Premenstrual dysphoric disorder causes debilitating periods: What we know about how to treat it

For people with premenstrual dysphoric disorder (PMDD), every month involves a struggle: feeling low and hopeless, navigating a minefield of intrusive thoughts and emotions, feeling so tired and overwhelmed that they are reduced to tears. The symptoms—which can also include depressed mood, anxiety, mood swings, irritability, sleep disturbances, difficulty concentrating and appetite changes—lift when their period starts, only to return again the next month.

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Sudan health minister declares cholera epidemic

Sudan’s health minister on Saturday declared a cholera epidemic after weeks of heavy rain in the war-torn country, in a video released by his ministry.

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Congo’s humanitarian crisis helped mpox spiral again into a global health emergency

Sarah Bagheni had a headache, fever, and itchy and unusual skin lesions for days, but she had no inkling that her symptoms might have been caused by mpox and that she might be another case in a growing global health emergency.

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Mineral sunscreen moisturizer effective option for for improving photodamage among patients across all skin tones: Study

Researchers have found that a new 100% mineral sunscreen moisturizer (MSM) with broad-spectrum SPF 50 is both effective and well-tolerated across all skin tones. A recent study was published in Journal of Drugs in Dermatology by Joel L. Cohen and colleagues. This 12-week study delivered positive results in photodamage and skin health.

Sun protection is important for all skin types, including darker skin. Mineral sunscreens are excellent at protection, although the textures are often thick, with highly prominent white casts on darker skin tones. Most of these sunscreens are tinted, which might temper this effect, but this may not be tolerated for all users. A sheer, multi-functional MSM has been developed to address the issues above by providing broad-spectrum SPF 50 protection, with positive aesthetics and anti-aging benefits for all skin tones.

This was an IRB-approved, open-label, 12-week clinical study conducted in 39 women aged 35–60 years with moderate to severe overall facial photodamage. Participants’ skin types ranged from I to VI according to Fitzpatrick skin types (FST). MSM was self-administered by participants to the face and neck in the morning, with applications repeated as guided by the US Food and Drug Administration. Efficacy was assessed by clinical grading and photography, ultrasound imaging, and corneometer measurements; tolerability was based on the questionnaires answered at baseline, after four weeks, after eight weeks, and at twelve weeks.

  • Statistically significant improvements in overall photodamage were observed from baseline to week 12.

  • Specifically, there was a 23.4% improvement for FST I-III and a 26.5% improvement for FST IV-VI.

  • The MSM showed favorable tolerability on both the face and neck across all participants.

  • Photography supported clinical grading results, and ultrasound imaging indicated a trend towards increased skin density.

  • Corneometer measurements corroborated improvements in skin hydration.

  • The product was well-received by participants, with positive feedback on its aesthetics and effectiveness.

The results of the study provide evidence for the efficacy and tolerance of the MSM across a wide range of skin tones. Its formulation is sheer, answering the typical concerns associated with mineral sunscreens regarding white cast but providing quite a considerable advantage against aging and skin health. Dramatic improvements in photodamage across a range of lighter to darker skin tones emphasize its broad applicability.

This 100% mineral sunscreen moisturizer with broad-spectrum SPF 50 is an effective and well-tolerated product, suitable for all skin tones. It solves the problems related to traditional sunscreens that often leave a white cast or greasy feel and, therefore, presents itself as a very viable option for those looking for a multifunctional sunscreen that confers added health benefits to the skin. Further studies could contribute to the generalization of these findings and further solidify recommendations for its use in broader populations.

Reference:

Effects of a sheer 100% mineral sunscreen moisturizer on facial photodamage across Fitzpatrick skin types. (2024, June 26). JDDonline – Journal of Drugs in Dermatology. https://jddonline.com/articles/effects-of-sheer-100-mineral-sunscreen-moisturizer-on-facial-photodamage-across-fitzpatrick-skin-types-S1545961624P8082X/

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Decreased CT use for diagnosis of pediatric appendicitis associated with increased use of ultrasound: Study

A new study by Jack Scaife and team found that increased ultrasound (US) usage was associated with lower computed tomography (CT) use for diagnosing appendicitis. The findings of this study were published in the Journal of Surgical Research.

One of the most frequent causes of acute abdominal pain, the most prevalent ailment requiring abdominal surgery in children and the most frequent reason for emergency room physician lawsuits is acute appendicitis. An obstruction of the appendiceal lumen can cause acute appendicitis, which manifests as fluid retention, luminal distention, inflammation, and ultimately perforation. The typical symptoms of appendicitis are well-described, but, unusual presentations can occur in as many as one-third of individuals with acute appendicitis. To reduce radiation exposure, imaging guidelines advise evaluating appendicitis with ultrasound initially. It is yet unknown how US and computed tomography use are related. Thus, this study was to ascertain the relationship between the rate of CT examination of juvenile acute appendicitis and increasing US usage.

This study used the Nationwide Emergency Department Sample for 2019 and included patients with an appendicitis diagnosis who were less than 18 years old. Current Procedural Terminology codes were used to determine imaging. The definition of concurrent imaging was the use of CT and US at the same visit. Hospitals were classified into three tertiles based on the rate of concurrent imaging: low (< 20%), medium (20%–40%), and high (> 40%). With inverse probability weighting, an extended ordinal logistic regression model was created to evaluate hospital rates of concurrent imaging associations in relation to patient variables.

A total of 23,976 patients and 485 hospitals were included in this investigation. Hospitals in the lowest tertile served 34% of patients, followed by those in the middle (35%), and the highest tertile (31%). The growing US use was shown to be negatively correlated (−0.27, P < 0.001) with concurrent imaging utilization. Blacks and Hispanics had significantly lower chances of presenting to a hospital with a greater concurrent imaging rate when compared to Whites. Also, the patients in the lowest income quartile and second income quartile had greater chances of coming to a hospital with a higher concurrent imaging rate than patients in the highest income quartile. Overall, decreased use of CT for appendicitis diagnosis was connected with increased use of US. Children of color and the kids living in less affluent areas are more likely to attend hospitals that employ a lot of imaging simultaneously.

Source:

Scaife, J. H., Iantorno, S. E., & Bucher, B. T. (2024). Rates of Concurrent Computed Tomography Imaging Following Ultrasound for Pediatric Patients With Appendicitis. In Journal of Surgical Research (Vol. 302, pp. 134–143). Elsevier BV. https://doi.org/10.1016/j.jss.2024.06.048

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Referral Delays in Rheumatoid Arthritis Patients Linked to Physician Reluctance, Knowledge Gaps, and Patient Factors: Study

India: Reluctance to refer and inadequate knowledge
about rheumatology lead to delayed treatment in Rheumatoid Arthritis (RA) patients, a recent study finds.

A study published in the Journal of The Association of Physicians of India, suggests both
patient and healthcare professional factors are responsible for referral delays in RA patients. Limited knowledge
of rheumatology, lack of rheumatologists, and hesitation in referring
patients to specialists are the major contributing factors causing referral delays.

RA is a chronic autoimmune disorder that affects
joints, leading to inflammation, pain, swelling, and eventual joint
destruction. The delayed introduction of disease-modifying
antirheumatic drugs (DMARDs) has led to major challenges in RA management,
increased disease burden, and treatment outcomes.

To find out the leading cause behind delayed referral
and treatment, Chandrashekara
S Managing Director, Department of Rheumatology and Clinical Immunology, Bengaluru,
Karnataka, India, and colleagues gathered
to carry out a prospective, multicenter, observational study that enrolled
4,643 RA patients from eight centers using the Indian Rheumatology Association
(IRA) database.

Factors related to the patient and referral were
identified based on the patient’s account. Modified
PRASAD scale to categorize patients’ socioeconomic status.

Results reveal the following
findings:

  • The
    predominant factor causing delay was a lack of
    awareness
  • 39% of patients were referred to the rheumatology specialty
    within 6 months of disease onset, while 26% reported later, and 34% reported
    over 2 years.
  • Socioeconomic factors lead to referral delays in
    Madhya Pradesh (21.43%) and West Bengal (28.57%).
  • Lack of awareness about the disease and rheumatology
    specialty was highest in West Bengal (100%), followed by Delhi and Rajasthan
    (93.70%).
  • Other factors influencing referral delay were
    misconceptions about modern medicine, reluctance to refer patients to the
    rheumatologist, and previous treatment by other specialties.
  • In Gujarat (33.56%) and Delhi and Rajasthan (25.18%)
    primary
    care clinicians’ lack of awareness about the rheumatology specialty was the
    main reason for the delay in referrals.

“The study’s findings may
be limited in their generalizability due to uneven recruitment from various
centers, lack of geographic representation, and potential recall bias,”
researchers reported.

Reference: S Chandrashekara,
Shenoy Padmanabh et al. Blockades in the Pathway of Specialty Care in
Rheumatoid Arthritis: A Report Based on Indian Rheumatology Association
Database. Journal of the Association of Physicians of
India, 72(8).doi: 10.59556/japi.72.0495.

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Tirbanibulin Proven Safe and Tolerable for Larger Actinic Keratosis Fields, Expanding Treatment Options: Study

USA: Tirbanibulin ointment, at a 1% concentration,
demonstrates good safety and effectiveness for treating actinic keratosis (AK) on
areas up to 100 cm² on the face and scalp, a recent study published in the
Journal of American Academy of Dermatology has concluded.

The study highlights that Tirbanibulin 1% ointment has the potential to be used in larger fields,
which leads to expanding its applicability for patients with extensive lesions.

Tirbanibulin is approved for treating actinic keratosis in areas up to 25 cm². However, because actinic keratosis frequently impacts larger regions, there is a need for treatments that can address larger affected areas. Considering this, Neal Bhatia, Therapeutics Clinical Research, San Diego, CA, USA, and colleagues aimed to evaluate the tolerability and safety of tirbanibulin when applied to a field of approximately 100 cm2.

For this purpose, the research team conducted a single–arm study with adult
patients having a treatment field on the face or balding scalp of 100 cm2 with
4-12 AKs. Patients received tirbanibulin 1% ointment to cover the
treatment field once daily for five consecutive days. Safety was assessed by
evaluating treatment-emergent adverse events (TEAEs) and tolerability was
measured using a composite score of six local tolerability signs (LTS).

The study was performed with the participation of
102 patients. The trial was conducted from June 2022 to December 2022 in the
United States by the Declaration of Helsinki and The International Council for
Harmonization Good Clinical Practice guidelines, a 4-week screening, a 5-day
treatment, and a 7-week response evaluation period were conducted. Till the
completion of the assessment period on Day 57 safety, tolerability, and
presence of Aks were evaluated.

They found the following results

·
Around 96.1% of LTS were erythema and 84.4% were
scaling, they are mostly from mild to moderate severity, and they return to
baseline by Day 29.

·
5.8% of severe LTS were erythema and 8.7% were
flaking/ scaling.

·
At day 57 the mean total number of Aks decreased
from 7.7 Aks at baseline to 1.8 Aks. 77.8% was a reduction in the baseline
lesion.

“Local
tolerability and safety profiles were well characterized in patients with 4-12
clinically typical, visible, and discrete AK lesions in a field of 100 cm2.
These results support the safety of tirbanibulin 1% ointment for use in
patients with actinic keratosis (AK) on the face or scalp in treatment areas up
to 100 cm²”, the researchers concluded.

Reference:

https://doi.org/10.1016/j.jdin.2024.07.001

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Elevated Maternal Uric Acid Linked to Higher Risk of Congenital Heart Diseases in Offsprings, suggests study

Researchers have found that elevated maternal serum uric acid levels in the first trimester are associated with a significant increase in the risk of congenital heart diseases (CHDs) in offspring. A recent study was published in Heliyon by Minli Zhao and colleagues. This underlines the importance of early uric acid monitoring and management in pregnancy to offset these risks.

Congenital heart diseases are among the most common kinds of birth defects, which annually hit thousands of newborn babies worldwide. The role of early pregnancy concentrations of uric acid in mothers’ serum has not been well documented until now, though many risk factors have been identified. This study aimed to find out the relationship between those levels and the occurrence of CHD in offspring.

This was a prospective cohort study conducted in southeast China from 2019 to 2022, involving 21 425 pregnant women. The participants were recruited from the Fujian birth cohort study and had their fasting blood samples taken at about 11·3 weeks of gestation for the estimation of serum uric acid levels. The perinatal outcome was followed up in relation to the incidence of CHDs in their offspring. All CHDs were confirmed by expert echocardiography doctors and pediatric cardiologists.

Key Findings

  • The study found a strong association between higher maternal serum uric acid levels in the first trimester and an increased risk of CHDs in offspring.

  • Maternal log2-transformed serum uric acid levels were linked to a 58.9% higher risk of CHDs (adjusted odds ratio [AOR] 1.589, 95% CI [1.149, 2.198]).

  • When comparing the lowest quartile of maternal uric acid levels to higher quartiles, the study observed a significant increase in risk.

  • The AORs for the second, third, and highest quartiles were 1.363 (95% CI [1.036, 1.793]), 1.213 (95% CI [0.914, 1.610]), and 1.472 (95% CI [1.112, 1.949]), respectively.

  • Pregnant women with hyperuricemia in the first trimester faced an 83.7% increased risk of CHDs in their offspring (AOR 1.837, 95% CI [1.073, 3.145]).

  • The restricted cubic spline (RCS) model demonstrated a linear relationship between maternal serum uric acid levels and the risk of CHDs, with no evidence of nonlinearity (P = 0.71).

These results further underscore the fact that there is no need for monitoring, much less managing, the levels of uric acid in the serum during the first trimester of pregnancy. Based on a strong relationship with an increased risk for CHD, health providers may want to consider looking at uric acid levels as part of routine prenatal care, especially in at-risk populations.

This study identified that elevated first-trimester maternal serum uric acid levels are one of the major risk factors for the occurrence of congenital heart diseases in their offspring. These results, therefore, underscore early detection and management strategies to achieve improved perinatal outcomes.

Reference:

Zhao, M., Wang, X., Zhang, D., Li, H., Zhu, Y., & Cao, H. (2024). Relationship between maternal serum uric acid in the first trimester and congenital heart diseases in offspring: a prospective cohort study. Heliyon, e35920, e35920. https://doi.org/10.1016/j.heliyon.2024.e35920

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TENS may Potentially Reduce Appetite and Help Weight Reduction in Obese Individuals: Study

A recent study conducted by researchers in India has explored a novel approach to obesity management using transcutaneous electrical nerve stimulation (TENS) on the T6 dermatome, suggesting that this non-invasive technique could potentially reduce appetite and facilitate weight loss in obese individuals.

The study, conducted in the department of Neurosciences in AIIMS, Delhi, enrolled 20 patients with a BMI ≥ 30 kg/m2 who had previously failed dietary interventions. The intervention consisted of weekly 30-minute TENS sessions applied to the T6 dermatome over a 12-week period. The TENS parameters were set to burst mode, 2.0 Hz frequency, and 300 microseconds width.

The results showed statistically significant reductions in appetite levels, weight, and BMI from pre- to post-intervention (p < 0.001). These effects were maintained at the 8-week follow-up. Notably, the effect size for appetite reduction was large (>1), while the effect sizes for weight and BMI reduction were small (0.14 and 0.16, respectively).

The researchers proposed that the mechanism of action may involve autonomic effects on the stomach via vagal response and altered activity in brain centers related to appetite. They also suggested that TENS stimulation of the T6 dermatome may mimic the satiety signals typically sent by stretch receptors in the stomach after eating.

While the study showed promising results, the authors acknowledged several limitations. The single-arm design made it impossible to differentiate between treatment effects, placebo effects, and natural history. Additionally, the study did not include comprehensive analyses of hunger, desire to eat, and fullness before and after meals, nor did it measure changes in body composition or plasma ghrelin levels.

Despite these limitations, this study presents TENS as a potentially safe, cost-effective, and non-invasive treatment option for obesity that does not require extensive expertise to administer. The researchers suggest that future investigations should aim at designing a simple, portable TENS device that obese individuals could use at home or in the workplace.

Reference

Effect of Transcutaneous Electrical Nerve Stimulation of T6 Dermatome on Appetite and Weight Reduction in Obese Individuals: A Pilot Study Sahu, Pradeep Kumar; Ranjan, Piyush; Agrawal, Deepak; Singh, Garima

Neurology India 72(3):p 534-539, May–Jun 2024. | DOI: 10.4103/neuroindia.NI_1063_20

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ASCVD risk scores may independently predict CKD in patients without diabetes or hypertension: Study

ASCVD risk scores may independently predict CKD in patients without diabetes or hypertension suggests a new study published in the BMC Nephrology.

The relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up. They analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m2. Results: During a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74–2.62) in the unadjusted model and 1.35 (1.02–1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group. An increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.

Reference:

Lee, H.S., Lim, H.I., Moon, T.J. et al. Trajectories of atherosclerotic cardiovascular disease risk scores as a predictor for incident chronic kidney disease. BMC Nephrol 25, 141 (2024). https://doi.org/10.1186/s12882-024-03583-1

Keywords:

ASCVD, risk, scores, independently, predict, CKD, patients, diabetes, hypertension, BMC Nephrology, Lee, H.S., Lim, H.I., Moon, T.J.

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