Ferromagnetic/paramagnetic orthodontic wires may create artefacts during MRI due to local alteration of magnetic field homogeneity: Study

Ferromagnetic/paramagnetic orthodontic wires may create artefacts during MRI due to local alteration of magnetic field homogeneity suggests a study published in the Dentomaxillofacial Radiology.

A study was done to evaluate magnetic susceptibility artefacts produced by orthodontic wires on MRI and the influence of wire properties and MRI image sequences on the magnitude of the artefact. Arch form orthodontic wires [four stainless steels (SS), one cobalt chromium (CC) alloy, 13 titanium (Ti) alloys] were embedded in a polyester phantom, and scanned using a 1.5-T superconducting magnet scanner with an eight-channel phased-array coil. All wires were scanned with T1-weighted spin echo (SE) and gradient echo (GRE) sequences according to the American Society for Testing and Materials (ASTM) F2119-07 standard. The phantom also scanned other eight sequences. Artefacts were measured using the ASTM F2119-07 definition and OsiriX software. Artefact volume was analysed according to metal composition, wire length, number of wires, wire thickness, and imaging sequence as factors. Results: With SE/GRE, black/white artefacts volumes from all SS wires were significantly larger than those produced by CC and Ti wires (P < .01). With the GRE, the black artefacts volume was the highest with the SS wires. With the SE, the black artefacts volume was small, whereas white artefacts were noticeable. The cranio-caudal extent of the artefacts was significantly longer with SS wires (P < .01). Although a direct relationship of wire length, number of wires, and wire thickness with artefact volume was noted, these factors did not influence artefact extension in the cranio-caudal direction. Ferromagnetic/paramagnetic orthodontic wires create artefacts due to local alteration of magnetic field homogeneity. The SS-type wires produced the largest artefacts followed by CC and Ti.

Reference:

Yuri Iwamoto, Hiroaki Shimamoto, Doaa Felemban, Tomoyuki Terai, Sven Kreiborg, Sanjay M Mallya, Fan-pei Gloria Yang, Chihiro Tanikawa, Shumei Murakami, MRI susceptibility artefacts caused by orthodontic wire, Dentomaxillofacial Radiology, 2024;, twae023, https://doi.org/10.1093/dmfr/twae023

Keywords:

Yuri Iwamoto, Hiroaki Shimamoto, Doaa Felemban, Tomoyuki Terai, Sven Kreiborg, Sanjay M Mallya, Fan-pei Gloria Yang, Chihiro Tanikawa, Shumei Murakami,MRI, orthodontic wire, magnetic susceptibility, artefacts, image sequences, Dentomaxillofacial Radiology

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Frequent COPD Exacerbations Linked to Increased Risk of Heart Attack and Pulmonary Embolism: Study

Researchers have found out that in patients with frequent acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) raise the risk of myocardial infarction and pulmonary embolism. A study performed on this subject was published in the Chest journal by Oskar Wallstrom and colleagues. A large real-life cohort study from Sweden showed that exacerbation history directly impacts the long-term risk of these cardiovascular events and is associated with a higher risk. The study underlines the fact that the management of exacerbations in COPD patients is not only crucial for the control of respiratory symptoms but also for mitigating cardiovascular risks.

Acute exacerbations of COPD are established inciting factors for further worsening of respiratory function; however, increasing evidence suggests that these events are also related to heightened cardiovascular risk. Cardiovascular disease (CVD) and pulmonary embolism (PE) present significant complications in COPD patients, and the need to clarify the relationship between frequency of exacerbation and cardiovascular outcomes is posed.This study examined whether increasing numbers and greater severity of exacerbations were associated with a long-term increased risk of myocardial infarction (MI) and PE.

This study used data from the Swedish National Airway Register and included 66,422 patients aged 30 years or older with a main COPD diagnosis from January 2014 through June 2022. Only patients with complete data on lung function at baseline were included in the cohort. AECOPDs before the index date were classified as moderate, requiring oral corticosteroids, or severe, requiring hospitalization, based on the year before the index date. Patients were followed up until December 2022, with more than 265 000 patient-years of data and a maximum follow-up of nine years.

The primary outcome variables of interest were hospitalized or fatal MI and PE. We calculated subdistribution hazard ratios with 95% confidence intervals using competing-risk regression adjusted for confounders.

Key Findings

  • The study found a clear and gradual increase in the risk of MI and PE with both the number and severity of exacerbations.

Compared to patients with no exacerbations in the baseline period:

  • Patients with one moderate exacerbation had a 10% increased risk of MI (SHR 1.10, 95% CI: 0.97-1.24) and a 33% increased risk of PE (SHR 1.33, 95% CI: 1.11-1.60).

  • In patients with two or more severe exacerbations, the risks increased to 82% for MI with an SHR of 1.82, 95% CI: 1.36–2.44, and to 162% for PE with an SHR of 2.62.

  • Sensitivity analysis showed that risk was highest in the first year following an exacerbation, with a subsequent decrease in associated strength over time. Therefore, it would seem that recent exacerbations have a more immediate impact on cardiovascular events.

  • Given the large sample size and long-term follow-up in a real-world setting, increased reliability means its conclusions like shifting to a greater importance of monitoring frequency of exacerbations in clinical practice can be applied.

These findings accentuate how important exacerbation management is in the care of patients with COPD for respiratory health and prevention of serious cardiovascular events, such as MI and PE. A graded increase in risk with exacerbation severity and frequency suggests that patients who have experienced multiple severe exacerbations are at especially high risk and might benefit from targeted cardiovascular prevention strategies.

This large cohort study demonstrates that in patients with COPD, frequent and severe AECOPDs are correlated with a significantly increased risk for MI and PE. These findings call for comprehensive management strategies oriented toward both pulmonary and cardiovascular health in this vulnerable population.

Reference:

Wallström, O., Stridsman, C., Lindberg, A., Nyberg, F., & Vanfleteren, L. E. G. W. (2024). Exacerbation history and risk of myocardial infarction and pulmonary embolism in chronic obstructive pulmonary disease. Chest. https://doi.org/10.1016/j.chest.2024.07.150

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Breakthrough Brain-Computer Interface may Restore Conversational Speech among ALS Patients: NEJM

UK: A brain-computer
interface (BCI) surgically implanted in a 45-year-old man with amyotrophic
lateral sclerosis (ALS) and severe dysarthria worked well enough to swiftly
restore conversational speech, according to research published in the New
England Journal of Medicine on August 14, 2024.

Amyotrophic lateral
sclerosis (ALS), sometimes known as ALS, is a neurological illness that
destroys nerve cells in the brain and spinal cord. ALS leads to loss of
muscular control. Muscle twitching and weakness in an arm or leg, as well as
difficulty swallowing or slurred speech, are common early signs of ALS. ALS
eventually impairs control of the muscles required to move, speak, eat, and
breathe. There is no cure for this deadly condition. Nicholas S. Card, From
the Departments of Neurological Surgery, Boston, et.al report the result of
decoding the neural cortical activity of a 45-year-old man.

For the conduction of the
research, a 45-year-old man with
amyotrophic lateral sclerosis, tetraparesis, and severe dysarthria, had
four microelectrode arrays surgically implanted into his left ventral
precentral gyrus 5 years after the disease began; these arrays recorded neural
activity from 256 intracortical electrodes.

The Decoded phrases were
shown on a screen before being vocalized using text-to-speech software that
mimicked his pre-ALS voice.

They revealed that on the first day of use (25
days after surgery), the neuroprosthesis obtained 99.6% accuracy with a 50-word
vocabulary. Calibration of the neuroprosthesis involved 30 minutes of brain
recordings while the person spoke, followed by processing. After 1.4 hours of
system training on the second day, the neuroprosthesis achieved 90.2% accuracy
with a vocabulary of 125,000 words. The neuroprosthesis maintained 97.5%
accuracy after 8.4 months of usage, allowing for self-paced discussions at a
rate of 32 words per minute for over 248 hours.

“After brief training, an
intracortical speech neuroprosthesis performed well enough to restore
conversational communication in a person with ALS and severe dysarthria”,
researchers concluded.

Reference

Elizabeth G. Phimister, Edward
F. Chang, Brain-Computer Interfaces for Restoring Communication, New
England Journal of Medicine, 391, 7, (654-657), (2024)./doi/full/10.1056/NEJMe2407363

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Constipation significant risk factor for major cardiac events finds new study

An international study led by Monash University researchers has found a surprising connection between constipation and an increased risk of major adverse cardiac events (MACE), including heart attacks, strokes and heart failure.

The study, led by Professor Francine Marques from the School of Biological Sciences and published in the American Journal of Physiology-Heart and Circulatory Physiology analysed data from over 400,000 participants in the UK Biobank.

“Our study suggests that constipation, a common yet often overlooked health issue, may be a significant contributor to cardiovascular disease,” said Professor Marques.

“Traditional cardiovascular risk factors such as high blood pressure, obesity and smoking have long been recognised as key drivers of heart disease,” she said.

“However, these factors alone do not fully explain the occurrence of major cardiac events.”

“This study explored the potential role of constipation as an additional risk factor, revealing concerning results.”

The research team analysed data from 408,354 individuals, identifying 23,814 cases of constipation.

The findings showed that individuals suffering from constipation were more than twice as likely to suffer from a major cardiac event as those without constipation.

Moreover, the study highlighted a particularly concerning link between constipation and hypertension.

Hypertensive individuals who also suffered from constipation were found to have a 34 per cent increased risk of subsequent cardiac events compared to those with hypertension alone.

“Our research suggests that constipation may exacerbate the cardiovascular risks associated with high blood pressure, further increasing the likelihood of heart attacks and strokes,” Professor Marques said.

In addition to these epidemiological findings, the study also explored the genetic links between constipation and cardiovascular disease. “Positive genetic correlations were identified between constipation and various forms of MACE, indicating that shared genetic factors may underlie both conditions. This discovery opens new avenues for research into the underlying mechanisms that connect gut health and heart health,” Dr Leticia Camargo Tavares, co-first author of the study, explained.

“The implications of this study are far-reaching,” Professor Marques said.

“With constipation affecting an estimated 14 per cent of the global population, particularly older adults and women, these findings suggest that a significant portion of the population may be at an increased risk of cardiovascular disease due to their bowel health,” she said.

The study authors emphasised the need for further research to explore the causal relationship between constipation and MACE and to identify the specific biological pathways involved. One of these mechanisms may be via a ‘leaky gut’. The team is recruiting participants to answer this question (www.marqueslab.com/gut).

This research challenges the traditional understanding of cardiovascular risk factors and underscores the importance of considering gut health in the prevention and management of heart disease. As the global burden of cardiovascular disease continues to rise, these findings could pave the way for new strategies in personalised medicine, helping to identify individuals at higher risk and potentially reducing the incidence of life-threatening cardiac events.

Reference:

Tenghao Zheng,Leticia Camargo Tavares,Mauro D’Amato, andFrancine Z. Marques, Constipation is associated with an increased risk of major adverse cardiac events in a UK population, American Journal of Physiology-Heart and Circulatory Physiology, https://doi.org/10.1152/ajpheart.00519.2024.

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Uric Acid Levels Associated with Bipolar Disorder and Major Depression, States study

A recent study found the potential role of the purinergic system in the pathophysiology of mood disorders, specifically Bipolar Affective Disorder (BPAD) and Major Depressive Disorder (MDD). This system involves purines like uric acid and could be crucial in understanding the biological underpinnings of these conditions. The study highlighted that increased uric acid levels might significantly impact behaviors in individuals with BPAD and MDD.

This study investigated the relationship between blood uric acid levels and mental health conditions by focusing on BPAD subtypes (manic and depressive) and MDD. Also, the study examined how blood uric acid levels change following treatment and assessed the effectiveness of different treatment approaches in reducing these levels.

The individuals with a confirmed diagnosis of BPAD (either manic or depressive) or MDD according to the International Classification of Diseases (ICD-10) were included in the study. Uric acid levels were measured at the beginning and at follow-up intervals. The study employed standardized rating scales to monitor symptom severity using the Young Mania Rating Scale (YMRS) for manic symptoms and the Hamilton Rating Scale for Depression (HAM-D) for depressive symptoms. And a treatment response was defined as a 50% reduction in the initial scores on these scales. To analyze the data, the research used ANOVA to compare the 3 patient groups and paired sample t-tests to examine changes in uric acid levels before and after treatment.

The findings of this study revealed a significant positive correlation between the severity of mood disorder symptoms and serum uric acid levels across all 3 patient groups which were BPAD-mania, BPAD-depression, and MDD. Among these, the patients with BPAD-mania expressed the highest uric acid levels, averaging 5.2±0.9 mg/dL, followed by the individuals with BPAD-depression at 4.8±1.0 mg/dL, and MDD patients at 4.0±1.1 mg/dL.

Following treatment, a marked reduction in uric acid levels was observed across all the groups. BPAD-mania and BPAD-depression patients both experienced a decrease of 3.1 mg/dL, while MDD patients underwent a slightly greater reduction of 3.5 mg/dL. Also, while this reduction was strongly correlated with illness severity in BPAD-mania patients, such a correlation was not observed in BPAD-depression or MDD patients. The study found that different mood stabilizers like lithium carbonate, sodium valproate and carbamazepine, were equally effective in reducing serum uric acid levels, irrespective of the specific medication used. Overall, the findings suggest that dysfunction in the purine system might be a key factor in the development and progression of BPAD.

Source:

Immanuel, S., Kaki, A., Jetty, R. R., Vupputuri, S. M., K V, R., & R, A. S. (2024). Uric Acid as a Biomarker for Mood Disorders: A Comparative Study of Blood Uric Acid Levels Correlating With the Symptom Severity and Treatment Response. In Cureus. Springer Science and Business Media LLC. https://doi.org/10.7759/cureus.66784

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Nemolizumab: New Effective Drug for Management of Atopic Dermatitis, Study Finds

USA: Nemolizumab,
a newly developed medication for atopic dermatitis, is effective when combined
with topical corticosteroids (TCS) or topical calcineurin inhibitors (TCI), a
recent randomized control trial has shown. 

The trial report published in The Lancet Journal, suggests Nemolizumab
when used in combination with TCS and TCI has shown to be effective and there have
been significant clinical improvements in reducing inflammation and itch in
both adults and adolescents with moderate-to-severe atopic dermatitis.

Atopic dermatitis is a chronic, itchy inflammatory
skin disease commonly affecting children resulting in significant morbidity and
greatly affecting the quality of life. Nemolizumab, an interleukin (IL)-31 receptor inhibitor has recently been
introduced to manage atopic dermatitis, and a phase 3 clinical trial was
conducted to assess its efficacy and safety.

For this purpose, Jonathan I Silverberg, Department of
Dermatology, George Washington University School of Medicine and Health Sciences,
Washington, DC, USA, and colleagues organized ARCADIA
1 and ARCADIA 2, a double-blind, placebo-controlled phase 3 trials in
adult and adolescent participants, aged ≥12 years with moderate-to-severe
atopic dermatitis, associated pruritus, and inadequate response to topical
steroids.

Participants from 281 clinics, hospitals, and academic
centers in 22 countries were enrolled in both trials. They were randomly
assigned in a 2:1 ratio to receive either nemolizumab 30 mg subcutaneously
(with a baseline loading dose of 60 mg) or a matching placebo every 4 weeks.
This treatment was given alongside background topical corticosteroids (TCS)
with or without topical calcineurin inhibitors (TCI).

Both study staff and participants were blinded
throughout the study, with outcome assessors remaining blinded until the
database was locked. Coprimary endpoints at week 16 post-baseline were Investigator’s
Global Assessment (IGA) success (score of 0 [clear skin] or 1 [almost clear
skin] with a ≥2-point improvement from baseline) and at least 75% improvement
in Eczema Area and Severity Index score from baseline (EASI-75 response).

Outcome rates were compared between groups with
the Cochran–Mantel–Haenszel test adjusting for randomisation strata.

Efficacy analyses were done on
an intention-to-treat basis; safety analyses included all participants who
received one dose of nemolizumab or placebo.

The study reveals the following
findings:

  • Both trials achieved the co-primary endpoints.
    At week 16, a higher proportion of participants receiving nemolizumab plus
    TCS–TCI achieved IGA success compared to those receiving placebo plus TCS–TCI
    (ARCADIA 1: 221 [36%] of 620 vs 79 [25%] of 321, with an adjusted percentage
    difference of 11.5%, ARCADIA 2: 197 [38%] of
    522 vs 69 [26%] of 265, adjusted difference 12·2%)
  • EASI-75 response (ARCADIA 1: 270 [44%] vs 93
    [29%], adjusted difference 14·9%, ARCADIA 2: 220 [42%] vs 80
    [30%], adjusted difference 12·5%)
  • Nemolizumab demonstrated significant benefits
    across all key secondary endpoints, including itch improvement as early as week
    1 and sleep improvement by week 16.
  • The safety profile was similar between nemolizumab plus
    TCS–TCI and placebo plus TCS–TCI.
  • 306 participants in ARCADIA 1 and 215 participants
    ARCADIA 2 who received nemolizumab plus TCS–TCI had at least one
    treatment-emergent adverse event.
  • 146 participants in ARCADIA 1 and 117 participants
    ARCADIA 2 who received placebo plus TCS–TCI had at least one treatment-emergent
    adverse event.
  • In
    ARCADIA 2, ten serious treatment-emergent adverse events potentially related to
    nemolizumab were reported in five (1%) participants. No deaths were reported.

“Nemolizumab demonstrates improvements in inflammation
and itch in adults and adolescents with moderate-to-severe atopic dermatitis. If approved, nemolizumab could
provide a valuable addition to existing therapies,” said the researchers.

Reference: Silverberg JI, Wollenberg A, Reich A, Thaçi D,
Legat FJ, Papp KA, Stein Gold L, Bouaziz JD, Pink AE, Carrascosa JM, Rewerska
B, Szepietowski JC, Krasowska D, Havlíčková B, Kalowska M, Magnolo N, Pauser S,
Nami N, Sauder MB, Jain V, Padlewska K, Cheong SY, Fleuranceau Morel P, Ulianov
L, Piketty C; ARCADIA 1 and ARCADIA 2 Study Investigators. Nemolizumab with
concomitant topical therapy in adolescents and adults with moderate-to-severe
atopic dermatitis (ARCADIA 1 and ARCADIA 2): results from two replicate,
double-blind, randomised controlled phase 3 trials. Lancet. 2024 Aug
3;404(10451):445-460. doi: 10.1016/S0140-6736(24)01203-0. Epub 2024 Jul 24.
PMID: 39067461.

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Pregnant women vaccinated against Covid-19 less likely to have caesarean section or hypertension: BMJ

Pregnant women who have been vaccinated against Covid-19 are less likely to have a caesarean section or experience hypertension, according to a study.

A meta-analysis funded by the National Institute for Health and Care Research Birmingham Biomedical Research Centre of 67 studies which included more than 1.8m women found that being fully vaccinated against COVID-19 had a protective benefit against infection and hospitalisation, while vaccination with at least one dose lowered the risk of adverse pregnancy-related and neonatal outcomes.

Drawing on data from December 2019 to January 2023, the PregCOV study published in BMJ Global Health assessed evidence from global studies to evaluate the effectiveness of COVID vaccinations for pregnant women, who had increased risks associated with the virus.

The study found that women involved in the studies who had been fully vaccinated had a 61% reduction in the likelihood of getting COVID, and 94% reduced odds of hospital admission. Moreover, the meta-analysis suggests that vaccination leads to a 9% reduction in caesarean section risk, 12% reduction in hypertensive disorders in pregnancy; and an 8% reduction in the risk of intensive care unit admission for newborn babies born to vaccinated mothers.

Professor Shakila Thangaratinam, Dame Hilda Lloyd Chair of Maternal and Perinatal Health at the University of Birmingham and lead author of the PregCOV study said:

“Our findings show how beneficial the vaccination programme against COVID-19 has been for pregnant women. As well as the expected benefits from reduced infections, we have also seen a significant reduction in pregnancy complications including hypertension and caesarean sections. This underlines the importance of a systems approach to maternal health and the need to ensure that future healthcare policy, including pandemic preparedness, takes into account how connected natal care is for our healthcare.

“Pregnant women were unfortunately neglected during the heights of the COVID-19 pandemic, especially when it came to a robust understanding of the impact of vaccinations for expectant mothers. PregCOV was launched during the pandemic to conduct a series of reviews to pull together the best evidence possible to support informed policy making for pregnant and postnatal women.”

Evidence from the meta-analysis of studies has been able to draw robust conclusions about the reduction in risk of several pregnancy-related conditions, including less common outcomes such as neonatal intensive care unit admissions.

The research team however note that there have been too few cases and studies relating to adverse impacts such as thrombotic events or Guillan Barre syndrome from COVID-19 vaccination to draw any meaningful results, and that cases of several known impacts are very low. In addition, the team note that studies have drawn on evidence across multiple waves of the COVID-19 pandemic and weren’t able to differentiate potential changes in the effects caused by new variants of concern.

Reference:

Fernández-García S, del Campo-Albendea L, Sambamoorthi D on behalf of the PregCOV-19 Living Systematic Review Consortium, et alEffectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysisBMJ Global Health 2024;9:e014247.

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Cardiac Surgery in Pregnancy: Pre-Surgery Cesarean Could Minimize Fetal Mortality, Study Reveals

USA: In a groundbreaking study, researchers from the renowned Mayo Clinic have analyzed the safety and outcomes of cardiac surgeries performed on pregnant women over a 40-year period. The study, published in The Annals of Thoracic Surgery, sheds light on the complexities and advancements in managing cardiac conditions during pregnancy, offering hope and valuable insights for expectant mothers facing heart surgery.

The study revealed that cardiac surgery during pregnancy was linked to low rates of maternal mortality but notably higher fetal mortality.

“This extensive single-institution study suggests that performing a cesarean delivery before initiating cardiopulmonary bypass procedures—provided the fetus is of viable gestational age—could be a beneficial strategy to reduce fetal mortality,” the researchers wrote.

Cardiac surgery during pregnancy is a delicate and rare scenario, with only a few centers worldwide specializing in such procedures. Kathleen A. Young, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA, and colleagues aimed to characterize maternal and fetal outcomes during pregnancy using cardiopulmonary bypass.

For this purpose, the researchers performed a retrospective review of all pregnant women who underwent cardiac surgery utilizing cardiopulmonary bypass at a single center from 1978 to 2023. A descriptive statistical analysis reported medians for continuous variables and incidence rates for dichotomous variables.

The study led to the following findings:

  • Twenty-nine pregnant patients with a median age of 28 years underwent cardiac surgery using cardiopulmonary bypass at a median gestation of 25 weeks.
  • Surgery was performed in the 1st trimester for 10%, 2nd trimester for 55%, and 3rd trimester for 35% of patients; 52% were emergent and 48% were urgent procedures.
  • There was one (3%) maternal death two days after mechanical aortic valve thrombectomy and 17% fetal losses.
  • Fourteen patients who underwent cardiac surgery using cardiopulmonary bypass with continuing pregnancy experienced a 29% fetal mortality rate, and seven patients underwent delivery before surgery and experienced 14% fetal mortality.
  • Among cases of fetal loss, surgery was performed at a median of 25 weeks compared to a median of 23 weeks in cases without fetal loss.

“The findings indicate that while cardiac surgery during pregnancy is linked to low maternal mortality, it is associated with high fetal mortality. When the fetus is viable, it is advisable to consider performing a cesarean section before cardiac surgery, ideally coordinated by a specialized Pregnancy Heart Team,” the researchers concluded.

Reference:

Schmitz, Katlin T., et al. “Is Cardiac Surgery Safe During Pregnancy? a 40-Year Single Institution Experience.” The Annals of Thoracic Surgery, 2024.

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Cranberry components use and increased fluid intake improve UTI symptoms: Study

A new study published in the journal of European Urology Focus showed data that suggests cranberry juice as a potential to prevent urinary tract infections (UTIs) with moderate to low certainty. One of the most prevalent bacterial illnesses is urinary tract infection which is more common in children by affecting almost 50% of girls and 20% of males at some point in their lives. Even while antimicrobials have historically had a high percentage of prompt cure, the bacteria that cause UTIs are becoming more and more resistant to antibiotics. It is now necessary to take action and find evidence-based non-drug therapies for the prevention and treatment of UTIs since microbial resistance is beginning to reduce the efficiency of antibiotics in the treatment of UTIs. Thus, this study by Christian Moro and colleagues evaluated the effectiveness of cranberry juice, cranberry pills, and increased liquids in the treatment of urinary tract infections.

The randomized controlled studies were looked for using PubMed, Embase, and Cochrane CENTRAL. UTI frequency was the main result, whereas antibiotic use and UTI symptoms were the secondary results. The Cochrane risk of bias tool was used to assess the risk of bias, and Grading of Recommendations Assessment, Development and Evaluation was used to determine the degree of evidence certainty.

There were 20 trials altogether with 3091 individuals; 18 of them showed that cranberry juice drinking was associated with a 54% lower risk of UTIs than no therapy and a 27% lower rate than placebo liquid. Based on a network meta-analysis of six studies, cranberry juice also led to a 49% lower rate of use of antibiotics than placebo liquid and a 59% lower rate than no therapy. Utilizing cranberry components also decreased the frequency of UTI symptoms.

Overall, the efficacy of cranberry juice to prevent UTIs is supported by the outcomes of this analysis. The combination of these, in cranberry juice, offers clear and significant clinical outcomes for the reduction in UTIs and antibiotic use, and should be taken into consideration for the management of UTIs. Increased liquids benefit the rate of UTIs and reduce antibiotic use and cranberry compounds benefit infection symptoms. Alternative non-drug therapy approaches are needed for the management of UTIs due to their rising incidence of antimicrobial-resistant infections. 

Source:

Moro, C., Phelps, C., Veer, V., Jones, M., Glasziou, P., Clark, J., Tikkinen, K. A. O., & Scott, A. M. (2024). Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis. In European Urology Focus. Elsevier BV. https://doi.org/10.1016/j.euf.2024.07.002

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Oral Ibuprofen Superior To Topical Diclofenac for Acute Low Back Pain, Study Finds

Acute low back pain is a common complaint in emergency departments (EDs), often leading to discomfort and functional impairment. Nonsteroidal anti-inflammatory drugs (NSAIDs), including oral ibuprofen and topical diclofenac, are commonly used to manage musculoskeletal pain. However, the comparative efficacy of these medications in the treatment of acute nonradicular musculoskeletal low back pain remains uncertain.

A recent study was published in the journal of Annals of Emergency Medicine by Nauman K. and colleagues. A randomized, placebo-controlled double-blind study was conducted among patients aged 18 to 69 years presenting to the ED with acute, nontraumatic, nonradicular musculoskeletal low back pain. Participants were randomized to receive one of three treatments: oral ibuprofen + placebo topical gel, 1% diclofenac topical gel + oral placebo, or a combination of oral ibuprofen + 1% diclofenac topical gel. The primary outcome measure was the change in Roland Morris Disability Questionnaire (RMDQ) score between ED discharge and 2 days later.

The key findings of the study were:

  • A total of 198 patients were randomized, with 36% women and a mean age of 40 years.

  • The median RMDQ score at baseline indicated substantial low back-related functional impairment.

  • Two days after the ED visit, patients receiving oral ibuprofen + placebo showed the greatest improvement in RMDQ score (10.1), followed by those receiving diclofenac gel + placebo (6.4), and those receiving ibuprofen + diclofenac gel (8.7).

  • Oral ibuprofen was found to be more efficacious than topical diclofenac, with no additional benefit observed when diclofenac gel was co administered with ibuprofen.

  • Medication-related adverse events were reported by a small percentage of patients in each treatment group, with no significant differences observed between groups.

In patients with acute nontraumatic, nonradicular musculoskeletal low back pain discharged from the ED, oral ibuprofen was more effective than topical diclofenac in improving functional impairment as measured by RMDQ scores. Furthermore, the addition of diclofenac gel to oral ibuprofen did not provide additional benefit. These findings highlight the importance of considering oral NSAIDs as the primary treatment option for acute low back pain in the ED setting. Further research may help elucidate the optimal management strategies for this common condition.

Reference:

Khankhel, N., Friedman, B. W., Baer, J., Lopez, L., Feliciano, C., Lee, S., & Irizarry, E. (2024). Topical diclofenac versus oral ibuprofen versus diclofenac + ibuprofen for emergency department patients with acute low back pain: A randomized study. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2024.01.037

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