Elevated risks of liver steatosis and Fibrosis in Type 2 diabetes individuals: Study finds

India: With the high
prevalence of Nonalcoholic fatty liver disease (NAFLD) in Type 2 diabetes
patients (T2DM) and the rise of the global diabetic pandemic, scientists
gathered to investigate the prevalence and risk factors associated with NAFLD
stages in individuals with T2DM.

The study, published
in the Journal of the Association of
Physicians of India, suggests a high prevalence of hepatic steatosis
and fibrosis in patients with Diabetes mellitus.

“There is a higher incidence of having hepatic steatosis (75.1%) and fibrosis (28.0%) in patients with type 2 diabetes. Additionally, age and gender play minor roles with WC and BMI emerging as significant predictors of severity of liver steatosis and fibrosis in T2DM patients,” the researchers reported. 

Rising cases of Type
2 Diabetes Mellitus all over the world have led to an upsurge in the global diabetic
epidemic. Specifically having Nonalcoholic fatty liver disease which
is highly prevalent among the Type 2 diabetes population, poses risks of
significant treatment challenges, adverse outcomes, and accelerates disease
progression.

To understand the incidence
and risk factors associated with stages of NAFLD in the population having Type
2 Diabetes Mellitus, Vijay Panikar, Consultant and HOD, Lilavati Hospital, Mumbai, Maharashtra, India, and the team
conducted an observational, cross-sectional study.

Scientists recruited 1,521 T2DM patients at Dr Panikar’s Speciality
Care Centre, Mumbai, between September 1, 2022, and October 31, 2022,
where they measured certain demographic parameters such as age, gender, height,
weight, and anthropometric parameters such as body mass index (BMI) and
waist circumference (WC). Vibration-controlled transient elastography (VCTE)
using FibroScan was used to recognize liver fibrosis and steatosis stages.

Study results reveal:

  • 75.1%
    prevalence of liver steatosis was observed among 1,521 diabetes
    cases [S0 (24.9%), S1 (15.1%), S2 (24%), and S3 (36%)], along with
    that prevalence of liver fibrosis was 28.0% [F0 (72%), F1 (19%), F2 (5%), F3
    (1.5%), and F4 (3.4%)].
  • S1 grades
    suggest a positive connection with significant gender-related changes.
  • Waist
    circumference was associated with disease severity in both liver steatosis and fibrosis
    stages.
  • BMI was exclusively
    associated with the degree of steatosis.
  • No
    statistical significance was found in mean age differences between these
    categories.

“It is crucial to assess and manage liver health in T2DM patients for the
prevention and early management of associated risk factors”, the researchers concluded.

Reference: Panikar V, Gupta A, Nasikkar N, et al. Prevalence and Association of Risk Factors
According to Liver Steatosis and Fibrosis Stages among Nonalcoholic Fatty Liver
Disease Patients with Type 2 Diabetes Mellitus in India: A Cross-sectional
Study. J Assoc Physicians India 2024;72(7):29–33.

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Hepatic encephalopathy can be mistaken for dementia in many cases: Study

USA: Individuals with compromised brain function could be mistakenly diagnosed with dementia instead of hepatic encephalopathy which is commonly associated with liver Cirrhosis, recent research reveals.

A study published in The American Journal of Medicine reports that the fibrosis (FIB-4) index could be utilized as a potential biomarker to investigate undiagnosed cirrhosis in patients with dementia and that hepatic encephalopathy which is associated with cirrhosis is misdiagnosed as dementia.

Dementia is an untreatable condition that affects the memory and thinking ability of an individual and these symptoms coincide with the symptoms associated with hepatic encephalopathy which is a potentially reversible condition. Around 5-10 % of patients with undiagnosed cirrhosis are mistakenly diagnosed with dementia and may have hepatic encephalopathy

Scott Silvey, Department of Population Health, Virginia Commonwealth University, and colleagues conducted a retrospective cohort study between 2009 and 2019 using the FIB – 4 index as a biomarker for screening cirrhosis in non-veteran patients with dementia.

Using national non-veteran patient data from the multi-center TriNetX database, researchers allocated 68,807 patients diagnosed with dementia at two or more physician visits. Patients had no prior diagnosis of cirrhosis. The team measured the prevalence of 2 FBI-4 index at 2 cut-off points i.e. >2.67 and >3.25 for predicting liver cirrhosis in dementia patients.

Results revealed as:

• Within the cohort (44.7% male, 78.0% white, mean age 72.73 years, 7.6% (n = 5815) had a FIB-4 index >3.25

• 12.8% (n=8683) had FIB-4 >2.67

• In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender, congestive heart failure, viral hepatitis, alcohol use disorder, and chronic kidney disease.

• FIB-4 > 3.25 is inversely associated with white race and diabetes.

In conclusion, researchers suggest that the FBI-4 index could be used for screening undiagnosed cirrhosis in patients with dementia and also hepatic encephalopathy could be mistaken for dementia because of overlapping symptoms.

Reference: Silvey S, Sterling RK, French E, Godschalk M, Gentili A, Patel N, Bajaj JS. A Possible Reversible Cause of Cognitive Impairment: Undiagnosed Cirrhosis and Potential Hepatic Encephalopathy in Patients with Dementia. Am J Med. 2024 Jun 26:S0002-9343(24)00398-X. doi: 10.1016/j.amjmed.2024.06.014. Epub ahead of print. PMID: 38942345.

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Both Low Extra-Virgin Olive Oil and Plant-Based Diet Reduce LDL More Effectively: Recipe for Heart Health

USA: A recent randomized crossover trial (Recipe for Heart Health trial) has provided new insights into how extra virgin olive oil (EVOO) affects cardiometabolic health when included in a whole-food plant-based vegan diet.

The study published in the Journal of the American Heart Association suggests reducing extra-virgin olive oil intake within a whole-food, plant-based diet may help lower LDL cholesterol levels in individuals at risk for atherosclerotic cardiovascular disease (CVD).

Whole-food, plant-based vegan diets that are low in oils, and Mediterranean diets rich in EVOO are known to lower cardiovascular disease risk factors. However, the ideal amount of dietary fat, especially EVOO, remains uncertain. Andrea M. Krenek, Food Science and Human Nutrition Department University of Florida Gainesville FL, USA, and colleagues aimed to compare the effects of consuming a high versus low amount of EVOO within a whole‐food plant‐based diet (WFPBD) vegan diet pattern on LDL‐C and other cardiometabolic markers in the Recipe for Heart Health (RFHH) trial. They hypothesized that the WFPBD would reduce LDL-C levels and that LDL-C would decrease more significantly from baseline during the low EVOO phase of the WFPBD.

For this purpose, the researchers conducted a randomized crossover trial with weekly cooking classes, adults with a cardiovascular disease risk of 5% or higher followed a whole-food, plant-based diet with extra virgin olive oil (EVOO) for four weeks each, switching between high (4 tablespoons/day) and low (<1 teaspoon/day) EVOO levels. The trial included a 1-week washout period between the two diet phases.

The primary outcome was the difference in LDL-C from baseline. Secondary outcomes included changes in other cardiometabolic markers. Linear mixed models were used to evaluate changes from baseline between diet phases, adjusting for age, sex, and changes in body weight.

The study led to the following findings:

  • In 40 participants, fat intake comprised 48% and 32% of energy during the high and low EVOO phases, respectively.
  • Both diets resulted in comparable reductions in LDL‐C, total cholesterol, apolipoprotein B, high‐density lipoprotein cholesterol, glucose, and high‐sensitivity C‐reactive protein.
  • With diet‐sequence interactions for LDL‐C, differences were detected between diets by diet order (mean high to low: Δ‐12.7mg/dL versus low to high: Δ+15.8 mg/dL).
  • Low to high order led to increased glucose, total cholesterol, and high‐density lipoprotein cholesterol.
  • Over period 1, LDL‐C reductions were −25.5 post‐low versus −16.7 mg/dL post‐high EVOO, which diminished over period 2.

“Both plant-based diet patterns improved cardiometabolic risk profiles compared to baseline diets, with more pronounced reductions in LDL-C observed after the low EVOO diet. However, adding EVOO following a period of low intake may limit further decreases in lipid levels,” the researchers concluded.

Study limitations include potential carryover effects from diet sequences despite washout periods and a short study duration, which might have missed long-term metabolic changes. Uncontrolled macronutrient distribution affects insights into EVOO’s role in appetite and fat consumption. The impact of the COVID-19 pandemic on recruitment, recall bias in dietary assessments, and inadequate food options for capturing dietary patterns are also noted. Future research should address these issues and include more diverse samples.

Reference:

Krenek AM, Mathews A, Guo J, Courville AB, Pepine CJ, Chung ST, Aggarwal M. Recipe for Heart Health: A Randomized Crossover Trial on Cardiometabolic Effects of Extra Virgin Olive Oil Within a Whole-Food Plant-Based Vegan Diet. J Am Heart Assoc. 2024 Jul 24:e035034. doi: 10.1161/JAHA.124.035034. Epub ahead of print. PMID: 39045758.

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Two narrow-diameter titanium-zirconium implants with stud-attachments tied to highly satisfactory outcome in mandible: Study

Two narrow-diameter titanium-zirconium implants with stud-attachments tied to highly satisfactory outcome in mandible, suggests a study published in the Clinical oral implants research.

To evaluate the survival rates and marginal bone loss of narrow-diameter titanium-zirconium implants supporting complete maxillary and mandibular overdentures up to 3 years after loading. Ten completely edentulous patients who were dissatisfied with their complete dentures were enrolled. Two narrow-diameter implants were placed in the canine region of the maxilla and mandible. After second-stage surgery, implant-supported overdentures (palatal-free) attached by parallel alignable stud-attachments were placed. Patients were followed periodically for up to 36 months. Standardized radiographs were taken at baseline, 12 and 36 months to analyze mean marginal bone level changes around the implants.

Results: The Kaplan-Meier survival rates were 100% for mandibular and 68.0% (SE ± 10.9%) for maxillary implants at 36 months (p = .008). Six maxillary implants failed after loading; no mandibular implants were lost. Five implants failed due to loss of osseointegration. One implant fractured. The mean marginal bone level changes around the analyzed implants (n = 28, 9 patients) were -0.71 ± 0.82 mm in the mandible and -2.08 ± 1.52 mm in the maxilla at the 36-month follow-up. The difference in marginal bone level changes between the maxilla and mandible was significant (p = .019) at the 12- and 36-month follow-ups. Two narrow-diameter titanium-zirconium implants with stud-attachments showed a highly satisfactory outcome in the mandible. The maxillary implants showed a high failure rate and significantly more bone loss over time than the mandibular implants. The minimal concept of two implants and an overdenture should be limited to the edentulous mandible.

Reference:

Kern JS, Salin E, Elvers D, Rittich A, Tuna T, Hölzle F, Wolfart S. Maxillary and mandibular overdentures retained by two unsplinted narrow-diameter titanium-zirconium implants – A clinical pilot study. Clin Oral Implants Res. 2024 Jun 1. doi: 10.1111/clr.14303. Epub ahead of print. PMID: 38822688.

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Early life antibiotic increases risk of asthma: Study provides clues to potential prevention adult asthma

Early exposure to antibiotics can trigger long term susceptibility to asthma, according to new research from Monash University. Importantly the research team isolated a molecule produced by gut bacteria that in the future could potentially be trialed as a simple treatment, in the form of a dietary supplement, for children at risk of asthma to prevent them developing the disease.

Asthma affects over 260 million people globally and causes around 455,000 deaths annually.

The research led by Professor Ben Marsland and published today (TBC) in the journal, Immunity– found a molecule, called IPA, that is crucial to long term protection against asthma.

Importantly the finding of the molecule produced by bacteria in a healthy gut provides an explanation as to why the recurrent use of antibiotics increases the risk of asthma, according to Professor Marsland. “We know that recurrent use of antibiotics early in life disrupts a person’s healthy gut microbiota and increases the risk of allergies and asthma. We have discovered that a consequence of antibiotic treatment is the depletion of bacteria that produce IPA, thus reducing a key molecule that has the potential to prevent asthma,” he said.

The first years of life are important in developing a stable gut microbiota, according to Professor Marsland. “It is shaped first by food intake – both milk and solid foods – as well as genetics, and environmental exposures. Infants at high risk of allergies and asthma have been shown to have a disrupted and delayed maturation of the gut microbiome,” he said.

“The use of antibiotics in the first year of life can have the unintentional effect of reducing bacteria which promote health, and we now know from this research that antibiotics lead to reduced IPA, which we have found is critical early in life as our lung cells mature, making it a candidate for early life prevention of allergic airway inflammation. “

Working in mice predisposed to develop asthma, the research team found that – when given antibiotics in early life – the mice were more susceptible to house-dust mite-induced allergic airway inflammation and this lasted into adulthood. Asthma is commonly triggered by exposure to house dust mite.

This susceptibility was maintained long-term, even after the gut microbiome and IPA levels returned to normal, highlighting that this molecule’s function was particularly important early in life.

When these mice had their diet supplemented with the IPA molecule early in life, the researchers found that the mice were effectively cured of developing the house dust mite induced allergic airway inflammation, or asthma, in adulthood.

Reference:

Olaf Perdijk,Alana Butler, Matthew Macowan, Nicola L. Harris, Tomasz P. Wypych, Benjamin J. Marsland, Antibiotic-driven dysbiosis in early life disrupts indole-3-propionic acid production and exacerbates allergic airway inflammation in adulthood, Immunity, DOI:https://doi.org/10.1016/j.immuni.2024.06.010.

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Post-Transplant Diabetes: A Key Risk Factor for Kidney Transplant Recipients, study reveals

UK: A study published in Diabetic Medicine revealed that post-transplant diabetes frequently occurs in individuals undergoing solid organ transplants and increases the risk of mortality and morbidity among kidney transplant recipients.

Diabetes mellitus is a chronic metabolic disorder marked by hyperglycemia due to insulin deficiency, insulin resistance, or both. It precipitates significant complications, including cardiovascular diseases, neuropathy, nephropathy, and retinopathy, necessitating meticulous management through pharmacological interventions and lifestyle modifications.

Effective management includes regular monitoring of blood glucose levels, adherence to a balanced diet, physical activity, and medication or insulin therapy. Advances in diabetes research are continually improving treatment protocols and outcomes for individuals with this condition.

Diabetes is the leading cause of end-stage kidney disease worldwide, responsible for nearly 40% of new cases needing renal replacement therapy. Managing diabetes in individuals with advanced kidney disease on renal replacement therapy presents challenges due to unique aspects of their assessment and treatment.

Standard glycemic assessment using glycated hemoglobin may not be reliable in these patients because of altered red blood cell turnover or iron/erythropoietin deficiency, which affects red blood cell longevity. Therefore, continuous glucose monitoring can be advantageous for more precise glycemic assessment and better therapy adjustment.

Tahseen A Chowdhury, Department of Diabetes, The Royal London Hospital, London, UK et. al. conducted a study to evaluate diabetes management in people with advanced chronic kidney disease.

Individuals with advanced kidney disease are at a higher risk of hypoglycemia due to several physiological factors and therapeutic options are limited due to a lack of experience or licensing. Insulin therapy is the cornerstone of treatment for those with diabetes and advanced kidney disease since many other drug classes are contraindicated.

Glycemic control targets should be tailored based on co-morbidity and frailty, and continuous glucose monitoring should be used in dialysis patients to minimize the risk of hypoglycemia. 

Post-transplant diabetes is prevalent in solid organ transplant patients and significantly increases mortality and morbidity risks for kidney transplant recipients. Therefore, screening for and managing this condition in the post-transplant period is crucial to improve patient outcomes.

Reference

Chowdhury TA, Mukuba D, Casabar M, Byrne C, Yaqoob MM. Management of diabetes in people with advanced chronic kidney disease. Diabet Med. 2024 Jul 11:e15402. doi: 10.1111/dme.15402. Epub ahead of print. PMID: 38992927.

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Fatty acids in umbilical cord blood might cause autism spectrum disorder, claims study

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects learning capability and social behavior of people. Over the past few decades, awareness regarding ASD has increased, especially regarding its prevalence and effect on the lives of people diagnosed with ASD. However, several aspects related to ASD are not well understood, leaving much to be explored.

Although the exact causes of ASD are unclear, currently available evidence points to neuroinflammation as a major factor. Several studies in mouse models of ASD have hinted at the importance of polyunsaturated fatty acids (PUFA) and their metabolites during pregnancy in playing a key role in ASD development. PUFA metabolites regulated by the cytochrome P450 (CYP) affect fetal development in mice causing impairments closely linked to ASD symptoms. However, it is still unclear if the same is true for humans and needs further investigation.

To address this knowledge gap, a research team from Japan consisting of Professor Hideo Matsuzaki from the Research Center for Child Mental Development, University of Fukui, Dr. Takaharu Hirai at the Department of Psychiatric and Mental Health Nursing, School of Nursing, University of Fukui and Dr. Naoko Umeda from the Department of Maternal and Child Health Nursing, School of Nursing, University of Fukui, analyzed the CYP-PUFA levels in neonatal umbilical cord blood samples. Their study, published on July 23, 2024 in Psychiatry and Clinical Neurosciences, sheds light on the possible causes of ASD.

Sharing the motivation behind their study, Prof. Matsuzaki explains, “CYP metabolism forms both epoxy fatty acids (EpFAs), which have anti-inflammatory effects, and dihydroxy fatty acids, or ‘diols,’ which have inflammatory properties. We hypothesized that the dynamics of CYP-PUFA metabolites during the fetal period, that is, lower EpFA levels, higher diol levels, and/or increased EpFA metabolic enzymes would influence ASD symptoms and difficulties with daily functioning in children after birth.”

To test this hypothesis, the researchers investigated the link between PUFA metabolites in umbilical cord blood and ASD scores in 200 children. The cord blood samples had been collected immediately after birth and preserved appropriately, whereas ASD symptoms and adaptive functioning were assessed when the same children were six years old, with the help of their mothers.

After careful statistical analyses of the results, the researchers identified one compound in cord blood that may have strong implications for ASD severity, namely 11,12- dihydroxyeicosatrienoic acids (diHETrE), a dihydroxy fatty acid derived from arachidonic acid.

“The levels of diHETrE, an arachidonic acid-derived diol, in cord blood at birth significantly impacted subsequent ASD symptoms in children and were also associated with impaired adaptive functioning. These findings suggest that the dynamics of diHETrE during the fetal period is important in the developmental trajectory of children after birth,” highlights Prof. Matsuzaki.

More specifically, the researchers found that higher levels of the molecule 11,12-diHETrE had an impact on social interactions, whereas low levels of 8,9-diHETrE impacted repetitive and restrictive behaviors. Moreover, this correlation was more specific for girls than for boys. This newfound knowledge could be crucial in understanding, diagnosing, and potentially preventing ASD. By measuring diHETrE levels at birth, it may be possible to predict the likelihood of ASD development in children.

“The effectiveness of early intervention for children with ASD is well established and detecting it at birth could enhance intervention and support for children with ASD,” muses Prof. Matsuzaki. He also adds that inhibiting diHETrE metabolism during pregnancy might be a promising avenue for preventing ASD traits in children, although more research will be needed in this regard.

In conclusion, these findings open a promising avenue for researchers unraveling the mysteries surrounding ASD. We hope that enhanced understanding and early diagnostics will be able to improve the lives of people with ASD and their families.

Reference:

Takaharu Hirai PhD, Naoko Umeda PhD, Taeko Harada PhD, Akemi Okumura PhD, Chikako Nakayasu BA, Takayo Ohto-Nakanishi PhD, Kenji J. Tsuchiya MD, PhD, Tomoko Nishimura PhD, Hideo Matsuzaki, Arachidonic acid-derived dihydroxy fatty acids in neonatal cord blood relate symptoms of autism spectrum disorders and social adaptive functioning: Hamamatsu Birth Cohort for Mothers and Children (HBC Study), Psychiatry and Clinical Neurosciences, https://doi.org/10.1111/pcn.13710.

 

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New compound effective against flesh-eating bacteria, finds research

Researchers at Washington University School of Medicine in St. Louis have developed a novel compound that effectively clears bacterial infections in mice, including those that can result in rare but potentially fatal “flesh-eating” illnesses. The compound could be the first of an entirely new class of antibiotics, and a gift to clinicians seeking more effective treatments against bacteria that can’t be tamed easily with current antibiotics.

The research is published in Science Advances.

The compound targets gram-positive bacteria, which can cause drug-resistant staph infections, toxic shock syndrome and other illnesses that can turn deadly. It was developed through a collaboration between the labs of Scott Hultgren, PhD, the Helen L. Stoever Professor of Molecular Microbiology, and Michael Caparon, PhD, a professor of molecular microbiology, and Fredrik Almqvist, a professor of chemistry at the University of Umeå in Sweden.

A new type of antimicrobial would be good news for clinicians seeking effective treatments against pathogens that are becoming more resistant to currently available drugs, and thus much more dangerous.

“All of the gram-positive bacteria that we’ve tested have been susceptible to that compound. That includes enterococci, staphylococci, streptococci, C. difficile, which are the major pathogenic bacteria types,” said Caparon, the co-senior author. “The compounds have broad-spectrum activity against numerous bacteria.”

It’s based on a type of molecule called ring-fused 2-pyridone. Initially, Caparon and Hultgren had asked Almqvist to develop a compound that might prevent bacterial films from attaching to the surface of urethral catheters, a common cause of hospital-associated urinary tract infections. Discovering that the resulting compound had infection-fighting properties against multiple types of bacteria was a happy accident.

The team named their new family of compounds GmPcides (for gram-positive-icide). In past work, the authors showed that GmPcides can wipe out bacteria strains in petri dish experiments. In this latest study, they decided to test it on necrotizing soft-tissue infections, which are fast-spreading infections usually involving multiple types of gram-positive bacteria, for which Caparon already had a working mouse model. The best known of these, necrotizing fasciitis or “flesh-eating disease,” can quickly damage tissue severely enough to require limb amputation to control its spread. About 20% of patients with flesh-eating disease die.

This study focused on one pathogen, Streptococcus pyogenes, which is responsible for 500,000 deaths every year globally, including flesh-eating disease. Mice infected with S. pyogenes and treated with a GmPcide fared better than did untreated animals in almost every metric. They had less weight loss, the ulcers characteristic of the infection were smaller, and they fought off the infection faster.

The compound appeared to reduce the virulence of the bacteria and, remarkably, speed up post-infection healing of the damaged areas of the skin.

It is not clear how GmPcides accomplish all of this, but microscopic examination revealed that the treatment appears to have a significant effect on bacterial cell membranes, which are the outer wrapping of the microbes.

“One of the jobs of a membrane is to exclude material from the outside,” Caparon said. “We know that within five to ten minutes of treatment with GmPcide, the membranes start to become permeable and allow things that normally should be excluded to enter into the bacteria, which suggests that those membranes have been damaged.”

This can disrupt the bacteria’s own functions, including those that cause damage to their host, and make the bacteria less effective at combating the host’s immune response to infections.

In addition to their antibacterial effectiveness, GmPcides appear to be less likely to lead to drug-resistant strains. Experiments designed to create resistant bacteria found very few cells able to withstand treatment and thus pass on their advantages to the next generation of bacteria.

Caparon explained that there is a long way to go before GmPcides are likely to find their way into local pharmacies. Caparon, Hultgren and Almqvist have patented the compound used in the study and licensed it to a company, QureTech Bio, in which they have an ownership stake, with the expectation that they will be able to collaborate with a company that has the capacity to manage the pharmaceutical development and clinical trials to potentially bring GmPcides to market.

Hultgren said that the kind of collaborative science that created GmPcides is what is needed to treat intractable problems like antimicrobial resistance.

“Bacterial infections of every type are an important health problem, and they are increasingly becoming multi-drug resistant and thus harder to treat,” he said. “Interdisciplinary science facilitates the integration of different fields of study that can lead to synergistic new ideas that have the potential to help patients.”

Reference:

Dihydrothiazolo ring-fused 2-pyridone antimicrobial compounds treat Streptococcus pyogenes skin and soft tissue infection Zongsen Zou, Chloe L. P. Obernuefemann, Pardeep Singh, Jerome S. Pinkner, Wei Xu, Taylor M. Nye, Karen W. Dodson, Fredrik Almqvist, Scott J. Hultgren, Michael G. Caparon bioRxiv 2024.01.02.573960; doi: https://doi.org/10.1101/2024.01.02.573960.

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Couvelaire uterus linked to adverse maternal outcomes but not neonatal ones, claims study

According to researchers in a recently published study the presence of a Couvelaire uterus during placental abruption is a predictor of worse maternal outcomes but has no significant effect on neonatal outcomes. The study was published in the International Journal of Obstetrics and Gynecology by Kazuya and colleagues. This was a single-center retrospective study done at a tertiary perinatal center in Japan, which aimed to show maternal and neonatal outcomes based on the presence or absence of a Couvelaire uterus.

The study involved patients who were diagnosed with acute placental abruption, gave live birth by cesarean section from 2016 to 2023, and were divided according to whether a Couvelaire uterus was or was not present during surgery into the Couvelaire group and the normal uterus group. Parameters studied in regard to maternal and neonatal outcomes included the effect of Couvelaire uterus on them.

A total of 76 patients were included in the study, with 24 in the Couvelaire group and 52 in the normal uterus group. Key findings include:

  • Intraoperative blood loss was significantly higher in the Couvelaire group (median 1152g vs 948g, P=0.010).

  • Blood transfusion rates were higher in the Couvelaire group (58% vs 31%, P=0.022).

  • Fibrinogen administration rates were higher in the Couvelaire group (38% vs 13%, P=0.038).

  • Intensive care unit/high care unit admission rates were higher in the Couvelaire group (29% vs 7.7%, P=0.013).

  • Disseminated intravascular coagulation complication rates were higher in the Couvelaire group (25% vs 7.7%, P=0.038).

  • There were no significant differences between the two groups in neonatal outcomes, including birth weight (median 2387g vs 2065g, P=0.082), Apgar score <4 at 5 minutes (4.2% vs 3.9%, P=0.95), umbilical artery blood pH <7.1 (25% vs 22%, P=0.82), and neonatal death (4.2% vs 1.9%, P=0.57).

Results suggest that the presence of a Couvelaire uterus in placental abruption should alert the health professional to possible adverse maternal outcomes, with preparation required for blood transfusions and intensive monitoring of the patient. After all, despite the increased risks to the mother, neonatal outcome was unaffected. Therefore, proper management may minimize its effect on the newborn.

This study found that in cases of placental abruption, a Couvelaire uterus was associated with poor maternal outcomes; therefore, thorough preparation and close monitoring in that regard are very essential. Neonatal outcomes, however, were not that much affected, raising the need for individual maternal care in order to optimize outcomes.

Reference:

Hiiragi, K., Obata, S., Miyagi, E., & Aoki, S. (2024). Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.15821

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Synthetic slings show better operative outcomes and fewer complications among females undergoing suburethral sling surgery: Study

Synthetic slings show better operative outcomes and fewer complications among females undergoing suburethral sling surgery suggests a study published in the American Journal of Obstetrics and Gynecology.

This study aimed to systematically review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator).

They systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered). They double-screened studies and used backward citation chaining. They included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of retropubic or transobturator synthetic vs nonsynthetic (autologous, allograft, or xenograft) slings for female stress or mixed urinary incontinence, with available English or French full texts. We excluded minislings (single insertion point). We allowed slings for recurrent stress or mixed urinary incontinence, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. They excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings. They evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. They used pooled relative risk with 95% confidence intervals to estimate the effect of sling material type on each outcome through meta-analysis and meta-regression, as appropriate. Results: They screened 4341 abstracts, assessed 104 full texts, and retained 35 articles (30 separate studies). For retropubic synthetic vs nonsynthetic slings, there was no difference in the number of objectively or subjectively continent patients. The rates of reoperation for stress urinary incontinence and overall were higher with nonautologous retropubic slings than with synthetic slings. Compared with autologous slings, retropubic synthetic slings were associated with higher subjective continence in populations with ≥25% recurrent stress urinary incontinence (relative risk, 1.27; 95% confidence interval, 1.12–1.43). There were no differences in continence between transobturator synthetic and nonsynthetic slings. Subjective satisfaction was better in the transobturator synthetic group than in the autologous sling group (relative risk, 1.42; 95% confidence interval, 1.03–1.94). Synthetic and nonsynthetic slings have comparable objective and subjective success, with synthetic materials generally showing better operative outcomes and fewer complications.

Reference:

Maryse Larouche, Mei Mu Zi Zheng, Emily C. Yang, Rea Konci, Eric Belzile, Prubjot Kaur Gill, Roxana Geoffrion. Synthetic vs nonsynthetic slings for female stress and mixed urinary incontinence: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. Volume 231, Issue 2, 2024. Pages 166-186.e8. ISSN 0002-9378. https://doi.org/10.1016/j.ajog.2024.02.306.

(https://www.sciencedirect.com/science/article/pii/S0002937824004204)

Keywords:

Synthetic, slings, show, better, operative, outcomes, fewer, complications, among, females, undergoing, suburethral, sling, surgery, study, American Journal of Obstetrics and Gynecology, autologous fascia; mixed urinary incontinence; retropubic sling; stress urinary incontinence; synthetic; transobturator sling, Maryse Larouche, Mei Mu Zi Zheng, Emily C. Yang, Rea Konci, Eric Belzile, Prubjot Kaur Gill, Roxana Geoffrion

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