Hike in OPD, IPD charges at Bengaluru Govt Hospitals

Bengaluru: The state health department has announced a sharp increase in charges for outpatient (OPD) and inpatient (IPD) services across major government hospitals. The new rates will apply to Victoria Hospital, Vani Vilas Hospital, Minto Hospital, the super speciality hospitals, and state trauma care centres.

This move is expected to severely affect the affordability of healthcare across the state. The revised fee structure follows a meeting with department officials on Tuesday, during which the new rates were finalized.

As per the meeting, several hospital charges have been doubled. As directed by the department, this adjustment will be implemented immediately. 

Also Read: AIIMS Rishikesh becoming pricey- Announces Rollback after public outcry

According to the announcement, the hospital’s OPD registration fees have been increased from Rs 10 to Rs 20. Similarly, inpatient services will also see a rise, with admission fees jumping from Rs 25 to Rs 50. Ward charges, which were previously set at Rs 25, have also been doubled to Rs 50.

Commenting on this a Health official told TNIE that these changes are part of a broader effort to standardize charges across all government hospitals in the state, particularly those under the Bangalore Medical College and Research Institute (BMCRI). The cost of diagnostic services has also been impacted by the new rate structure. Blood test fees, which were previously Rs 70, have risen sharply to Rs 120. Overall, the increases range from 10% to 30%, across various services, reflecting the growing operational costs at these healthcare facilities.

The health department has instructed the Hospital administrators to update the new rates and ensure the changes are reflected in the e-hospital software system immediately.

Also Read: 54 medicines will see only 1 paisa hike: Health Ministry after media reports on drug price hike

These hikes in the new rates are expected to burden patients, especially those who rely on government hospitals for essential medical care. Any increase in service fees could create a financial burden and affect their access to healthcare. However, the health department has defended the decision, stating that these changes are vital for sustaining the hospitals’ operations and providing quality healthcare.

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South Goa District Hospital struggles with lack of Cardiologists

Margao: The South Goa district hospital, a major healthcare facility serving the South district, is facing a severe healthcare crisis. Despite its significance, the hospital lacks both a cardiology department and a cardiologist to address the needs of patients with heart-related conditions.

The hospital currently offers cardiology consultations once a week, every Thursday, which is insufficient to meet the growing demand. The shortage of cardiologists, combined with the increasing number of patients with cardiac issues, leaves the hospital with no choice but to refer patients to the Goa Medical College in Bambolim for further treatment. 

Due to the lack of a cardiologist or a dedicated cardiology department at South Goa District Hospital, patients have relied on Dr Eddie, a senior physician, to address their cardiac health concerns. The situation is expected to worsen with the retirement of Dr Edward D’Mello, a senior physician who has served the community for 32 years.

Also Read: Lack of infrastructure at South Goa District Hospital, patients referred to Goa Medical College

Commenting on the retirement of Dr Eddie and the lack of cardiologists, a senior hospital official told The Goan Everyday, “We have no idea about the government’s plans as Dr Eddie is set to retire from service on December 31 this year. He has been the face of the hospital over the years. Right now, we have no cardiologist or a cardiology department. It is purely for the government to take a call to find a replacement for the senior physician.”

Despite repeated assurances from Health Minister Vishwajit Rane, the hospital remains without a cardiology department. Over two years ago, the hospital was commissioned with promises of establishing both cardiology and urology departments, yet the necessary infrastructure is still lacking.

On Monday, a Congress delegation, led by South Goa MP Captain Viriato Fernandes, South Goa District Congress Chief Savio D’Silva, and leader Savio Coutinho, visited South Goa District Hospital to assess the status of a promised cardiology department. Upon arriving at the hospital, they discovered that it lacked even a full-time cardiologist, highlighting the significant gaps in healthcare services for the region’s cardiac care needs.

Viriato expressed concern over the absence of a cardiologist at South Goa District Hospital, which serves the entire district. He pointed out that the hospital only has a visiting consultant on Thursdays. As a result, patients with cardiac and hypertension issues are often referred to the GMC in Bambolim. Viriato emphasized that this situation is unsustainable and requires immediate attention.

Also Read: Telangana Government Hospitals lack Minimally Invasive Surgeries facilities

Captain Viriato told the media that he would honour the promise of providing an ambulance to the South Goa district hospital out of MLPAD funds. “I have sanctioned the ambulance after former MMC Chairperson Savio Coutinho drew my attention to the ambulance shortage plaguing the district hospital after a resident of Colmorod died in an accident,” he said.

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Karnataka to Launch First Government-Funded IVF Centre at KMCRI by March

Hubballi: Karnataka is set to launch its first government-funded in vitro fertilization (IVF) unit at Karnataka Medical College and Research Institute (KMC-RI) in Hubballi by March 2024. The IVF unit will be located on the second floor of the MCH building and aims to provide world-class fertility treatments to couples facing financial challenges.

Medical Dialogues had earlier reported that concerned about the increasing costs associated with private IVF treatment, the Karnataka government is considering launching IVF (In Vitro Fertilization) clinics in government hospitals. If the project is finalized, this will be considered the first time an IVF clinic will be installed in government hospitals.
Also Read: Karnataka plans to launch IVF clinics in Government medical colleges

In recent times with the declining fertility rates, private IVF clinics are mushrooming in urban areas, offering their services to those in need. However, the cost of treatment, which can range from Rs 8-10 lakh per child, makes it unaffordable for a large portion of the population.

In vitro fertilization (IVF) is a medically advanced and intricate series of procedures designed to help individuals and couples facing fertility challenges or genetic concerns. The high cost of private IVF treatments remains a major obstacle for many, especially in lower-income groups. This new initiative is spearheaded with government funding and support from various non-governmental organizations (NGOs).

Also Read: Natural cycles with properly scheduled oocyte retrieval benefits women with low ovarian reserve undergoing IVF: Study

Commenting on the matter, KMC-RI director Dr SF Kammar told TOI that the unit will be a boon for the poor. Even poor and middle-class people can get treatment for free or at discounted rates. The IVF center at KMC-RI will start in 2-3 months’ time. Here, the treatment will be free for BPL cardholders and chargeable for APL cardholders, he said.

Kammar stated that Nirmithi Kendra is carrying out the civic work. He further added that some NGOs will provide funds for the IVF equipment. The work has commenced, and demolition is currently in progress. Later, compartments will be made, the equipment will be installed, and the unit will start functioning.

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Long-Term Use of Cardiovascular Drugs Linked to Lower Dementia Risk, suggests research

Researchers have recently discovered that long-term use of cardiovascular drugs like antihypertensives, diuretics, lipid-lowering drugs, and oral anticoagulants appears to be associated with considerably reduced dementia risk. A recent study was published in the journal Alzheimer’s & Dementia conducted by Mozhu Ding and colleagues.

Cardiovascular risk factors have been associated with dementia development. Some earlier studies showed that managing cardiovascular conditions may reduce the risk of dementia. However, evidence remains inconclusive. This study aimed to evaluate the role of cardiovascular drug use, particularly its duration and combination, in preventing dementia.

This case-control study was conducted using Swedish national registers, including 88,065 individuals diagnosed with dementia between 2011 and 2016 and 880,650 age- and sex-matched controls. The study focused only on participants aged 70 years and older. Cardiovascular drug use was extracted from the Prescribed Drug Register and categorized into antihypertensives, diuretics, LLDs, OACs, and antiplatelets. Analysis was conducted on long-term use (≥5 years) and drug combinations.

Key findings of the study were as follows:

Reduced Risk with Long-Term Use:

  • For long-term users of antihypertensives, diuretics, LLDs, and OACs, there was an associated reduced risk of dementia compared with non-users, of 25%-9% (odds ratios [OR]: 0.75–0.91).

Combination Therapy:

  • An even greater reduced risk was observed for combination use of antihypertensives with diuretics, LLDs, and OACs for ≥5 years, at 16%-34% lower risk of dementia (OR: 0.66–0.84).

Negative Association with Antiplatelets:

  • The antiplatelets use was related with increased risks of dementia, along with odds ratios that oscillate between 1.13 and 1.25 irrespective of duration.

Long-term use of cardiovascular drugs, particularly in combination therapies, has significantly decreased the risk of dementia, and preventive strategies against cognitive decline are being made. However, the need for personalized approaches in cardiovascular care for balance between the benefits and possible cognitive effects from antiplatelets points out a remaining gap that needs to be filled.

Reference:

Ding, M., Wennberg, A. M., Engström, G., & Modig, K. (2024). Use of common cardiovascular disease drugs and risk of dementia: A case–control study in Swedish national register data. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. https://doi.org/10.1002/alz.14389

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Semaglutide Improves Sperm Quality and Testosterone Levels in Obese Men with Type 2 Diabetes and Hypogonadism: Study

Slovenia: A recent study published in Diabetes, Obesity and Metabolism has revealed that semaglutide, a medication primarily used to treat type 2 diabetes and obesity, may offer unexpected benefits for men suffering from obesity-related functional hypogonadism (FH).

The research, which focused on men with both obesity and type 2 diabetes, found that semaglutide significantly improved sperm morphology, testosterone levels, and symptoms of hypogonadism. The findings open the door to new treatment options for men with fertility concerns linked to metabolic and hormonal conditions.

Functional hypogonadism, characterized by low testosterone levels and associated symptoms like fatigue, reduced libido, and erectile dysfunction, is common among men with obesity and type 2 diabetes. The condition can also impair fertility, contributing to difficulties in conceiving. Traditionally, treatment options for functional hypogonadism have included testosterone replacement therapy, but this approach can carry risks, including suppression of sperm production. As a result, many men seeking to improve fertility have limited therapeutic options.

Against the above background, Mojca Jensterle, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, and colleagues aimed to compare the effects of semaglutide and testosterone replacement therapy (TRT) on semen quality and functional hypogonadism symptoms in men with type 2 diabetes and obesity.

For this purpose, the researchers designed a randomized open-label trial involving 25 men with type 2 diabetes (aged 50 [46–60] years, BMI 35.9 [32.8–38.7] kg/m²) and functional hypogonadism (FH). The participants were randomly assigned to receive either semaglutide (SEMA) 1 mg per week or intramuscular testosterone undecanoate (TRT) 1000 mg every 10–12 weeks for 24 weeks.

Semen analysis and FH parameters were assessed at baseline and after the 24-week treatment period. Additionally, participants completed the International Index of Erectile Function-15 (IIEF-15) and Aging Symptoms in Men (AMS) questionnaires to evaluate erectile function and symptoms of aging.

The following were the key findings of the study:

  • Baseline sperm quality in the study cohort was poor, with parameters falling below the 5th percentile of reference values.
  • In the SEMA group, there was a significant improvement in morphologically normal sperm from baseline to the end of the study (2% versus 4%).
  • In contrast, the TRT group saw a significant decrease in sperm concentration and total sperm count.
  • Compared to TRT, the SEMA group had significantly higher levels of morphologically normal sperm, sperm concentration, and total sperm count.
  • Both treatment groups experienced an increase in total testosterone levels and an improvement in AMS scores (indicating better aging-related symptoms).
  • The IIEF-15 score (which measures erectile function) improved significantly only in the TRT group.

The findings revealed positive effects of semaglutide on body weight, metabolism, general symptoms of functional hypogonadism, and sperm morphology. However, testosterone replacement therapy had a stronger impact on sexual function in men with diabetes and obesity-related FH.

“Given its benefits for reproductive health, semaglutide could be a promising treatment for men with obesity and diabetes-related FH who are seeking to improve fertility. Combining both treatments may offer broader health benefits for certain patients with obesity and diabetes-related FH, warranting further research on this potential approach,” the researchers concluded.

Reference:

DOI: https://doi.org/10.1111/dom.16042

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Pulmonary vein isolation with Ethanol infusion of vein of Marshall bests pulmonary vein isolation for treatment of persistent AF:JAMA

Pulmonary vein isolation with Ethanol infusion of vein of Marshall bests pulmonary vein isolation for treatment of persistent AF suggests a study published in the JAMA.

Success rates of pulmonary vein isolation (PVI) are modest for persistent atrial fibrillation (AF). Additional linear ablation beyond PVI has not been proved superior to PVI alone in randomized trials. Ethanol infusion of the vein of Marshall (EIVOM) facilitates ablation at the mitral isthmus and may lead to improved effectiveness of a linear ablation strategy. A study was done to determine whether linear ablation with radiofrequency energy combined with EIVOM added to PVI improves sinus rhythm maintenance compared with PVI alone in patients with persistent AF. The PROMPT-AF trial is an investigator-initiated, multicenter, open-label, randomized trial involving 12 tertiary hospitals in China. A total of 498 patients aged 18 to 80 years, with AF persisting for more than 3 months, undergoing first-time AF ablation, were enrolled and randomized from August 27, 2021, to July 16, 2023. Patients were randomized to undergo PVI alone or PVI plus EIVOM and linear ablation (intervention). The latter group first underwent EIVOM, followed by PVI and linear ablation of the left atrial roof, mitral isthmus, and cavotricuspid isthmus. The primary end point was freedom from any documented atrial arrhythmias lasting more than 30 seconds, without the use of antiarrhythmic drugs within 12 months. Secondary outcomes included freedom from atrial arrhythmia recurrence, AF, atrial arrhythmia recurrence after multiple procedures, and documented atrial tachycardia or atrial flutter with or without antiarrhythmic drugs; AF burden; and improvement in quality of life. Patients were monitored with wearable single-lead electrocardiographic (ECG) patches, worn for 24 hours a week, supplemented by symptom-triggered ECGs and Holter monitoring. Results Among 498 randomized patients, 495 (99.4%) were included in the primary analysis (mean age, 61.1 years [SD, 9.7] years, 361 male [72.9%]). After 12 months, 174 of 246 patients (70.7%) assigned to undergo PVI plus EIVOM and linear ablation and 153 of 249 patients (61.5%) assigned to undergo PVI alone remained free from atrial arrhythmias without taking antiarrhythmic drugs (hazard ratio, 0.73; 95% CI, 0.54-0.99, P = .045). The intervention effect was consistent across all prespecified subgroups. The comparison of secondary outcomes did not demonstrate significant results. Among patients with persistent AF, linear ablation combined with EIVOM in addition to PVI significantly improved freedom from atrial arrhythmias within 12 months compared with PVI alone.

Reference:

Sang C, Liu Q, Lai Y, et al. Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF: The PROMPT-AF Randomized Clinical Trial. JAMA. Published online November 18, 2024. doi:10.1001/jama.2024.24438

Keywords:

Pulmonary vein, isolation, Ethanol infusion, vein, Marshall, bests, pulmonary vein, isolation, treatment, persistent AF, JAMA, Sang C, Liu Q, Lai Y

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Perioperative Erythropoietin Administration can reduce Delirium in Older Adults after Total Joint Arthroplasty: Study

Post-operative delirium, also known as PD, is described as a clinical condition characterized by sudden changes in consciousness, disorganized thoughts, and impaired attention following surgery. The prevalence of PD can range significantly across different groups, impacting as many as 60% of susceptible populations. Recent study aimed to examine the role of perioperative administration of erythropoietin (EPO) in the development of post-operative delirium in older adult patients undergoing total joint arthroplasty. Post-operative delirium is a common complication with significant clinical and financial impacts on patients. EPO has anti-inflammatory properties, and the researchers investigated whether perioperative EPO administration can influence the occurrence of post-operative delirium in this patient population.

Seventy-one patients over 65 years old scheduled for total joint arthroplasty were randomly assigned to either an EPO-treated group (n=35) or a placebo control group (n=36). All patients underwent cognitive and delirium assessments before and after surgery. Serum C-reactive protein (CRP) and inflammatory cytokine levels were also measured.

The results showed that one patient in the control group developed delirium on post-operative day 2, while no patients in the EPO group developed delirium (0% vs 3.2%, p=0.500). Post-operatively, there were no significant differences in Mini-Mental State Examination (MMSE) scores between the groups. Both groups showed increases in pro- and anti-inflammatory cytokine levels, with no significant differences between the groups. Similarly, CRP levels, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio showed no intergroup differences in post-operative inflammatory responses.

Conclusion and Limitations

In conclusion, perioperative EPO administration reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses. The authors suggest that future larger-scale, long-term studies are needed to confirm the effects of EPO on post-operative neurocognitive disorders. The study’s limitations include the small sample size, single-center design, and lack of long-term follow-up for cytokines, neurocognitive assessment, and neuroinflammation.

Key Points

1. The study aimed to examine the role of perioperative administration of erythropoietin (EPO) in the development of post-operative delirium in older adult patients undergoing total joint arthroplasty.

2. Seventy-one patients over 65 years old scheduled for total joint arthroplasty were randomly assigned to either an EPO-treated group (n=35) or a placebo control group (n=36). All patients underwent cognitive and delirium assessments before and after surgery, and serum C-reactive protein (CRP) and inflammatory cytokine levels were measured.

3. The results showed that one patient in the control group developed delirium on post-operative day 2, while no patients in the EPO group developed delirium (0% vs 3.2%, p=0.500). There were no significant differences in Mini-Mental State Examination (MMSE) scores between the groups post-operatively.

4. Both groups showed increases in pro- and anti-inflammatory cytokine levels, with no significant differences between the groups. Similarly, CRP levels, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio showed no intergroup differences in post-operative inflammatory responses.

5. The authors concluded that perioperative EPO administration reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses.

6. The study’s limitations include the small sample size, single-center design, and lack of long-term follow-up for cytokines, neurocognitive assessment, and neuroinflammation. The authors suggest that future larger-scale, long-term studies are needed to confirm the effects of EPO on post-operative neurocognitive disorders.

Reference –

Kim, E.J., Park, K.K., Choi, S.Y. et al. Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study. BMC Anesthesiol 24, 418 (2024). https://doi.org/10.1186/s12871-024-02770-9

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Pre-Workout Beetroot Juice Improves Fitness Gains in Late Postmenopausal Women

Drinking beetroot juice before a workout could enhance the benefits of exercise training in postmenopausal women, according to new research. The findings from the study are published in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. The study has been chosen as an APSselect for November.

As we age, declining mobility can lead to a dangerous cycle that raises the risk of falls, physical inactivity and dependence on others. In some cases, it can even lead to premature death. While exercise training is the most effective way to counter the age-related decline in physical function, late postmenopausal women—those at least six years past their final menstrual period—often find it harder to build strength and improve fitness compared to premenopausal women and men of the same age.

Reduced nitric oxide availability may diminish the responsiveness of skeletal muscles and blood vessels during exercise, potentially explaining why late postmenopausal women respond differently to exercise training. To address these challenges, the researchers investigated whether beetroot juice, rich in dietary nitrate, could enhance the health benefits of exercise for late postmenopausal women. Nitrate is stored in limited amounts in skeletal muscle and converted to nitric oxide during physical exertion.

For the study, 24 postmenopausal volunteers completed supervised, circuit-based exercise training three times per week for eight weeks. Half of the participants drank 140 milliliters (about half a glass) of beetroot juice two to three hours before each workout. Before and after the training period, all participants underwent physical fitness assessments, including a six-minute walk test and maximal knee extensor strength test.

Participants who drank the beetroot juice prior to exercise showed greater improvements in several aspects of physical function such as aerobic capacity and recovery compared to those who did not consume beetroot juice. Specifically, those who drank beetroot juice increased their distance in the six-minute walk test by 40 meters, while the exercise-only group improved by just eight meters.

These gains were reflected in an increase in aerobic capacity of 1.5 milliliters per kilogram per minute among beetroot juice consumers compared to just 0.3 milliliters per kilogram per minute in the exercise-only group. Heart rate recovery also improved, with a 10 beats-per-minute decrease after the six-minute walk test for the beetroot juice group compared to a one beat-per-minute decrease for the exercise-only group.

According to the researchers, the study results provide compelling preliminary evidence that consuming beetroot juice before exercise could be uniquely beneficial for late postmenopausal women. These findings could inform new, targeted, non-pharmacologic interventions to help sustain mobility independence and quality of life in this population.

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Early Changes in ROX Index Predicts Treatment Failure After Awake Prone Positioning in Acute Respiratory Failure: Study

A recent groundbreaking study
conducted on COVID-19 patients found the predictive value of the respiratory
rate-oxygenation (ROX) index in acute respiratory failure. The study found that changes in the ROX index after the
first awake-prone positioning session led to intubation and death as per the
findings published in the journal Intensive Care Medicine.

Proning is a method of treating
intubated and sedated patients by making them lie on their stomachs. During the
COVID-19 pandemic, many physicians found beneficial effects of treating individuals
in prone positions. However, the accurate physiological parameters that have to
be monitored after a session of awake-prone positioning in individuals with
acute respiratory failure are not known. Hence, researchers conducted a study
to identify the early physiologic changes that are linked to the need for
invasive mechanical ventilation or death in patients with acute respiratory
failure after the first session of awake-prone positioning.

Also Read: Study Finds Pathophysiological Similarities Between Preeclampsia and COVID-19

a secondary analysis of a
prospective cohort study was carried out by including adult patients with acute
respiratory failure related to coronavirus disease 2019 (COVID-19) treated with
awake prone positioning. the association between relative changes in
physiological variables such as oxygenation, respiratory rate, pCO2,
and respiratory rate-oxygenation [ROX] index was assessed within the first
6 h of the first awake prone positioning session with treatment failure. A
treatment was considered to be a failure when there arose a necessity for endotracheal
intubation and/or death within 7 days.

Findings:

  • About 244 patients that included 70 females
    (29%), with a mean age of 60 were included.
  • Nearly Seventy-one (29%) patients experienced awake-prone
    positioning failure.
  • ROX index was found to be the main physiologic
    predictor.
  • Patients with treatment failure had lower mean
    [SD] ROX index at baseline [5 (1.4) versus 6.6 (2.2), p < 0.0001]
    and within 6 h of prone positioning [5.6 (1.7) versus 8.7 (2.8), p < 0.0001].
  • After adjusting for baseline characteristics and
    severity, a relative increase of the ROX index compared to baseline was
    associated with lower odds of failure.
Also Read: Noninvasive malaria test could be global game changer, claims research

Thus, the study concluded that the
ROX index was the main predictive factor for intubation and mortality in
individuals treated by awake-prone positioning.

Further reading: Olmos M,
Esperatti M, Fuentes N, et al. Early physiologic changes after awake prone
positioning predict clinical outcomes in patients with acute hypoxemic
respiratory failure. Intensive Care Med. Published online November
14, 2024. doi:10.1007/s00134-024-07690-3

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Intranasal Antihistamines and Corticosteroids Effective in Allergic Rhinitis, but Evidence Variability Remains: Review

Portugal: A recent systematic review and meta-analysis have provided valuable insights into the effectiveness of intranasal antihistamines and corticosteroids for treating allergic rhinitis, a common condition affecting millions globally.

The meta-analysis, published in the Journal of Allergy and Clinical Immunology found that most intranasal medications effectively alleviate rhinitis symptoms and enhance quality of life. However, there were notable variations in the reliability of the evidence supporting these treatments. 

Antihistamines and intranasal corticosteroids are primary treatments for allergic rhinitis (AR), with intranasal medications preferred due to their higher effectiveness and quicker action than oral treatments. However, most guidelines report a low level of evidence for these recommendations. There is a lack of consistent data on the effectiveness of specific intranasal medications, and randomized controlled trials vary in quality. A systematic review using standardized methods is needed to better assess their effectiveness. 

Against the above background, Bernardo Sousa-Pinto, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal, and colleagues aimed to conduct a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines versus placebo in alleviating nasal and ocular symptoms, as well as improving rhinoconjunctivitis-related quality of life in patients with perennial or seasonal allergic rhinitis.

For this purpose, the researchers conducted a comprehensive search across four electronic bibliographic databases and three clinical trial databases to identify randomized controlled trials (1) involving adult patients with seasonal or perennial allergic rhinitis (AR) and (2) comparing the use of intranasal corticosteroids or antihistamines with placebo.

Outcomes assessed included the Total Nasal Symptom Score, Total Ocular Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. Random-effects meta-analyses were performed to calculate mean differences for each medication and outcome. Evidence certainty was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

The following were the key findings of the study:

  • The review included 151 primary studies, primarily assessing patients with seasonal allergic rhinitis majority having unclear or high risk of bias.
  • In both perennial and seasonal AR, most treatments were more effective than placebo.
  • In seasonal AR, azelastine-fluticasone, fluticasone furoate, and fluticasone propionate showed the highest likelihood of achieving moderate or large improvements in the Total Nasal Symptom Score and Rhinoconjunctivitis Quality-of-Life Questionnaire.
  • Azelastine-fluticasone had the highest probability of leading to moderate or large improvements in the Total Ocular Symptom Score.
  • Evidence certainty was categorized as “high” in 6 of 46 analyses, “moderate” in 23 of 46 analyses, and “low” or “very low” in 17 of 46 analyses.

In seasonal allergic rhinitis (SAR), all intranasal antihistamines and corticosteroids demonstrated effectiveness in improving nasal symptoms, both statistically and clinically. Most medications also led to significant improvements in the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ). However, there were notable differences between treatments concerning the likelihood of surpassing the Minimal Important Difference (MID).

“In perennial allergic rhinitis (PAR), the assessed medications were effective, but there was a lack of evidence for some drugs and outcomes. While evidence certainty for most outcomes was rated as “moderate,” several limitations in the available data were identified. This systematic review provides valuable insights to guide future recommendations for intranasal medications in managing both PAR and SAR,” the researchers concluded.

Reference:

Sousa-Pinto, B., Vieira, R. J., Brozek, J., Cardoso-Fernandes, A., Lourenço-Silva, N., Ferreira-da-Silva, R., Ferreira, A., Gil-Mata, S., Bedbrook, A., Klimek, L., Fonseca, J. A., Zuberbier, T., Schünemann, H. J., & Bousquet, J. (2024). Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis. Journal of Allergy and Clinical Immunology, 154(2), 340-354. https://doi.org/10.1016/j.jaci.2024.04.016

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