of dexmedetomidine versus ketamine on postoperative analgesia in fracture femur patients operated under subarachnoid block. The study enrolled 75 patients aged 18–65 years, randomly divided into three groups to receive ketamine, dexmedetomidine, or saline (control group). Postoperative pain was evaluated using the numerical rating scale (NRS), duration of analgesia, and analgesic consumption. The results showed that patients in the ketamine group had better postoperative analgesia with decreased pain on the NRS scale and reduced need for postoperative rescue analgesics. The duration of sensory block and motor block was prolonged in the ketamine group compared to the other two groups. The conclusion drawn from the study was that intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block. The background of the study highlighted the limitations of postoperative analgesia in patients undergoing orthopedic surgery and the importance of effective pain management for postoperative rehabilitation and quality of life. Multimodal analgesia was emphasized as the standard of care for postoperative pain management. The study design involved enrolling patients aged 18–65 years with fractured femurs and subjected to subarachnoid block. Dexmedetomidine and ketamine were administered intraoperatively, and postoperative outcomes were assessed, including pain scores, duration of analgesia, rescue analgesic consumption, and complications. The results indicated that ketamine was more effective than dexmedetomidine in providing postoperative analgesia, as evidenced by lower NRS scores and reduced need for rescue analgesics. This is consistent with previous studies on the analgesic efficacy of ketamine, also showing its effectiveness in prolonging the duration of analgesia and providing better postoperative pain relief. However, both drugs were found to be effective in postoperative pain management. The study also highlighted the safety and efficacy of ketamine in terms of sedation, as it resulted in a lower Richmond Agitation Sedation Scale (RASS) score compared to dexmedetomidine. The duration of sensory and motor block was also prolonged in the ketamine group, further emphasizing its effectiveness in postoperative pain management. In conclusion, the study demonstrated that intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block. The findings suggest the potential benefit of using ketamine for pain management in orthopedic surgeries, particularly for femur fractures under spinal anesthesia.

Key Points

– A prospective randomized double-blind controlled trial compared the effects of intravenous bolus and infusion of dexmedetomidine versus ketamine on postoperative analgesia in femur fracture patients operated under subarachnoid block.

– 75 patients aged 18–65 were randomly divided into three groups: ketamine, dexmedetomidine, and saline (control group). Pain was evaluated using the numerical rating scale (NRS), duration of analgesia, and analgesic consumption.

– Patients in the ketamine group had better postoperative analgesia with decreased pain on the NRS scale and reduced need for postoperative rescue analgesics. The duration of sensory and motor block was also prolonged in the ketamine group compared to the other two groups.

– The study highlighted the limitations of postoperative analgesia in orthopedic surgery patients and the importance of effective pain management for postoperative rehabilitation and quality of life. Multimodal analgesia was emphasized as the standard of care.

– Ketamine was found to be more effective than dexmedetomidine in providing postoperative analgesia, with lower NRS scores and reduced need for rescue analgesics. Both drugs were effective in postoperative pain management, but ketamine showed superiority.

– The study concluded that intraoperative use of intravenous ketamine was superior to dexmedetomidine for postoperative analgesia in fracture femur patients operated under subarachnoid block, suggesting the potential benefit of using ketamine for pain management in orthopedic surgeries, particularly for femur fractures under spinal anesthesia.

Reference –

Ather R, Nikhar SA, Kar AK, Durga P, Prasanna PL. Comparison of the effect of intraoperative dexmedetomidine versus ketamine on postoperative analgesia in fracture femur patients operated under subarachnoid block – A prospective randomized double‑blind controlled trial. J Anaesthesiol Clin Pharmacol 2024. DOI: 10.4103/joacp.joacp_67_23.

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Inadequate anticoagulation and hyperuricemia may cause knee pain after platelet-rich plasma injection: Study

A recent study provided strong evidence that platelet-rich plasma (PRP) therapy can delay the need for total knee replacement (TKR) in patients suffering from knee osteoarthritis (OA). However, the findings highlighted the importance of the preparation process, particularly the type and amount of anticoagulant used, which appears to significantly influence treatment outcomes.

The study retrospectively analyzed data from a total of 225 patients with knee OA who received PRP treatment between June 2021 and January 2022. The primary goal was to examine the relationship between the use of different anticoagulants in PRP preparation and the level of post-treatment pain experienced by patients. Also, the study evaluated the long-term efficacy of PRP treatment and identify other factors that might affect the success of therapy.

The patients were divided into groups based on the type and amount of anticoagulant used during the preparation of PRP. The groups included the individuals treated with varying doses of 4% sodium citrate (SC) (0.6 mL, 1 mL, and 2 mL) and heparin (0.1 mL and 0.2 mL). The research assessed pain levels after treatment, as well as the presence of inflammatory markers in the joint fluid like interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and hypersensitive C-reactive protein (hs-CRP).

These findings revealed that patients in the 4% SC 0.6 mL and heparin 0.1 mL groups reported less pain following PRP treatment when compared to the patients in the high-dose anticoagulant groups. The lower levels of inflammatory markers were found in the joint fluid of patients who underwent less pain. This suggested that higher doses of anticoagulants may exacerbate inflammation which could lead to increased discomfort post-treatment.

Moreover, the study highlighted that patients treated with sodium citrate (SC) generally showed better medium- and long-term outcomes when compared to the patients treated with heparin. It was also noted that the therapeutic effect of PRP gradually diminished over time, indicating that while PRP can delay the progression of knee OA.

Another significant finding was the impact of poorly controlled hyperuricemia on treatment outcomes. The patients with elevated uric acid levels experienced more pain following PRP therapy which suggested that underlying metabolic conditions could negatively influence the effectiveness of the treatment. Further research is required to fully understand the safety and efficacy of PRP therapy and to optimize its use in clinical practice.

Source:

Chen, Y., Sang, H., Wu, S., Zhang, H., Zhang, Y., & Li, H. (2024). Inadequate anticoagulation and hyperuricemia cause knee pain after platelet-rich plasma injection: A retrospective study. In Journal of Orthopaedic Surgery (Vol. 32, Issue 2). SAGE Publications. https://doi.org/10.1177/10225536241277604

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Could psychedelic-assisted therapy change addiction treatment?

After years of being seen as dangerous “party drugs,” psychedelic substances are receiving renewed attention as therapies for addiction-but far more research is needed, according to a new special series of articles in the Journal of Studies on Alcohol and Drugs, published at Rutgers University.

Psychedelics are substances that essentially alter users’ perceptions and thoughts about their surroundings and themselves. For millennia, indigenous cultures have used plants with psychedelic properties in traditional medicine and spiritual rituals. And for a time in the mid-20th century, Western researchers became interested in the potential for psychedelics to help treat a range of psychiatric conditions, including substance use disorders.

That research ground to a halt not long after it began, partly due to recreational use of drugs such as LSD (“acid”) and psilocybin (“magic mushrooms”) as well as the U.S. federal government’s so-called war on drugs.

Things have shifted in more recent years. Drugs such as psilocybin, ketamine and MDMA (“ecstasy”) are under study again, in what researchers call psychedelic-assisted therapy: In a nutshell, small doses of the drugs are given under medical supervision, in combination with conventional talk therapy.

As the JSAD series highlights, a collection of small clinical trials have tested psychedelic-assisted therapy for helping people with alcohol dependence, opioid addiction and certain other substance use disorders. There have been promising results, suggesting the approach can lead to higher abstinence rates than conventional therapy alone.

What really stands out is how fast psychedelic-assisted therapy can work versus the standard approach: Lasting benefits have been seen after just one to three treatment sessions.

“It really flips conventional substance use disorder treatment on its head,” said Dominique Morisano, Ph.D., of the University of Toronto’s Centre for Addiction and Mental Health.

On the surface, it might seem counterintuitive to treat addiction with a psychedelic drug, according to Morisano, who co-authored an editorial published with the series. But, she said, people with substance use disorders typically use drugs to “hide” from their troubling thoughts and feelings.

Psychedelic-assisted therapy, by contrast, seems to help “lift the veil” and allow people to have insights-“lightbulb moments”-that aid in their recovery, Morisano explained. Patients may, for example, have renewed feelings of self-efficacy that make it easier to adopt healthier behaviors and coping skills. No one knows exactly how psychedelics do this. One theory, Morisano said, is that they act via “neuroplasticity”-the brain’s ability to reorganize its wiring.

It’s clear that much more research is needed, according to Morisano. There are still basic questions, such as, Which psychedelics are effective for substance use disorders? Which protocols work best? That will take funding, she noted, which until now has mainly come from private sources, but government funding is just starting to open up more.

For now, Morisano stressed, people should understand that psychedelics are not a do-it-yourself treatment for substance abuse or mental health disorders: The psychotherapy component is crucial.

“A lot of people have been misled into thinking they can ‘microdose’ on their own,” Morisano said. “But you can’t wipe the psychotherapy out of this.”

Reference:

Dominique Morisano, Thomas F. Babor, Brian Rush,Doris Payer, From Research to Reality: Crafting an Image of the Current State of Psychedelic-Assisted Psychotherapies for Substance Use Disorders, Journal of Studies on Alcohol and Drugs, https://doi.org/10.15288/jsad.24-00208.

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Two-Year Study Affirms Safety and Efficacy of eCoin ITNS for Urgency Urinary Incontinence

USA: In a pivotal two-year study, the eCoin implantable tibial nerve stimulation (ITNS) system was validated as a safe and effective treatment for urgency urinary incontinence, a challenging condition affecting millions worldwide. This innovative therapy, designed to address overactive bladder symptoms, has shown remarkable consistency in both safety and efficacy, offering new hope for patients who have not found relief through traditional methods.

The findings, published in the Urology Journal, support it as an excellent treatment option for refractory patients.

Urgency urinary incontinence, characterized by a sudden and intense urge to urinate, is a common yet distressing condition that can significantly impact daily life. For patients who do not respond to conventional treatments such as medications or behavioral therapies, implantable tibial nerve stimulation presents a promising alternative. Therefore, Vincent Lucente, Hamilton Court Professional Center, Allentown, PA, and colleagues aimed to assess the ongoing effectiveness and safety of the eCoin ITNS for treating urgency urinary incontinence in patients with overactive bladder, the initial one-year pivotal study was extended to two years. The ITNS is a new and recently FDA-approved treatment option.

For this purpose, the researchers conducted a prospective, multicenter, single-arm trial involving 137 subjects with refractory urgency urinary incontinence to evaluate the effectiveness of eCoin ITNS therapy. Data collection included a 3-day voiding diary, an overactive bladder questionnaire, the Patient Global Impression of Improvement, and a custom Likert scale assessing subject satisfaction.

The primary efficacy measure was the proportion of subjects achieving at least a 50% reduction from baseline in the number of urgency urinary incontinence episodes. The primary safety measure focused on device-related adverse events.

The study revealed the following findings:

  • Sevent-two subjects completed the 96-week evaluation.
  • 78% experienced at least a 50% reduction in urgency urinary incontinence episodes; 48% experienced at least a 75% reduction, and 22% were dry on a 3-day diary.
  • Subjects reported a decrease from baseline in their urgency urinary incontinence episodes/day of 2.61 and 2.97 at 48 weeks and 96 weeks, respectively.
  • 91.3% did not require additional medications for overactive bladder.
  • No serious or unanticipated adverse events were reported in this extension phase.

The results of the two-year pivotal study highlight the sustained effectiveness and safety of the eCoin ITNS.

“This innovative, minimally-invasive device provides a long-lasting solution for the symptoms of urgency urinary incontinence, enhancing patient quality of life while reducing compliance burdens through its automatic therapy delivery,” the researchers wrote.

In conclusion, the two-year analysis of the eCoin ITNS system confirms its efficacy and safety, establishing it as a promising treatment for urgency urinary incontinence and potentially setting a new standard in managing this prevalent condition.

About eCoin ITNS System

The eCoin Implantable Tibial Nerve Stimulator system, designed to treat urgency urinary incontinence, is a coin-sized neurostimulator implanted just below the skin in the lower leg through a minimally invasive outpatient procedure using local anesthesia. It is the first subcutaneous tibial nerve stimulator to receive recent approval from the Food and Drug Administration.

Reference:

Lucente, V., Giusto, L., & MacDiarmid, S. (2024). Two-Year Pivotal Study Analysis of the Safety and Efficacy of Implantable Tibial Nerve Stimulation with eCoin® for Urgency Urinary Incontinence. Urology. https://doi.org/10.1016/j.urology.2024.07.046

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Three different fluoride varnishes demonstrate equal preventive effectiveness against early childhood caries: Study

Three different fluoride varnishes demonstrate equal preventive effectiveness against early childhood caries suggests a study published in the Journal of Dentistry.

A study was done to compare the effectiveness of two 5% sodium fluoride (NaF) varnishes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) (MI VarnishTM) or tricalcium phosphate (TCP) (ClinproTM White) to the conventional 5% NaF varnish (Duraphat®) in preventing early childhood caries (ECC) in high-risk preschool children. A double-blinded, randomized controlled trial recruited healthy 3–4-year-old children (N = 582) having at least one carious lesion (pre-cavitated or cavitated) after obtaining written informed consent from parents. Using a computer-generated random-number table, children were assigned to one of the 3 groups: Control group (n = 196): 5% NaF varnish (Duraphat®) or two test groups: 5% NaF with TCP (Clinpro™ White) (n = 193) and 5% NaF varnish with CPP-ACP (MI Varnish™) (n = 193) to receive quarterly (every 3 months) application over 24 months.

Results: Incidence of new caries over 2 years was 59.2% in MI Varnish™ group (n = 125), 65.1% in the Clinpro™ White group (n = 129) and 66.1% in the Duraphat® group (n = 127) (p = 0.466). The mean cavitated lesions increment was not significant among the 3 groups (p = 0.714), as was the mean increment in non-cavitated carious lesions (p = 0.223). There was no significant difference (p = 0.630) in the distribution of total fluoride varnish applications among the three groups. Also, no significant difference was found in comparison of outcomes among the different number of fluoride varnish applications received by children in each groups.

Both calcium- and phosphate-containing NaF varnishes showed similar efficacy against cavitated and non-cavitated carious lesions as compared to conventional NaF varnish in high-risk preschool children. Randomized trial provided a crucial opportunity to advance the understanding of the clinical effectiveness of different fluoride varnishes in preventing early childhood caries. Varnishes containing tricalcium phosphate or casein phosphopeptide amorphous calcium phosphate when compared to sodium fluoride varnish, demonstrated a similar efficacy against early childhood caries in high caries-risk preschool children.

Reference:

Sheetal Manchanda, Pei Liu, Divesh Sardana, Simin Peng, Edward CM Lo, Cynthia KY Yiu, Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries. Journal of Dentistry. Volume 147, 2024, 105141, ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2024.105141.

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Cell-Free DNA Testing Delivers 100% Accuracy for Early Fetal Genotyping for Alloimmunized Pregnancies: Study

USA: In a recent multicenter study, cell-free DNA analysis for fetal antigen genotyping in alloimmunized pregnancies demonstrated 100% concordance with neonatal genotype, affirming the reliability of the assay for clinical use. The findings were published online in Obstetrics & Gynecology on July 25, 2024.

“We found that cell-free DNA analysis is a highly effective tool for determining fetal red blood cell antigen genotypes in individuals with alloimmunized pregnancies. This breakthrough comes from a diverse cohort and highlights the test’s high sensitivity and specificity, even at just ten weeks of gestation,” the researchers wrote.

Alloimmunization occurs when a pregnant person’s immune system produces antibodies against fetal blood antigens that are different from their own, potentially leading to complications such as hemolytic disease of the newborn. Traditional methods for determining fetal antigen genotypes often involve invasive procedures or can be less accurate early in pregnancy. However, the new cell-free DNA analysis offers a non-invasive and reliable alternative.

Against the above background, Kenneth J. Moise, MD, Department of Obstetrics and Gynecology, Department of Women’s Health, Dell Medical School, Austin, TX, and colleagues assessed the accuracy of next-generation sequencing-based quantitative cell-free DNA analysis for fetal antigen genotyping in individuals with alloimmunized pregnancies, the study aims to evaluate its clinical use across practices in the United States. Conducted as early as 10 weeks of gestation, the objective is to identify pregnancies at risk for hemolytic disease of the fetus and newborn and to guide appropriate management strategies.

For this purpose, the researchers conducted a prospective cohort study involving patients with alloimmunized pregnancies who underwent clinical fetal antigen cell-free DNA analysis at 120 clinical sites between 10 0/7 and 37 0/7 weeks of gestation. The study included both the pregnant individuals and their resulting neonates.

The laboratory provided cell-free DNA results as part of routine clinical care. Following delivery, neonatal buccal swabs collected within 270 days of birth were sent to an independent laboratory for antigen genotyping. This external laboratory, blinded to the initial fetal cell-free DNA results, compared its findings with those from the fetal analysis. Concordance rates were reported for fetal antigen genotyping where the pregnant individual was alloimmunized, and for antigens where the pregnant individual was genotype negative.

The study led to the following findings:

  • One hundred fifty-six pregnant individuals who underwent clinically ordered cell-free DNA fetal antigen testing were provided neonatal buccal swabs for genotyping after delivery. The participant demographics were as follows: 15.4% Hispanic, 9.0% non-Hispanic Black, 65.4% non-Hispanic White, 4.5% Asian, 1.3% identified as more than one race or ethnicity, and 4.5% had unknown racial or ethnic backgrounds.
  • The median gestational age at the time of testing was 16.4 weeks, with a median fetal fraction of 11.1%.
  • Concordance between cell-free DNA analysis results and neonatal genotype was determined for 465 antigen calls for the following antigens: K1 (n=143), E (124), C (60), Fya (50), c (47), and D(RhD) (41). These 465 calls included 145 in which the fetus was antigen positive and 320 in which the fetus was antigen negative.
  • There was a complete concordance between prenatal fetal antigen cell-free DNA analysis results and neonatal genotypes for the 465 calls, resulting in 100% sensitivity, specificity, and accuracy.

In a diverse multicenter cohort, cell-free DNA analysis is highly sensitive and specific for determining fetal antigen genotypes as early as ten weeks of gestation in individuals with alloimmunized pregnancies.

“Combined with existing evidence, this study advocates for the adoption of cell-free DNA testing in managing alloimmunized pregnancies across the United States,” the researchers concluded.

Reference:

Rego, Shannon MS; Ashimi Balogun, Olaide MD; Emanuel, Kirsten MS, FNP; Overcash, Rachael MD; Gonzalez, Juan M. MD, PhD; Denomme, Gregory A. PhD; Hoskovec, Jennifer MS; King, Haley MS; Wilson, Ashley MS; Wynn, Julia MS, MS; Moise, Kenneth J. Jr MD. Cell-Free DNA Analysis for the Determination of Fetal Red Blood Cell Antigen Genotype in Individuals With Alloimmunized Pregnancies. Obstetrics & Gynecology ():10.1097/AOG.0000000000005692, July 25, 2024. | DOI: 10.1097/AOG.0000000000005692

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Platelet count and Ca-125 levels correlate in ovarian cancer patients prior to treatment: Study

Ovarian cancer is the second leading cause of gynaecologic
cancer deaths worldwide, trailing only cervical cancer. It is the most fatal of
all gynaecological cancers, with nearly two-thirds of patients diagnosed in the
advanced stage. Ovarian cancer has a 5-year overall survival rate of around
48%. The prognosis varies depending on the stage, histologic type, and
sensitivity to chemotherapy. It is the leading cause of gynaecologic cancer
deaths in most developed countries, with a lifetime risk of 1 in 70.

Cancer antigen 125 (Ca-125) is currently used as an adjunct
to ovarian cancer diagnosis, prognosis, and monitoring. Platelet (PLT) count
and Ca-125 levels are both prognostic markers in ovarian cancer that are linked
to inflammation and immune evasion. To determine the relationship between
pre-operative platelet count and serum Ca125 level, and their diagnostic
accuracy for the prediction of stage IV epithelial ovarian cancer, a study was
carried out by Alegbeleye and John.

The study included forty-two women with histologic diagnosis
of epithelial ovarian cancer managed at the University of Port Harcourt
Teaching Hospital between January 1, 2016, and December 31, 2020. Following
informed consent, a data collection form was used to obtain sociodemographic
and clinical characteristics. Pretreatment levels of Cancer Antigen 125
(Ca-125) and Platelets count (PLT) were determined from blood samples.

The sample median platelet count was 308 (307) x 109 /L and
median Ca-125 was 286µ/ml (397).

Pre-operative platelets count was significantly associated
with Ca-125 (rho= 0.28 p-value = 0.03). Ca-125 had a statistically significant
relationship with ovarian cancer histology (X2:19.522; p-value 0.001).

PLTCa-125 (0.51) and PLT only (0.29) had a statistically
significant positive correlation with ovarian cancer stage (p 0.001). Since it
had an area under the curve (AUC) greater than 0.7, PLT-Ca-125 can be used as a
predictive model to correctly stage patients with epithelial ovarian cancer.
Ca-125 level (z:-2.24; p-value = 0.025) was significantly associated with
thrombocytosis in ovarian cancer patients

Despite new chemotherapeutic, surgical, and other auxiliary
treatments, the 5-year survival rate in malignant ovarian tumours remains low.
Thus, early detection and treatment are critical for extending the life and
improving the quality of life of women with epithelial ovarian cancer. As a
result, researchers are constantly looking for new markers for the early
detection of malignant ovarian tumours.

In the study, predictive models were developed using ROC
curve analysis on PLT alone and PLT-Ca-125 against stage IV ovarian cancer as
an outcome. PLT-Ca-125 and tumour stage were found to have a strong positive
correlation. This implies that, when compared to both markers alone, PLT-Ca-125
can be used to correctly stratify patients. As a result, it could be a useful
marker in predicting advanced-stage disease. Furthermore, because this is a
pilot study among women with epithelial ovarian cancer in Nigeria’s southern
region, the preliminary data collected will serve as the foundation for a
larger future longitudinal study.

Source: Alegbeleye and John / Indian Journal of Obstetrics
and Gynecology Research 2024;11(1):17–23; https://doi.org/10.18231/j.ijogr.2024.004

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Pregnancy Complications More Likely in Women with Anorexia Nervosa: finds Study

USA: Pregnant individuals diagnosed with anorexia nervosa face a heightened risk of adverse live-born outcomes compared to those without an eating disorder diagnosis, according to recent research. This increased risk highlights the critical need for targeted interventions and careful management for those affected.

The study, published in the American Journal of Obstetrics and Gynecology, reveals that anorexia nervosa during pregnancy is associated with several significant adverse outcomes. These include a higher likelihood of preterm birth, low birth weight, and other complications that can affect both the mother and the baby. However, adjusting for factors such as anxiety, depression, substance use, and smoking during pregnancy reduces but does not eliminate this risk.

Moreover, a significant portion of the increased risk of adverse outcomes was attributed to an underweight body mass index (BMI) before pregnancy, while an even greater proportion of the risk was linked to inadequate gestational weight gain.

Previous research on the link between anorexia nervosa and adverse pregnancy outcomes has produced varied results. Considering this, Rebecca J. Baer, California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, and colleagues aimed to examine the link between anorexia nervosa and adverse live-born pregnancy outcomes by using adjustment modeling to account for confounding factors. Additionally, it included a mediation analysis to assess how underweight pre-pregnancy body mass index and inadequate gestational weight gain contribute to these outcomes.

The study analyzed data from California live-born singletons between 2007 and 2021, using birth certificates and linked hospital discharge records to identify pregnancies with anorexia nervosa via ICD codes. It assessed a range of adverse pregnancy outcomes, including gestational diabetes, preeclampsia, and preterm birth, using Poisson regression models to calculate risks. These risks were first analyzed unadjusted, then adjusted for demographic factors, and further refined to account for anxiety, depression, substance use, and smoking. Mediation analysis was conducted to determine how much of the risk was influenced by underweight pre-pregnancy BMI and inadequate gestational weight gain.

The study led to the following findings:

  • The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis.
  • A diagnosis of anorexia nervosa during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis.
  • In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55).
  • Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational-age infants.
  • Gestational weight gain below the recommendation mediated 38.89% of the excess in preterm births and 40.44% of the excess in low-birthweight infants.

“The findings are crucial for clinicians managing patients with anorexia nervosa. Addressing anorexia nervosa along with any comorbid conditions and providing guidance on preconception weight and gestational weight gain can potentially enhance pregnancy outcomes for individuals with this disorder,” the researchers concluded.

Reference:

Baer, R. J., Bandoli, G., Jelliffe-Pawlowski, L. L., Rhee, K. E., & Chambers, C. D. (2024). Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. American Journal of Obstetrics and Gynecology, 231(2), 248.e1-248.e14. https://doi.org/10.1016/j.ajog.2023.11.1242

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Increased mental illnesses incidence linked to severe COVID-19, especially in unvaccinated people, finds Study of 18 million people

A new study that examined health data on 18 million people reveals higher incidence of mental illnesses for up to a year following severe COVID-19 in unvaccinated people. Vaccination appeared to mitigate the adverse effects of COVID-19 on mental illnesses. The University of Bristol-led study, published in JAMA Psychiatry investigated associations of COVID-19 with mental illnesses according to time since diagnosis and vaccination status.

COVID-19 is associated with mental illnesses in both hospital and population-based studies. However, until now, there was limited evidence about the association of COVID-19 with mental illnesses when individuals had received COVID-19 vaccination.

A cross-institution team, including researchers from University of Bristol Medical School, University College London (UCL), University of Oxford, University of Cambridge and Swansea University Medical School, sought to answer this by analysing the medical records of 18,648,606 adults aged between 18 and 110 years and registered with a GP in England.

Among the 18,648,606 adults in the cohort studied during the period before vaccination was available, the average age was 49 years, 50.2 per cent were female (9,363,710) and 1,012,335 adults had a confirmed COVID-19 diagnosis (recorded in testing data, by a GP, in hospital or in their death record).

The authors also studied a vaccinated cohort including 14,035,286 adults, of whom 866,469 had a confirmed COVID-19 diagnosis, with an average age of 53 years and 52.1 per cent female (7,308,556), and an unvaccinated cohort including 3,242,215 adults, of whom 149,745 had a confirmed COVID-19 diagnosis, with an average age of 35 years and 42.1 per cent female (1,363,401).

Using these data, the researchers compared the incidence of mental illnesses in people before and after a COVID-19 diagnosis, in each cohort. Mental illnesses included in this study comprised depression, serious mental illness, general anxiety, post-traumatic stress disorder, eating disorders, addiction, self-harm, and suicide.

The team found that the incidence of most of these conditions was higher one to four weeks after COVID-19 diagnosis, compared to the incidence before or without COVID-19. This elevation in the incidence of mental illnesses, was mainly seen after severe COVID-19 that led to hospitalisation and remained higher for up to a year following severe COVID-19 in unvaccinated people.

The elevation in incidence of mental illnesses was mainly after severe COVID-19 that led to hospitalisation, with little elevation after COVID-19 that did not lead to hospitalisation. For instance, the incidence of depression after non-hospitalised COVID-19 was up to 1.22 times higher than that before or without COVID-19, while the incidence of depression after hospitalised COVID-19 was up to 16.3 times higher than that before or without COVID-19. In the vaccinated cohort, the incidence of depression after non-hospitalised COVID-19 was similar to that before or without COVID-19.

The findings add to a growing body of evidence highlighting the higher risk of mental illnesses following COVID-19 diagnosis, and the benefits of vaccination in mitigating this risk, with stronger associations found in relation to more severe COVID-19 disease, and longer-term associations relating mainly to new-onset mental illnesses.

Dr Venexia Walker, Senior Research Fellow in Epidemiology at Bristol Medical School: Population Health Sciences (PHS) and MRC Integrative Epidemiology Unit at the University of Bristol, and one of the study’s lead authors, said: “Our findings have important implications for public health and mental health service provision, as serious mental illnesses are associated with more intensive healthcare needs and longer-term health and other adverse effects.

“Our results highlight the importance COVID-19 vaccination in the general population and particularly among those with mental illnesses, who may be at higher risk of both SARS-CoV-2 infection and adverse outcomes following COVID-19.”

Jonathan Sterne, Professor of Medical Statistics and Epidemiology at the University’s Bristol Medical School: PHS, Director of the NIHR Bristol Biomedical Research Centre, and one of the study’s authors, added: “We have already identified associations of COVID-19 with cardiovascular disease, diabetes and now mental illnesses. We are continuing to explore the consequences of COVID-19 with ongoing projects looking at associations of COVID-19 with renal, autoimmune and neurodegenerative conditions.”

Reference:

Walker VM, Patalay P, Cuitun Coronado JI, et al. COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People. JAMA Psychiatry. Published online August 21, 2024. doi:10.1001/jamapsychiatry.2024.2339

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