Eyes on the field: Researchers use neuro-ophthalmologic principles to improve NFL officiating

Hamza Memon and Nicholas Panzo, students at Texas A&M University School of Engineering Medicine (ENMED), are leading an innovative project at the intersection of sports and ophthalmology to improve National Football League (NFL) officiating. Rooted deeply in Houston’s vibrant sports culture, these Class of 2026 students combine their interest in ophthalmology and their love for sports to contribute significantly to a project with the NFL.

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3D body scanner with AI predicts metabolic syndrome risk

Mayo Clinic researchers are using artificial intelligence (AI) with an advanced 3D body-volume scanner—originally developed for the clothing industry—to help doctors predict metabolic syndrome risk and severity. The combination of tools offers doctors a more precise alternative to other measures of disease risk like body mass index (BMI) and waist-to-hip ratio, according to findings published in the European Heart Journal—Digital Health.

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Long-Term Low-Carb Diets Effective for Dyslipidemia, Not Glycemic Control in Type 2 Diabetes: Study

In a recent study, researchers indicated that long-term low-carbohydrate diets (LCD) in people with type 2 diabetes had significant improvements in some lipid parameters but did not have substantial additional benefits for glycemic control. The conclusion was drawn from the overall analysis across RCTs of the effects of LCD on the glycemic management and other metabolic risk markers in diabetic adults for a period of more than 12 months. The research was published in the Journal of Diabetes Investigation by Takahiro Ichikawa and colleagues.

The efficacy of long-term LCD in the management of type 2 diabetes is arguable. In spite of many trials in this respect, controversy still persists regarding the influence of such diets on glycemic control. Thus, the present meta-analysis sought to resolve this issue through data synthesis from multiple RCTs on long-term effects of LCD on glycemic control and other health outcomes.

A PubMed, Embase, and Cochrane Database search up to June 2023 for the identification of articles was undertaken. The inclusion criteria were RCTs of LCD interventions that had been conducted in people with T2D and having an intervention period of >12 months. Primary outcome: Change in HbA1c (long-term LCD vs control). Secondary outcomes were changes in SBP, DBP, LDL-C, HDL-C, TGs, and body weight.

Results

  • Six studies met the inclusion criteria and were included in the analysis.

  • The findings revealed no significant difference in changes in HbA1c levels between the long-term LCD and control diets (standardized mean difference [SMD] −0.11, 95% confidence interval [CI] −0.33 to 0.11, P = 0.32).

  • No significant differences were observed in weight loss, blood pressure, and LDL-C between the two diet groups.

  • Significant improvements were noted in lipid profiles for individuals on long-term LCD.

  • These diets were associated with a greater increase in HDL-C (SMD 0.22, 95% CI 0.04–0.41, P = 0.02) and a greater reduction in triglycerides (SMD −0.19, 95% CI −0.37 to 0.02, P = 0.03) compared to control diets.

This meta-analysis indicates that, though there is no significant effect of long-term LCD on glycemic control in people with T2D, they do convey the most striking benefits toward the management of dyslipidemia. On the other hand, the increase in HDL-C and the decrease in triglycerides suggest that LCD might be an effective way to improve the lipid profiles important for cardiovascular health in patients with diabetes.

This systematic review updates the possible benefit of long-term low-carbohydrate diets in improving lipid parameters but not significantly enhancing glycemic control in people with T2D. Providers should consider these findings in counselling patients about dietary strategies for the management of diabetes and related metabolic diseases.

Reference:

Ichikawa, T., Okada, H., Hironaka, J., Nakajima, H., Okamura, T., Majima, S., Senmaru, T., Ushigome, E., Nakanishi, N., Hamaguchi, M., Joo, E., Shide, K., & Fukui, M. (2024). Efficacy of long‐term low carbohydrate diets for patients with type 2 diabetes: A systematic review and meta‐analysis. Journal of Diabetes Investigation. https://doi.org/10.1111/jdi.14271

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Kauvery Hospital performs three lung transplants in three consecutive days

Chennai: In a ground-breaking achievement, Kauvery Hospital, Vadapalani, a vital link in Tamil Nadu’s leading multi-specialty healthcare chain, successfully performed three consecutive lung transplants, in three consecutive days, giving a new lease of life to three terminally ill patients.

On the occasion of World Organ Donation Day, celebrated on August 13th, Kauvery Hospital extends heartfelt thanks to the organ donors and their families, our reputed donor organ coordination authority – TRANSTAN, donor hospitals and our coordinators who make a second lease of life possible for patients who are very sick with organ failure. The success of these transplants highlights the importance of organ donation and the life-saving potential it holds.

Also Read:Doctors at Kauvery Hospital give new lease of Life to 22-year-old man with Rare Diaphragmatic Hernia caused by road accident

Lung transplantation is a complex procedure where a diseased lung is replaced with a healthy one from a deceased donor. Despite the challenges, these transplants can significantly improve a patient’s survival and quality of life. Currently, in Tamil Nadu, there are two or fewer lung transplants being done in a month. The Heart and Lung Transplant team at Kauvery Hospital completed three such lung transplants within three days, showcasing their expertise and dedication.

The first patient was 72-year- aged, with a BMI of 18, with progressive lung fibrosis on home oxygen and ventilator support, who underwent a single lung transplant. The second patient, who had lost 40 kgs due to his advanced disease from post-COVID fibrosis, received bilateral lung transplants. An out-of-hours virtual crossmatch was performed to ensure safety of donor-recipient matching for the third patient who was immunologically sensitized, and received a double lung transplant.

The first two patients are already off the ventilator and making excellent progress, while the third patient is also recovering well. All three cases were performed without the traditional peri-operative use of circulatory support. This incredible feat was achieved by our gifted surgical team of Dr. Kumud Dhital, Dr Prakash & Dr Ram and our equally versatile anaesthetic & critical care team headed by Dr Pradeep.

Dr. Srinivas Rajagopal who, with his team of transplant pulmonologists, played a crucial role in the management of these patients with very advanced lung failure, will also be spearheading their long-term surveillance and care after hospital discharge.

Credit also goes to our staff in Clinical Perfusion, OR technicians, specialist nurses in the OR and ICU, dedicated physiotherapy, and other multi-disciplinary support staff who made this monumental task successful. The smooth course of recovery of all three patients is a testament to the skill and tireless dedication of the entire transplant team. It also reflects the highest standard of care rendered at Kauvery Hospital and underscores the hospital leadership’s unwavering resolve and commitment to provide such advanced medical care to improve patient outcomes.

Dr Aravindan Selvaraj, Co-Founder & Executive Director, Kauvery Group of Hospitals, said, “This remarkable achievement by our team at Kauvery Hospital, Vadapalani, highlights the hospital’s commitment to advancing medical science and providing cutting-edge healthcare. The success of these three lung transplants, carried out in such a short span, underscores the dedication, expertise, and collaborative spirit of our entire medical team. We are proud to offer such life-saving procedures and to support the cause of organ donation, which continues to transform lives.”

Also Read:Kauvery Hospital opens 200-bedded Maa Kauvery Hospital for women and children

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Higher glucose levels worsen prognosis in ischemic stroke patients, suggests study

Having higher than usual blood sugar levels at the time of hospital admission for an ischemic stroke significantly increases the risk of a poor functional prognosis or death within three months of the stroke.

This is the main conclusion of a study by the Endocrinology and Nutrition Services and the Neurology Department of Hospital del Mar, with researchers from the hospital’s Research Institute, the RICORS-ICTUS network, and the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM). The study is published in the journal Cardiovascular Diabetology and will continue with further studies to determine the utility of this factor in treating patients with this pathology.

It is known that the inflammatory state in certain diseases can cause increased blood sugar levels, or hyperglycemia, which can influence prognosis. In the case of ischemic stroke, this increase is common, but it has not been analyzed in depth. The Hospital del Mar study delves into this issue, reviewing data from 2,774 patients with this condition. Besides blood sugar levels at the time of admission and their comparison with each patient’s usual levels, other variables were considered, such as age, diabetes, disability, stroke severity, and treatment received.

Considering these variables, higher blood glucose levels compared to usual were confirmed as a factor for worse functional prognosis and mortality three months after the stroke, independently of other factors. An increase of just 13% above usual levels worsens the prognosis, regardless of the glucose level. This was also observed in patients who previously had diabetes, accounting for 35% of the total studied.

Dr. Elisenda Climent, associate doctor of the Endocrinology and Nutrition Service at Hospital del Mar and researcher at its Research Institute, points out, “This variable better reflects the effect of sugar at the time of patient admission, and in the group of patients with higher indices, there is a worse prognosis and mortality.” Specifically, for every 10% increase, the risk of a worse prognosis rises by 7%. In those with higher levels, this risk increases by 62%, and mortality risk by 88%.

Continuing the Line of Study

Researchers plan to continue studying the effect of sugar in this population to determine if it is beneficial to act on glucose levels. Currently, it is not done due to the risks associated with excessive lowering of glucose levels. “A more conservative treatment approach is currently chosen, as strict control strategies have not proven superior due to the risks posed by glucose drops for patients’ conditions. At present, sugar is not aggressively treated in patients who have had an ischemic stroke. Our study may allow for selecting the population that can be worked on more intensively, leveraging new technologies for safer monitoring,” explains Dr. Ana Rodríguez, head of the stroke section of the Neurology Service and researcher at the Research Institute of Hospital del Mar.

To do this, new studies will be conducted. “It is necessary to study whether it is a severity marker, acting on which does not improve the prognosis, or whether it is a factor that can be worked on to improve the condition of patients with higher than usual glucose levels,” says Dr. Juan José Chillarón, head of the Endocrinology and Nutrition Service at Hospital del Mar and researcher at its Research Institute. All this could allow “this subgroup of patients to benefit from more intensive insulin therapy, which could be a potential conceptual change in their approach,” notes researcher Joan Jiménez Balado from the Research Institute of Hospital del Mar.

References; Elisenda Climent, Ana Rodriguez-Campello, Joan Jiménez-Balado, Mercè Fernández-Miró, Jordi Jiménez-Conde, Gemma Llauradó, Ángel Ois, Juana A. Flores, Elisa Cuadrado-Godia, Eva Giralt Steinhauer, Juan J. Chillarón & Neurovascular Research Group (NEUVAS) Cardiovascular Diabetology volume 23, Article number: 206 (2024) DOI https://doi.org/10.1186/s12933-024-02260-9

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Vitamin D Deficiency Linked to Heightened Nausea and Gastric Issues in Gastroparesis Patients: Study

USA: More than half of patients with gastroparesis symptoms exhibit low vitamin D levels, which are associated with increased nausea, vomiting, and impaired gastric neuromuscular function, says a recent study published in Digestive Diseases and Sciences.

Gastroparesis (Gp) is a gastrointestinal disorder characterized by delayed gastric emptying and often accompanied by debilitating symptoms such as nausea, vomiting, and bloating. Gp patients have diets deficient in electrolytes, calories, and vitamins. Although some patients with gastroparesis have been reported to have low vitamin D levels, this issue has not been systematically investigated. Considering this, Kenneth L. Koch, Section Of Gastroenterology, Wake Forest University, Winston-Salem, NC, USA, and colleagues aimed to determine vitamin D levels and relationships among symptoms, gastric emptying, and gastric myoelectrical activity (GMA) in patients with symptoms of Gp.

For this purpose, the researchers measured 25-hydroxy-vitamin D levels in patients upon enrollment in the Gastroparesis Clinical Consortium Registry. They also assessed gastroparesis symptoms using the Gastroparesis Cardinal Symptoms Index (GCSI), evaluated gastric emptying, and conducted gastric myoelectric activity tests before and after the water load satiety test (WLST). GMA was recorded using electrogastrography, with activity percentages categorized into normal and dysrhythmic ranges.

The study revealed the following findings:

  • Vitamin D levels were low (< 30 ng/ml) in 56.1% of patients with symptoms of Gp (54.8% of patients with delayed gastric emptying (Gp) and 59.9% of patients with symptoms of Gp and normal gastric emptying).
  • Low vitamin D levels were associated with increased nausea and vomiting but not fullness or bloating subscores.
  • Low vitamin D levels in patients with Gp were associated with greater meal retention at four hours (36% retention) compared with Gp patients with normal vitamin D levels (31% retention).
  • Low vitamin D in patients with normal gastric emptying was associated with decreased normal 3 cpm GMA before and increased tachygastria after WLST.

“This study establishes a foundation for further research into vitamin D supplementation in patients with gastroparesis who exhibit low vitamin D levels. Future investigations should explore whether replenishing vitamin D can improve gastric neuromuscular function and alleviate gastroparesis symptoms. In the interim, we recommend evaluating vitamin D levels in patients with gastroparesis and administering vitamin D supplements if a deficiency is found.” the researchers concluded.

Reference:

Koch, K.L., Parkman, H.P., Yates, K.P. et al. Low Vitamin D Levels in Patients with Symptoms of Gastroparesis: Relationships with Nausea and Vomiting, Gastric Emptying and Gastric Myoelectrical Activity. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08520-8

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Neonatal Vitamin B12D Screening Cuts Risk of Symptomatic Deficiency by Fourfold in Infants: Study

Germany: A study published in the Pediatrics Journal revealed that newborn screening for neonatal vitamin B12 deficiency can reduce the risk of developing symptomatic vitamin B12 deficiency in the first year of life by four times compared to infants who do not undergo newborn screening.

Vitamin B12 deficiency can lead to neuro-developmental impairments within the first year of life. Newborn screening for Vitamin B12 deficiency has proven to be technically feasible, and early treatment has resulted in positive developmental outcomes for infants. This study aims to assess the effectiveness of newborn screening in preventing symptomatic Vitamin B12 deficiency in infants.

Dr. Ulrike Mütze, Divisions of Child Neurology and Metabolic Medicine et. al. conducted a study to evaluate the effectiveness of newborn screening for Vitamin B12 deficiency.

A nationwide surveillance study was conducted in collaboration with the German Pediatric Surveillance Unit to gather data for this research. Incident cases of Vitamin B12 deficiency in infants under 12 months old were prospectively collected from 2021 to 2022.

The key findings of the research were as follows:

  • A total of 61 cases of Vitamin B12 deficiency were analyzed by the German Pediatric Surveillance Unit.
  • These cases were identified either through newborn screening (N = 31) or after the onset of suggestive symptoms (N = 30).
  • Ninety percent of infants identified by newborn screening were still asymptomatic.
  • The non-NBS cohort presented at a median age of 4 months with symptoms such as muscular hypotonia (68%), anemia (58%), developmental delay (44%), microcephalia (30%), and seizures (12%).
  • Symptomatically diagnosed Vitamin B12 deficiency in the first year of life was reported four times more frequently in infants who did not receive newborn screening compared to those who were screened as newborns.
  • The estimated overall cumulative incidence was 1:9600 newborns per year for neonatal Vitamin B12 deficiency and 1:17,500 for symptomatic infantile VitB12D.  

Researchers concluded that newborn screening for neonatal vitamin B12 deficiency can decrease the risk of developing symptomatic vitamin B12 deficiency within the first year of life by a factor of four compared to infants who do not receive such screening.

Reference:

Ulrike Mütze, Florian Gleich, Dorothea Haas, Michael S. Urschitz, Wulf Röschinger, Nils Janzen, Georg F. Hoffmann, Sven F. Garbade, Steffen Syrbe, Stefan Kölker; Vitamin B12 Deficiency Newborn Screening. Pediatrics August 2024; 154 (2): e2023064809. 10.1542/peds.2023-064809

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Active Smoking Reduces Long-Term Benefits of subcutaneous immunotherapy in Allergic Rhinitis Patients, Study Finds

China: A recent study published in Otolaryngology-Head and Neck Surgery has highlighted significant insights into how smoking affects allergic rhinitis (AR) and the effectiveness of subcutaneous immunotherapy (SCIT). The research, conducted with 505 patients with allergic rhinitis, offers new perspectives on the interplay between smoking habits and treatment outcomes for this common allergic condition.

The analysis revealed that in allergic rhinitis patients, while baseline severity was comparable among never, former, and current smokers, active smokers experienced diminished benefits from subcutaneous immunotherapy. Current smokers reported reduced early effectiveness and a decline in long-term benefits, particularly two years after starting treatment. Additionally, smoking was associated with a higher risk of asthma and more severe allergic conjunctivitis.

Zhihai Xie, Xiangya Hospital of Central South University, Changsha, People’s Republic of China, and colleagues aimed to evaluate the impact of smoking statuses on disease severity and subcutaneous immunotherapy efficacy in allergic rhinitis (AR).

For this purpose, the researchers conducted an open observational cohort study at a tertiary referral center to evaluate the impact of smoking on allergic rhinitis patients undergoing SCIT for dust mite allergens. The study included 505 AR patients, who were classified into three groups: never-smokers, former smokers, and current smokers. Disease severity was assessed using standard questionnaires commonly used in clinical settings.

The study analyzed changes in questionnaire scores before and after SCIT to determine the efficacy of the treatment. By comparing these scores across the different smoking status groups, researchers aimed to identify differences in disease severity and the effectiveness of SCIT. This approach provided insights into how smoking influences both the severity of allergic rhinitis and the response to SCIT.

The following were the key findings of the study:

  • Compared to never-smokers, former and current smokers exhibited a higher proportion of male, alcohol, and asthma.
  • Current smokers had a greater prevalence of allergic conjunctivitis than former smokers.
  • Before SCIT, AR severity was similar across three groups, even after adjusting for confounders.
  • Current smokers reported lower SCIT efficacy in the first year.
  • By the third year, three groups showed comparable long-term efficacy.
  • Current smokers experienced a significant decrease in benefits two years post-SCIT and lower improvement rates at the end of the 3-year SCIT period and two years following SCIT.

The findings showed that patients with allergic rhinitis, regardless of smoking status, exhibited similar baseline disease severity and long-term efficacy from SCIT. However, active smoking was linked to a higher risk of asthma, a delayed perception of early SCIT benefits, reduced improvement over three years, and diminished advantages two years post-treatment.

“Prompt smoking cessation is essential to counteract these adverse effects and enhance treatment outcomes,” the researchers concluded.

Reference: https://doi.org/10.1002/ohn.937

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Maximizing or minimizing patient oxygenation during cardiac surgery may not affect postoperative organ injury: JAMA

Researchers found that while intraoperative hyperoxia did increase oxidative stress during cardiac surgery, there was no effect on kidney injury or other organ dysfunctions. This was from a study published in JAMA Surgery by Marcos G. Lopez and co-researchers. The result puts in doubt the therapeutic benefit of the routine administration of high inspired oxygen concentrations during surgery.

Liberal oxygen administration also known as hyperoxia is commonly used in the surgical setting to ensure adequate oxygenation. However, the consequence of such hyperoxia on the mechanisms of organ injury in the perioperative period has recently come into question. Thus, the current study investigated the effects of intraoperative hyperoxia versus normoxia on post-cardiac surgery oxidative stress, kidney injury, and other organ dysfunctions.

The objective of this randomized clinical trial was to assess the effect of intraoperative hyperoxia versus normoxia on oxidative stress, kidney injury, and other organ dysfunctions following cardiac surgery.

This participant and assessor-blinded, randomized clinical trial was conducted from April 2016 to October 2020 at a single tertiary care medical center. Adult patients (≥18 years) scheduled for elective open cardiac surgery were eligible for inclusion, provided they did not have preoperative oxygen requirements, acute coronary syndrome, carotid stenosis, or were on dialysis. Out of 3919 patients assessed, 2501 were eligible, and 213 consented to participate. After exclusions, 200 patients were randomized to either hyperoxia, where fraction of inspired oxygen was set to a value of 1.00, or normoxia, which maintained a minimum FiO2 to keep oxygen saturation within the range of 95% to 97% during surgery.

Patients were assessed for oxidative stress by F2-isoprostanes and isofurans, for AKI, delirium, myocardial injury, atrial fibrillation, and other secondary outcomes, with follow-up to one year after surgery.

Results

  • This was a prospective cohort study of 200 patients with a median age of 66 years (IQR 59 to 72), including 140 men and 60 women, and 82 (41%) had diabetes.

  • Oxidative stress markers, F2-isoprostanes and isofurans, were higher during surgery from a median baseline value of 73.3 pg/mL to 85.5 pg/mL at ICU admission.

  • Levels were 9.2 pg/mL higher (95% CI, 1.0-17.4; P = .03) in the hyperoxia group.

  • The primary clinical endpoint, change in serum creatinine from baseline to postoperative day 2, showed a median change of 0.01 mg/dL (IQR, −0.12 to 0.19) in the hyperoxia group versus −0.01 mg/dL (IQR, −0.16 to 0.19) in the normoxia group (median difference, 0.03; 95% CI, −0.04 to 0.10; P = .45).

  • AKI occurred in 21 participants (21%) in each group.

  • Hyperoxia did not affect additional acute organ injuries, safety events, or long-term kidney, neuropsychological, and functional outcomes at one year.

This study, therefore, is an indication that while intraoperative hyperoxia increases the level of oxidative stress, it neither results in kidney injury nor other organ dysfunctions in adults going through cardiac surgery. The results suggest that the maintenance of normoxia might be sufficient and could avoid unnecessary risks of hyperoxia.

Among adults undergoing cardiac surgery, intraoperative hyperoxia was associated with increased oxidative stress but did not affect kidney injury or other organ dysfunctions. These findings indicate that hyperoxia may not be necessary and that normoxia might be a safer option for maintaining adequate oxygenation during surgery.

Reference:

Lopez, M. G., Shotwell, M. S., Hennessy, C., Pretorius, M., McIlroy, D. R., Kimlinger, M. J., Mace, E. H., Absi, T., Shah, A. S., Brown, N. J., Billings, F. T., IV, ROCS trial investigators, Deegan, R., Eagle, S. S., Hernandez, A., Gelfand, B. J., Kertai, M. D., Kingeter, M., LeFevre, R., … Wanderer, J. P. (2024). Intraoperative oxygen treatment, oxidative stress, and organ injury following cardiac surgery: A randomized clinical trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.2906

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Dupilumab use among pediatric atopic dermatitis patients may improve comorbid asthma, finds study

Dupilumab use among pediatric atopic dermatitis patients may improve comorbid asthma, finds a study published in the Pediatric Allergy and Immunology.

Atopic dermatitis (AD) is frequently associated with asthma and allergic rhinitis (AR). Dupilumab is an effective treatment for pediatric AD, although the effect on atopic comorbidities in pediatric AD patients is limited. A study was done to investigate the prevalence of asthma and AR in pediatric AD patients starting dupilumab treatment and to evaluate the effect of dupilumab on these comorbidities. This study included pediatric AD patients (aged 3-17 years) treated with dupilumab between 2019 and 2023. Patients were screened at baseline by a pulmonologist for the presence of asthma and AR.

Screening included evaluation of medical history and current symptoms, spirometry (including Forced Expiratory Volume in 1 s (FEV1)), Fractional exhaled Nitric Oxide (FeNO), and measurement of aeroallergen-specific IgE levels. In patients diagnosed with comorbid asthma and/or AR, measurements were repeated at weeks 16 and 52. Spirometry measurements, FeNO, and aeroallergen-specific IgE levels during treatment were analyzed using a covariance pattern model. Results: Eighty-four patients were included.

Asthma was diagnosed in 50 patients (59.5%) and AR in 72 patients (85.7%). Baseline FeNO levels were elevated in both patients with (29.0 ppb (95% CI 22.0-54.0)) and without asthma (26.0 ppb (95% CI 22.0-30.0)). During treatment, FeNO levels decreased (p < .001) and FEV1 scores increased (p < .001) in patients with asthma. In patients with asthma and/or AR, all aeroallergen-specific IgE levels decreased between 61.3% and 89.1% at 52 weeks of treatment. One year of dupilumab treatment, primarily indicated for AD, resulted in a significant improvement in comorbid asthma and a profound decrease in aeroallergen-specific IgE levels in patients with asthma and/or AR.

Reference:

Rijst LPvd, Groot K-d, Zuithoff NPA, de Bruin-Weller MS, de Graaf M. Effect of dupilumab on asthma and aeroallergen sensitization in pediatric atopic dermatitis patients: Results of the BioDay registry. Pediatr Allergy Immunol. 2024; 35:e14178. doi:10.1111/pai.14178.

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