Late Gadolinium Enhancement Helps Predict Sudden Cardiac Death in Youth with Hypertrophic Cardiomyopathy: Study

A recent multicenter study has found that late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging can predict the risk of sudden cardiac death (SCD) in children and adolescents with hypertrophic cardiomyopathy (HCM). This can significantly improve risk stratification for younger patients and increases the ability to identify high-risk patients and potentially guide early interventions. The study results were published in the journal JAMA Cardiology. 

Hypertrophic cardiomyopathy is a genetic heart condition and is one of the leading causes of sudden cardiac death in young people. It is marked by abnormal thickening of the heart muscle. Previous research shows that LGE has been associated with SCD events in adults with HCM, but its prognostic value in younger populations is uncertain. Hence, researchers conducted a study to examine the prognostic significance of LGE in patients with HCM who are younger than 21 years.

Also Read: Vutrisiran offers new lifeline to patients with transthyretin amyloidosis with cardiomyopathy: Study

A multicenter, retrospective cohort study was conducted from April 2015 to September 2022 at 37 international sites in the US, Europe, and South America. The study included 700 patients less than 21 years of age diagnosed with HCM who underwent CMR imaging. The observers were masked from the outcomes and the demographic data for objective analysis. The primary outcome of measurement was to assess the prognostic significance of LGE in predicting SCD or equivalent events, such as resuscitated cardiac arrest or appropriate shocks from implantable defibrillators. 

Key Findings

  • The study’s findings are significant. 
  • During a follow-up period of 1.9 years, 35 individuals experienced SCD or other similar events. 
  • Out of the 700 patients, 230 (32.9%) had evidence of LGE in the left ventricular myocardium, with an average burden of 5.9%.
  • The presence and extent of LGE were more pronounced in older patients and those with greater left ventricular mass and wall thickness.
  • Furthermore, patients with LGE showed signs of declining cardiac function, with lower left ventricular ejection fractions and larger left atrial diameters.
  • The study demonstrated that patients with LGE had a higher likelihood of SCD, even when controlling for other existing risk factors.
  • Notably, those with 10% or more LGE relative to total myocardium had more than double the risk of SCD (hazard ratio [HR] 2.19), suggesting a direct correlation between the extent of LGE and SCD risk.
  • The addition of LGE burden to existing risk prediction models significantly improved their accuracy by improving the performance of the widely used HCM Risk-Kids score that increased from 0.66 to 0.73.
  • The Precision Medicine in Cardiomyopathy score improved from 0.68 to 0.73 suggesting the importance of LGE as a valuable tool in refining current risk assessment methods for young HCM patients.
Also Read: Metformin Associated with Lower Mortality Rates in Diabetes Patients With Heart Failure: Study

Thus, the study concluded that LGE is a critical marker for assessing SCD risk in children and adolescents with HCM. Quantitative LGE enhanced the predictive power of existing risk models and was a risk factor for SCD. This information could be pivotal in improving clinical management, leading to more personalized care for young HCM patients at high risk of sudden cardiac death.

Further reading: Chan RH, van der Wal L, Liberato G, et al. Myocardial Scarring and Sudden Cardiac Death in Young Patients With Hypertrophic Cardiomyopathy: A Multicenter Cohort Study. JAMA Cardiol. Published online September 25, 2024. doi:10.1001/jamacardio.2024.2824

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Oral Corticosteroids Significantly Reduce Hospital Stay and Improve Early Preschool Wheeze: Study

In a study reported in The Lancet: Respiratory Medicine, Bohee Lee and colleagues provided evidence that oral corticosteroids decreased hospitalization time and offered early alleviation of symptoms among children aged 12-71 months who suffered from acute preschool wheeze. Corticosteroids demonstrated marked benefits, particularly during the first several hours after its intake in a systematic review and IPD meta-analysis that was performed. Hence, the research stresses that oral corticosteroids, despite previously conflicting evidence, could actually be clinically useful treatment, particularly in children with a history of wheezing or asthma.

Wheeze is a common preschool condition that leads to frequent emergency visits and hospitalizations. Oral corticosteroids are widely prescribed for this condition, yet previous studies have presented conflicting results regarding their effectiveness. The objective of the study was to establish the effectiveness of oral corticosteroids in managing acute preschool wheeze through the critical review of all available randomized controlled trials conducted from 1994 to 2020. The primary outcome measure was the change in WSS; the secondary outcome measure was hospital stay length. Finally, the adverse events due to corticosteroid use were also evaluated.

This systematic review with an IPD meta-analysis searched PubMed, Embase, and WHO Clinical Trials Registry from 1st January 1994 to 30th June 2020. Randomized controlled trials included in this study were all those that compared oral corticosteroids with a placebo among 12-71-month-old children with acute preschool wheeze. A total of 12 trials were found eligible after searching through 16,102 studies and then subsequently screening them. Individual data from 2,172 children of seven trials were available for the review; of those, 1,728 finally participated in the analysis.

Children were randomized to either oral corticosteroids, n=853, 63.8% male, and placebo, n=875, 66.6% male. Analyses were done by one-stage and two-stage meta-analysis with a random-effects model. WSS at 4 and 12 hours after commencing treatment was the primary outcome measure; secondary outcome measures included length of stay and occurrence of any adverse events, including vomiting.

Key Findings

• At 4 hours after treatment, the corticosteroids group showed a significant improvement in WSS compared to the placebo group, with a mean difference of -0.31 (95% CI: -0.38 to -0.24; p=0.011).

• No significant difference was observed at 12 hours (mean difference -0.02, 95% CI: -0.17 to 0.14; p=0.68). The low heterogeneity across studies (I²=0%) reinforces the consistency of this result.

• Oral corticosteroids led to a substantial reduction in hospital stay by an average of -3.18 hours (95% CI: -4.43 to -1.93; p=0.0021; I²=0%).

• Subgroup analysis indicated that this effect was most pronounced in children with a history of wheezing or asthma, where the reduction reached -4.54 hours (95% CI: -5.57 to -3.52; pinteraction=0.0007).

• While adverse events were infrequently reported (in only four of the seven datasets), there was an increased risk of vomiting associated with corticosteroid use (odds ratio 2.27, 95% CI: 0.87 to 5.88). The low heterogeneity (I²=0%) supports the reliability of these findings.

• Six of the seven datasets were found to have a low risk of bias, ensuring the robustness of the study’s conclusions.

There is clear evidence from the study that oral corticosteroids provide early symptomatic relief and decrease hospitalization for children with acute preschool wheeze, particularly in those who have had prior episodes of wheezing or asthma. The WSS improvement data at 4 hours indicates that corticosteroids act quickly, but with their effect waning by the 12-hour mark. The importance of this finding cannot be underestimated in an emergency setting, whereby rapid control of symptoms can impact decisions regarding further treatment and outcome.

This meta-analysis of IPD therefore confirms that oral corticosteroids have a beneficial effect on the management of acute preschool wheeze by reducing early symptoms and hospital stay. Corticosteroids should, therefore, be considered more in children with previous wheezing or asthma, where their effect is much more prominent. The findings of this study may influence guidelines in the future and lead to an improved approach to treatment for preschool wheeze.

Reference:

Lee, B., Turner, S., Borland, M., Csonka, P., Grigg, J., Guilbert, T. W., Jartti, T., Oommen, A., Twynam-Perkins, J., Lewis, S., & Cunningham, S. (2024). Efficacy of oral corticosteroids for acute preschool wheeze: a systematic review and individual participant data meta-analysis of randomised clinical trials. The Lancet. Respiratory Medicine, 12(6), 444–456. https://doi.org/10.1016/s2213-2600(24)00041-9

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Non-metallic implants effective in fixing subcutaneous bone in patellar fractures, reveals research

A new study published in the recent issue of Frontiers of Surgery showed that the non-metallic implants are effective and can be used to treat patella fractures. In orthopedic surgery, patella fractures make up 1% of skeletal fractures. The majority of fractures are comminuted with considerable articular involvement and simple two-part patella fractures are rare. In the past, patella fractures were treated using a tension band approach by utilizing cerclage wire. The drawbacks of this method include soft-tissue irritation, implant migration, and breaking, which can result in up to 37% of patients needing to have a secondary implant removed.

More recent techniques for fixation like the cannulated screws, hook plates, mesh plates, and locking plates, appear promising but are expensive and need a thorough dissection of soft tissues. Suture tape and sutures have been added to patellar fixation procedures by a number of studies, with positive results. In order to treat common patella fracture types, such as AO 34C1.1 (transverse), AO 34C2 (transverse and split), and 34C3 (comminuted), this research by Wie Jie Tee and team suggested a unique all-suture tape approach. 

Technique:

  • The patient is fully extended in a supine position.
  • Anterior midline standard procedure is used.
  • Cerclage wire is substituted with non-absorbable suture tapes after the fracture fragments have been reduced and secured with K-wires.
  • The tapes are passed through the soft tissue several times, forming loops that are subsequently tensioned to compress the fracture pieces.
  • Using extra suture tapes, a tension band fixation is created to finish the procedure.

Reduced operational time, less soft-tissue dissection, and a decreased chance of implant prominence and discomfort are just a few advantages of this approach that were expected. Due to the suture tape’s exceptional tensile strength and little tissue reactivity, problems and the need for additional procedures are decreased. Early findings from two instances indicate union established at 3 months without problems, with patients recovering full range of motion.

Overall, this study provides evidence that non-metallic implants can be used to treat patella fractures. This technique yields encouraging outcomes that points to a possible change in fracture fixing techniques. More dedicated investigations and bigger cohort studies are required to confirm these results.

Source:

Tee, W. J., Yeo, K. S. A., Chua, D. T. C., & Moo, I. H. (2024). Novel technique for comminuted patellar fixation using suture tape in spiderweb configuration. In Frontiers in Surgery (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fsurg.2024.1377921

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Single implant supported prosthesis viable treatment strategy in female patients with primary Sjogren’s syndrome

Single implant supported prosthesis viable treatment strategy in female patients with primary Sjogren’s syndrome suggests a study published in the Clinical Oral Implants Research.

Primary Sjögren’s syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren’s syndrome. They hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration. Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020.

The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment. Results: They included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group.

All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026). Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

Reference:

Hosseini, M., Jensen, S., Gotfredsen, K., Hyldahl, E. and Pedersen, A. (2024), Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren’s Syndrome: A Five-Year Prospective Clinical Study. Clin Oral Impl Res. https://doi.org/10.1111/clr.14356

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Glucagon test useful alternative to insulin tolerance test in Diagnosing GH Deficiency in Transition Age, finds research

Italy: A recent study published in The Journal of Clinical Endocrinology & Metabolism has shed light on the accuracy of glucagon testing across transition in young adults with childhood-onset growth hormone deficiency (GHD).

The study showed that a GH peak to glucagon test (GST) <5.8 μg/L is an accurate diagnostic cutoff for young adults with childhood-onset GHD and a high pretest probability of permanent GHD.

Our data confirm GST to be a safe alternative to insulin tolerance test (ITT) for evaluating GH secretion in young adults with childhood-onset GHD following attainment of adult height and that patients who demonstrated peak GH < 5.8 μg/L can restart rhGH therapy, the researchers wrote.

The insulin tolerance test is the “gold standard” for GHD confirmation following the attainment of adult stature, and a GH threshold of 6 μg/L or less is recommended to determine whether GHD continues at the time of transition to adult care. However, ITT is not suited for patients with epilepsy, seizures, or cardiovascular or cerebrovascular disease. While the GST could be an alternative form of GH stimulation for determining the need for ongoing GH therapy into adulthood, there is no confirmation of diagnostic cutoffs for this test in clinical practice.

The 2019 American Association of Clinical Endocrinologists guidelines indicate peak GH cutoffs to GST of ≤3, and ≤1 µg/L in permanent GHD diagnosis during the transition phase. Considering this, Daniela Fava, Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy, and colleagues aimed to evaluate the accuracy of GST compared to insulin tolerance test in the definition of GHD at adult height achievement.

The study included ninety-seven subjects with childhood-onset GHD (median age, 17.39 years). They underwent ITT, GST, and IGF-1 testing; 44 subjects were idiopathic (isolated GHD), 35 moderate organic GHD (0-2 hormone deficiencies), and 18 severe organic GHD (≥3 hormone deficiencies).

The study led to the following findings:

  • Bland and Altman’s analysis showed a high consistency of GH peak measures after ITT and GST.
  • Receiver operating characteristic analysis identified 7.3 μg/L as the optimal GH peak cutoff to GST [sensitivity 95.7%, specificity 88.2%, positive predictive value (PPV) 88.0%, negative predictive value (NPV) 95.7%] able to correctly classify 91.8% of the entire cohort while 5.8 μg/L was the best GH peak cutoff able to correctly classify 91.4% of moderate organic GHD patients (sensitivity 96.0%, specificity 80.0%, PPV 92.3%, NPV 88.9%).
  • Patients with ≥3 hormone deficiencies showed a GH peak <5 μg/L at ITT and <5.8 μg/L at GST but 1.
  • The optimal cutoff for IGF-1 was a −1.4 SD score (sensitivity 75%, specificity 94%, PPV 91.7%, NPV 81.0%) that correctly classified 85.1% of the study population.

Based on the results, the researchers propose to retest with GST all childhood onset-GHD patients with organic GHD (congenital anomalies, brain tumors, irradiation to the pituitary/hypothalamic region) with 0, 1, or 2 pituitary hormone defects with IGF-1≥ −2 SDS, and patients with idiopathic GHD with IGF-1 < 0 SDS.

Reference:

Fava, D., Guglielmi, D., Pepino, C., Angelelli, A., Casalini, E., Varotto, C., Panciroli, M., Tedesco, C., Camia, T., Naim, A., Allegri, A. E., Patti, G., Napoli, F., Gastaldi, R., Parodi, S., Salerno, M., Maghnie, M., & Di Iorgi, N. Accuracy of Glucagon Testing Across Transition in Young Adults With Childhood-Onset GH Deficiency. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae408

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NEJM: Results from targeted therapy for ulcerative colitis study

An international placebo-controlled study led by Cedars-Sinai suggests that a targeted drug therapy that was developed by researchers at Cedars-Sinai is safe and effective at helping people with moderate to severe ulcerative colitis reach clinical remission.

Results from the multicenter Phase II study, ARTEMIS-UC, were published in The New England Journal of Medicine.

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that damages the digestive tract, causing stomach cramping, diarrhea, weight loss and rectal bleeding. It affects as many as 900,000 people in the U.S., and current treatments are often only minimally effective.

“Findings from this study are poised to have a remarkable impact on treatment for ulcerative colitis and IBD overall,” said study senior author and IBD research pioneer Stephan Targan, MD, the Feintech Family Chair in Inflammatory Bowel Disease and executive director of the F. Widjaja Inflammatory Bowel Disease Institute at Cedars-Sinai. “The investigational therapy was generated based on the concept of precision medicine; it shows promise as being both anti-inflammatory and anti-fibrotic; it represents a potential turning point in drug development and discovery; and it could change how this complex disease is treated in the future.”

The study evaluated a therapy developed by Cedars-Sinai clinician-scientists called tulisokibart (previously PRA023)-a man-made monoclonal antibody that acts like endogenous antibodies. It is designed to target and block a protein called TL1A, which can contribute to the severity of ulcerative colitis. The antibody reduces inflammation and targets fibrosis, which causes many of the complications and severity of disease.

“Unlike other IBD treatments that can exacerbate inflammation or suppress the body’s natural anti-inflammatory responses, our findings suggest that tulisokibart modulates inflammation and the body’s anti-inflammatory mechanisms,” Targan said. “This dual action could lead to more balanced and effective management of ulcerative colitis.”

Notably, the role of TL1A as a master regulator of inflammation was discovered by Targan and collaborators at Cedars-Sinai. In groundbreaking work spanning two decades, the researchers found that while TL1A protects against invading pathogens, at high levels it also contributes to inflammation and fibrosis in IBD.

ARTEMIS-UC was a 12-week study involving 178 adults from 14 countries. It also included a genetic-based companion diagnostic test to help predict response to the therapy.

A Phase III study will further examine safety and test effectiveness of tulisokibart in patients who take it longer than 12 weeks.

Clinician-scientist and geneticist Dermot McGovern, MD, PhD, director of Translational Research in the F. Widjaja Inflammatory Bowel Disease Institute at Cedars-Sinai and one of the study authors, has focused his career on identifying genetic variants associated with ulcerative colitis and other autoimmune diseases, exploring drug targets and working to revolutionize treatment through a precision medicine approach.

Nearly 20 years ago at Oxford University, McGovern and colleagues, in the first-ever genome-wide association study in IBD, identified that a variation in the TNF superfamily 15 (TNFSF15) gene was associated with developing both ulcerative colitis and Crohn’s disease. The protein TL1A, simultaneously being studied by Targan at Cedars-Sinai, is encoded by TNFSF15. McGovern left Oxford to collaborate with Targan and team at Cedars-Sinai in the effort to bring scientific breakthroughs to IBD.

“Findings from the ARTEMIS-UC study exemplify how combining genetics and biology can transform IBD care,” said McGovern, the Joshua L. and Lisa Z. Greer Chair in Inflammatory Bowel Disease Genetics and the director of Precision Health at Cedars-Sinai.

McGovern, who was recently awarded the prestigious Sherman Prize for his pioneering work in advancing understanding of the genetic architecture of IBD in diverse populations, says the uniqueness of this target and the way tulisokibart was designed to interact with that target represent significant advancements in how clinicians approach IBD treatment.

“Previously we have only been able to prescribe a medication to a patient that we think will work well, but going forward we could imagine telling the patient, ‘Actually, the genetic test suggests that you would be more likely to respond to this therapy,’” McGovern said.

Targan and McGovern also noted that ARTEMIS-UC involved multiple countries and diverse populations, reflecting the global nature of IBD. The F. Widjaja Inflammatory Bowel Disease Institute has invested significant resources in extending genetic research in IBD to diverse populations.

“It’s taken a village-supported by Cedars-Sinai’s integrated science culture-to reach this point,” said Targan, a 2017 recipient of the Sherman Prize. “We’ve devoted our careers to getting better treatments to IBD patients, and now we’re closer than ever to helping all patients with ulcerative colitis get their disease into remission so they can get back to enjoying life.”

Reference:

Bruce E. Sands, Brian G. Feagan, Laurent Peyrin-Biroulet, Silvio Danese, Phase 2 Trial of Anti-TL1A Monoclonal Antibody Tulisokibart for Ulcerative Colitis, New England Journal of Medicine, DOI: 10.1056/NEJMoa2314076.

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Early postoperative feeding in kids after GA associated with shorter duration of hospital stay, finds research

The guidelines for perioperative care in neonatal intestinal surgery known as the Early Recovery After Surgery recommend initiating early enteral feeds for pediatric patients as soon as possible. However, the specific timing for when pediatric patients should resume oral intake after surgery remains unclear. Recent randomized controlled trial compared the effects of early oral feeding (EF) versus conventional feeding (CF) on postoperative outcomes in children undergoing daycare surgery under general anesthesia. The study included 300 children (150 in each group) and assessed the occurrence of postoperative nausea and vomiting (PONV), postoperative pain, duration of hospital stay, and parental satisfaction.

Comparison of PONV Incidence and Pain Scores

The results showed that the incidence of PONV was similar between the two groups, with 12% in the EF group and 18.7% in the CF group (p=0.109). However, the EF group had significantly lower Face, Legs, Activity, Cry, Consolability (FLACC) pain scores at 0 minutes, 30 minutes, and 1 hour postoperatively compared to the CF group.

Duration of Hospital Stay and Parental Satisfaction

Patients in the EF group had a significantly shorter duration of hospital stay, with a mean of 6.31 hours compared to 10.13 hours in the CF group (p<0.001). Parents of children in the EF group also had significantly better satisfaction scores compared to the CF group (p<0.001). The study concluded that early postoperative feeding in children undergoing lower abdominal, non-gastrointestinal surgery under general anesthesia does not increase the incidence of PONV. Furthermore, early feeding was associated with reduced postoperative pain, shorter hospital stay, and higher parental satisfaction. The authors suggest that early postoperative feeding can be safely implemented in this patient population without increasing the risk of adverse events.

Key Points

Based on the provided research paper, the 6 key points are:

1. The study was a randomized controlled trial that compared the effects of early oral feeding (EF) versus conventional feeding (CF) on postoperative outcomes in children undergoing daycare surgery under general anesthesia.

2. The study assessed the occurrence of postoperative nausea and vomiting (PONV), postoperative pain, duration of hospital stay, and parental satisfaction.

3. The incidence of PONV was similar between the EF and CF groups, with 12% in the EF group and 18.7% in the CF group.

4. The EF group had significantly lower Face, Legs, Activity, Cry, Consolability (FLACC) pain scores at 0 minutes, 30 minutes, and 1 hour postoperatively compared to the CF group.

5. Patients in the EF group had a significantly shorter duration of hospital stay, with a mean of 6.31 hours compared to 10.13 hours in the CF group.

6. Parents of children in the EF group had significantly better satisfaction scores compared to the CF group.

Reference –

Singh R, Huligeri HS, Singh P. A randomized controlled trial to compare the occurrence of postoperative nausea and vomiting in early versus conventional feeding in children undergoing daycare surgery under general anaesthesia. Indian J Anaesth 2024;68:815‑20

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Nasal mupirocin therapy post endoscopic sinus surgery does not reduce symptom recurrence: Study

A recent study published in the Iranian Journal of Otorhinolaryngology showed that nasal mupirocin therapy after endoscopic sinus surgery is not effective in reducing symptom recurrence in persistent rhinosinusitis with nasal polyps. In order to reduce the load of symptoms and future interventions for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), modern therapies often involve multi-modality therapy, which includes endoscopic sinus surgery (ESS) followed by ongoing appropriate medical therapy.

The pathophysiology of CRSwNP involves both immunologic processes and genetic predisposition. Asthma, allergy, and aspirin-exacerbated respiratory disease (AERD) appear to play a part in the development of CRSwNP. The most common medical treatments are intranasal and systemic corticosteroids, while functional endoscopic sinus surgery (FESS) is utilized for individuals who do not respond to conventional medications. Thus, Mohebbi and colleagues examined the potential benefits of a topical mupirocin ointment administered in the nasal vestibule for reducing the recurrence of symptoms and enhancing the efficacy of functional endoscopic sinus surgery.

A clinical trial comprised patients with nasal polyps, a positive nostril culture for Staphylococcus aureus, and chronic rhinosinusitis. Application of mupirocin ointment on the right nostril was designated as the intervention group, while application of vitamin A ointment to the left nostril was designated as the control group. At the time of diagnosis and 6 months later, Lund-Mackay radiological scores and Lund-Kennedy endoscopic scores were evaluated.

91% of the 60 patients with nasal polyps and chronic rhinosinusitis tested positive for Staphylococcus aureus in their nostrils. A substantial improvement following surgery was shown when the follow-up values in both groups were compared to the average of the diagnostic radiological and endoscopic scores (P-value=0.001, 0.001). The endoscopic and radiological score enhancements did not, however, differ significantly among the study as well as control groups (P-value > 0.56, 0.74).

Overall, after endoscopic nasal surgery, the use of mupirocin ointment twice a day in the nostrils of CRSwNP patients does not appear to have a substantial impact on the surgical result. Given the chance of gram negative pathogenic bacterial development, the administration of mupirocin in these individuals should be considered. It is advised that more research be done with a bigger sample size to examine the effectiveness of mupirocin and other topical antibiotics in preventing relapse in patients with CRSwNP.

Source:

Mohebbi, A., Mohsenian, M., Elahi, M., & Minaeian, S. (2024). Mupirocin Ointment Effect on Polyposis Recurrence After Sinus Surgery. Iranian Journal of Otorhinolaryngology, 36(5), 573-580. https://doi.org/10.22038/ijorl.2024.70685.3405

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Higher Circulating Lymphocytes and Incidence of Pre-eclampsia and Eclampsia

Pre-eclampsia and eclampsia are two of the most serious
acute multisystemic disorders during pregnancy and are significant determinants
of maternal and neonatal mortality on a global scale. Pre-eclampsia is
associated with an elevated susceptibility to adverse pregnancy outcomes, such
as preterm birth and intrauterine growth restriction, thereby amplifying the
risk of low birth weight. Furthermore, it is intricately linked to serious
maternal and neonatal health complications, including chronic hypertension,
maternal end-stage renal disease, and neonatal pulmonary dysplasia. The precise
etiology of pre-eclampsia remains elusive, although our current understanding
suggests that women afflicted with pre-eclampsia exhibit increased uterine
artery resistance due to impaired immune regulation. This, in turn, contributes
to the activation of the maternal endothelium and the onset of systemic chronic
inflammation. Multiple studies have found that immune cells change
significantly in women with pre-eclampsia.

Mendelian randomization (MR) presents a robust means to
investigate the causal relationship between immune cells and pre-eclampsia by
genetic variants (single nucleotide polymorphisms (SNPs)), and it is also less
susceptible to the shortcomings of classical epidemiological studies, such as
confounding bias, information bias, and selection bias. Recently, the
application of MR has gained significant traction in elucidating the causal
link between immune cells and various diseases such as hypertension, amyotrophic
lateral sclerosis and multiple sclerosis. In this study, authors utilized MR
and colocalization analysis to investigate the potential causal association
between immune cells and pre-eclampsia.

For exposure, authors extracted genetic variants associated
with immune cell-related traits, and for outcomes, they used summary genetic
data of pre-eclampsia/eclampsia. A two-sample Mendelian randomization (MR)
analysis was then performed to assess the causal relationship.

Study found that genetically proxied circulating lymphocyte
absolute count was causally associated with total eclampsia (odds ratio OR = 1
53, 95% confidence interval (CI) (1.31-1.79), p = 1 15E − 07) and pre-eclampsia
(OR = 1 50, 95% CI (1.28-1.77), p = 9 18E − 07); T cell absolute count was
causally associated with total eclampsia (OR = 1 49, 95% CI (1.28-1.73), p = 2
73E − 07) and pre-eclampsia (OR = 1 47, 95% CI (1.25-1.72), p = 1 76E − 06).
And CD28- CD25+ CD8+ T cell absolute count was causally associated with total
eclampsia (OR = 1 83, 95% CI (1.44-2.32), p = 7 11E − 07) and pre-eclampsia (OR
= 1 77, 95% CI (1.38-2.26), p = 6 55E − 06).

Study findings collectively demonstrate significant
associations between genetically predicted lymphocyte and T cell count and the
risk of pre-eclampsia, as well as the combined occurrence of pre-eclampsia and
eclampsia. A complex interplay of acquired, genetic, and immune risk factors
collectively contributes to the onset of early placental dysfunction, and many
researchers believe that an abnormal maternal immune response to the fetus is the
initiating factor in the development of eclampsia. Moreover, this process
involves cells of the innate and adaptive immune systems, including
neutrophils, monocytes, natural killer (NK) cells, and T lymphocytes. This
dysfunction also triggers the release of antiangiogenic factors ultimately
culminating in subsequent multiorgan dysfunction.

This study demonstrated a causal relationship between
lymphocyte and T cell count and pre-eclampsia and the combination of
pre-eclampsia and eclampsia. Based on these findings, authors suggest that
routine blood examinations should be incorporated into the clinical evaluation
of pregnant woman more frequently. In addition, lymphocyte and T cell counts
should be monitored in patients with pre-eclampsia and eclampsia. However, additional
investigations are imperative to corroborate and validate these findings, in
order to evaluate their robustness and generalizability.

Source: Qiuping Zhao, Rongmei Liu, Hui Chen; Hindawi Journal
of Pregnancy Volume 2024, Article ID 8834312, 7 pages https://doi.org/10.1155/2024/8834312

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Low Serum Uric Acid may Help Predict Recurrence among acute ischemic stroke patients : Study

A recent study highlighted the potential significance of renal function-normalized serum uric acid (SUA) levels in predicting stroke outcomes, particularly in patients with acute ischemic stroke (AIS). While the relationship between serum uric acid and stroke outcomes has been debated due to its dependence on renal clearance, this research introduces the ratio of SUA to serum creatinine (SUA/SCr) as a promising predictor of stroke recurrence over a one-year period.

This prospective, multicenter observational study explored the association between SUA/SCr levels and the outcomes of stroke patients over one year. This research followed 2,294 patients with AIS and monitored them for stroke recurrence, all-cause mortality and overall prognosis. The study assessed how SUA/SCr levels correlated with these critical outcomes by using multivariable Cox regression analyses and restriction cubic splines.

The findings were particularly compelling in regard to stroke recurrence. The study revealed that for every one-unit increase in SUA/SCr, there was a corresponding 19% decrease in the risk of stroke recurrence within one year. This suggests that higher SUA/SCr levels could serve as a protective factor against future strokes in patients with AIS.

To better understand the impact of SUA/SCr levels, the study divided the patients into 4 quartiles (Q1-Q4) based on their SUA/SCr ratios. The results showed that patients in the higher quartiles (Q2, Q3, and Q4) had significantly lower risks of stroke recurrence when compared to the individuals in the lowest quartile (Q1). The trend test further confirmed a significant decrease in stroke recurrence from the lowest to the highest quartiles, highlighting the importance of maintaining a higher SUA/SCr ratio.

The study found no significant association between SUA/SCr levels and other outcomes, such as poor prognosis or all-cause mortality. This suggests that while SUA/SCr may play a critical role in reducing stroke recurrence, it does not necessarily impact the overall survival or recovery in the long term. The findings of this study suggest that low SUA/SCr could be an independent risk factor for stroke recurrence within a year following an initial AIS event. The negative but nonlinear association between SUA/SCr and stroke recurrence highlights the complexity of this relationship. While more research would be required to fully understand the underlying mechanisms, these results offer a new perspective on managing stroke patients and potentially preventing future strokes.

Reference:

Zhang, D., Liu, Z., Guo, W., Lu, Q., Lei, Z., Liu, P., Liu, T., Peng, L., Chang, Q., Zhang, M., Lin, X., Wang, F., & Wu, S. (2024). Association of serum uric acid to serum creatinine ratio with 1‐year stroke outcomes in patients with acute ischemic stroke: A multicenter observational cohort study. In European Journal of Neurology. Wiley. https://doi.org/10.1111/ene.16431

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