PGI Endocrinologist Dr Ashu Rastogi awarded Dr Subhash Mukherjee Oration for Diabetic Foot Research

Chandigarh: Dr Ashu Rastogi, Associate Professor in the Department of Endocrinology has been bestowed with the esteemed “Dr Subhash Mukherjee” Oration by the Endocrine Society of India (ESI). Renowned for his significant contributions to the field of endocrinology, Dr Rastogi received the award during the 53rd Annual Meeting of the ESI held in Vizag. 

Dr Rastogi’s groundbreaking work in the management of diabetic foot complications has earned him international recognition. A faculty member in the Department of Endocrinology at PGIMER, Chandigarh, Dr Rastogi completed his DM in Endocrinology at PGIMER in 2012.

He was honoured with this prestigious award for his exceptional dedication to advancing the treatment of diabetic foot complications.

Also Read: Dr Sonalika Sharma wins Prestigious Award for AI Research in Hernia Surgery

Currently, he is working on research related to obesity and Charcot neuroarthropathy of the foot, aiming to advance understanding and improve patient care in these areas.

His innovative research on Charcot neuroarthropathy is outstanding. Charcot’s neuroarthropathy is a destructive complication of the joints, often found in people with diabetes who have peripheral neuropathy. His research on this has earned worldwide acclaim and has been instrumental in the formulation of clinical management guidelines used globally.  

Also Read: President Murmu confers Florence Nightingale Awards on 15 nurses for outstanding service

According to a recent media report in India News Calling, Dr Rastogi’s groundbreaking research in drug development for diabetic foot ulcers, specifically through a topical preparation of esmolol, has introduced a new treatment modality. This innovative approach aligns with the ‘Make in India’ initiative, offering a promising solution for the management of foot ulcers.  

Dr Rastogi’s work in this area has had a major impact, helping to prevent amputations and improve the quality of life for countless patients worldwide.

Medical Dialogues had earlier reported that a renowned Endocrinologist, Dr M Ashraf Ganie has been honoured with the “Subhash Mukherjee Memorial” Oration-2023 by the prestigious Endocrine Society of India (ESI). The prestigious Oration has been awarded to Dr Ashraf for his extensive research in the field of endocrine & metabolic disorders.

Powered by WPeMatico

New Study Reveals Best Antithrombotic Regimen for Atrial Fibrillation Post-ACS/PCI: Apixaban and P2Y12 Inhibitor Shine

USA: A new study from the AUGUSTUS trial has provided new insights into the most effective antithrombotic strategies for patients with atrial fibrillation (AF) who have recently undergone acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI).

The research, published in the Journal of the American College of Cardiology, highlights that a regimen including a P2Y12 inhibitor and apixaban, without aspirin, significantly reduces the incidence of adverse outcomes compared to traditional treatments involving vitamin K antagonists (VKAs), aspirin, or both.

The ideal antithrombotic regimen for patients with atrial fibrillation following ACS or PCI remains unclear. Renato D. Lopes, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA, and colleagues aimed to compare four different antithrombotic regimens to determine which combination offers the best outcomes for reducing death, bleeding, and cardiovascular hospitalization. They investigated which antithrombotic regimen best balances safety and efficacy.

The AUGUSTUS trial, a multicenter randomized study with a 2 × 2 factorial design, compared apixaban to vitamin K antagonist (VKA) therapy and aspirin to placebo in patients with AF who had recently undergone acute coronary syndrome or percutaneous coronary intervention and were receiving a P2Y12 inhibitor. The four-way analysis assessed safety and efficacy across the four randomized groups.

The primary outcome measured was a composite of all-cause mortality, major or clinically relevant non-major bleeding, and hospitalization for cardiovascular reasons over a 6-month follow-up period. Secondary outcomes included the individual components of this primary composite endpoint.

The study led to the following findings:

  • A total of 4,614 patients were enrolled. All patients were treated with a P2Y12 inhibitor.
  • The primary endpoint occurred in 21.9% of patients randomized to apixaban plus placebo, 27.3% randomized to apixaban plus aspirin, 28.0% randomized to VKA plus placebo, and 33.3% randomized to VKA plus aspirin.
  • Rates of major or clinically relevant nonmajor bleeding and hospitalization for cardiovascular causes were lower with apixaban and placebo compared with the other three antithrombotic strategies.
  • There was no difference between the four randomized groups for all-cause death.

The findings showed that in patients with atrial fibrillation who had recently experienced acute coronary syndrome or undergone PCI, an antithrombotic regimen combining a P2Y12 inhibitor with apixaban, and excluding aspirin, was associated with a lower rate of the composite outcome of death, bleeding, or cardiovascular hospitalization compared to regimens that included vitamin K antagonists, aspirin, or both.

“The findings support the preference for a regimen combining a direct oral anticoagulant with a P2Y12 inhibitor, as it effectively prevents ischemic events while minimizing bleeding risks in this high-risk patient population,” the researchers concluded.

Reference:

Berwanger O, Wojdyla DM, Fanaroff AC, et al. Antithrombotic strategies in atrial fibrillation after ACS and/or PCI. J Am Coll Cardiol. 2024;84:875-885.

Powered by WPeMatico

Tirzepatide Demonstrates Long-Term Weight Reduction and Diabetes Risk Reduction in Obesity and Prediabetes: NEJM

USA: In recent years, medical advancements have provided new hope for the management of obesity and the prevention of type 2 diabetes, with tirzepatide emerging as a groundbreaking option. This novel medication, developed by Eli Lilly, has shown promising results in clinical trials, offering significant benefits for people living with obesity and prediabetes.

A three-year study published in the New England Journal of Medicine revealed striking results for individuals with obesity and prediabetes who were treated with tirzepatide. The researchers found that tirzepatide in this population led to significant and sustained weight loss, as well as a notably reduced risk of progressing to type 2 diabetes compared to those receiving a placebo.

Obesity is a chronic condition and a key risk factor for a range of other health issues, including type 2 diabetes. In a previous analysis of the SURMOUNT-1 trial, tirzepatide produced significant and sustained weight loss in individuals with obesity over a 72-weeks. In the study, Ania M. Jastreboff, Yale School of Medicine, New Haven, CT, and colleagues present three-year safety outcomes for tirzepatide, along with its effectiveness in reducing weight and preventing the progression to type 2 diabetes in individuals with both obesity and prediabetes.

For this purpose, the researchers conducted a phase 3, double-blind, randomized, controlled trial involving 2,539 participants with obesity, including 1,032 who also had prediabetes. Participants were randomly assigned in a 1:1:1:1 ratio to receive once-weekly doses of tirzepatide at 5 mg, 10 mg, or 15 mg, or a placebo. The analysis focused on those with both obesity and prediabetes, who received their assigned treatment for a total of 176 weeks, followed by a 17-week off-treatment period.

The study’s primary objectives were three key secondary endpoints, controlled for type I error: the percent change in body weight from baseline to week 176 and the onset of type 2 diabetes during the 176-week and 193-week periods.

The key findings of the study at 176 weeks are as follows:

  • Weight Loss
    • Participants receiving tirzepatide showed significant weight reduction compared to the placebo group:
      • 5 mg dose: −12.3% mean percent change in body weight.
      • 10 mg dose: −18.7% mean percent change in body weight.
      • 15 mg dose: −19.7% mean percent change in body weight.
      • Placebo group: −1.3% mean percent change in body weight.
  • Type 2 Diabetes Diagnosis:
    • Fewer participants in the tirzepatide groups were diagnosed with type 2 diabetes compared to the placebo group:
      • Tirzepatide group: 2.4% developed type 2 diabetes.
      • Placebo group: 13.7% developed type 2 diabetes (hazard ratio, 0.12).
  • Adverse Events
    • The most common adverse events were gastrointestinal issues, primarily during the dose-escalation phase in the first 20 weeks of the trial. These were mostly mild to moderate in severity.
    • There were no new safety signals during the study besides those related to coronavirus disease 2019 (COVID-19).

“As tirzepatide becomes more widely available, it offers a promising option for those struggling with obesity and prediabetes, providing a new pathway for preventing the onset of type 2 diabetes and improving overall metabolic health. The ongoing success of tirzepatide in clinical settings signals a bright future for treating these interconnected health issues,” the researchers concluded.

Reference:

DOI: 10.1056/NEJMoa2410819

Powered by WPeMatico

Study reveals Power of Generic Remifentanil: A Game-Changer in General Anesthesia

Recent research paper which is a phase III, prospective, multi-centric, observer-blind, randomized controlled trial that compares the efficacy and safety of a generic remifentanil with fentanyl and Ultiva during general anesthesia in the Indian population. The study was conducted at 13 centers in India and included 314 subjects scheduled for elective therapeutic and diagnostic surgical procedures. The primary efficacy endpoint was the haemodynamic response during specific activities such as endotracheal intubation, skin incision, skin closure, and extubation. The results of the study indicated that there were no significant differences in demographic and baseline characteristics across the study groups. Heart rate was found to be similar between the remifentanil and Ultiva groups during the specific activities, whereas the fentanyl group exhibited significantly higher heart rates during these activities. The need for vasopressor and anti-cholinergic drugs was similar across the groups, and no subjects required naloxone administration. The study concluded that generic remifentanil is non-inferior to fentanyl and equivalent to Ultiva for general anesthesia in Indian patients undergoing various surgical and diagnostic procedures. Moreover, it was found that remifentanil offered advantages in terms of optimum haemodynamic stability, fast equilibrating analgesia, and rapid emergence from sedation, making it a suitable alternative to fentanyl.

Research Methodology

The study utilized a robust, observer-blind, multi-center design with rigorous monitoring of haemodynamic parameters. It employed ANOVA, paired t-test, and chi-square/Fisher’s exact test for statistical analysis. The study findings were consistent with earlier research, suggesting that remifentanil effectively attenuates the sympathetic response during intubation and aids in stable haemodynamic control during surgical stress. Despite some limitations, including the limited age range of the subjects and the single geographic focus on India, the study support the non-inferiority of generic remifentanil compared to fentanyl and its equivalence with Ultiva, establishing it as an alternative analgesic component for general anesthesia for various surgical procedures in the Indian population.

Conclusion and Disclosures

In conclusion, the study demonstrated the non-inferiority of generic remifentanil to fentanyl and its equivalence to Ultiva for general anesthesia in the Indian population, making remifentanil a suitable alternative analgesic option during induction and maintenance of general anesthesia in Indian patients. The authors indicated that de-identified data may be requested from the corresponding author and acknowledged the support of Themis Medicare Limited, Mumbai, India, as the study’s sponsor. The authors disclosed their potential conflicts of interest related to the study.

Key Points

– The research paper is a phase III, prospective, multi-centric, observer-blind, randomized controlled trial conducted at 13 centers in India, comparing the efficacy and safety of generic remifentanil with fentanyl and Ultiva during general anesthesia in the Indian population. It included 314 subjects scheduled for elective therapeutic and diagnostic surgical procedures.

– The primary efficacy endpoint was the haemodynamic response during specific activities such as endotracheal intubation, skin incision, skin closure, and extubation. The study found no significant differences in demographic and baseline characteristics across the study groups. Heart rate was similar between the remifentanil and Ultiva groups during specific activities, while the fentanyl group exhibited significantly higher heart rates.

– The need for vasopressor and anti-cholinergic drugs was similar across the groups, and no subjects required naloxone administration. The study concluded that generic remifentanil is non-inferior to fentanyl and equivalent to Ultiva for general anesthesia in Indian patients undergoing various surgical and diagnostic procedures. Remifentanil offered advantages in terms of optimum haemodynamic stability, fast equilibrating analgesia, and rapid emergence from sedation, making it a suitable alternative to fentanyl.

– The study utilized a robust, observer-blind, multi-center design with rigorous monitoring of haemodynamic parameters. It employed ANOVA, paired t-test, and chi-square/Fisher’s exact test for statistical analysis. The findings were consistent with earlier research, supporting the non-inferiority of generic remifentanil compared to fentanyl and its equivalence with Ultiva as an alternative analgesic component for general anesthesia for various surgical procedures in the Indian population.

– In conclusion, the study demonstrated the non-inferiority of generic remifentanil to fentanyl and its equivalence to Ultiva for general anesthesia in the Indian population. The authors indicated that de-identified data may be requested from the corresponding author and acknowledged the support of Themis Medicare Limited, Mumbai, India, as the study’s sponsor. The authors disclosed their potential conflicts of interest related to the study.

Reference –

Hemantkumar I, Swain AK, Mishra M, Singh S, Gurudatt CL, Giridhar JB. Efficacy and safety of a generic remifentanil formulation versus fentanyl and Ultiva during general anaesthesia: A phase III, prospective, multi‑centric, observer‑blind, randomised controlled trial. Indian J Anaesth 2024;68:985‑95

Powered by WPeMatico

Total-etch system outperfors self-etch system for pulp vitality preservation after indirect pulp capping treatments: Study

Total-etch system outperfors self-etch system for pulp vitality preservation after indirect pulp capping treatments suggests a study published in the Journal of Clinical Medicine.

This retrospective clinical study assessed dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). A significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described for indirect pulp-capping treatments. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

Reference:

Alovisi, M.; Baldi, A.; Comba, A.; Gamerro, R.; Paolone, G.; Mandurino, M.; Dioguardi, M.; Roggia, A.; Scotti, N. Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study. J. Clin. Med. 2024, 13, 3962. https://doi.org/10.3390/jcm13133962

Keywords:

Total-etch, system, outperfors, self-etch, system, pulp vitality, preservation, indirect, pulp, capping, treatments, study, Alovisi, M.; Baldi, A.; Comba, A.; Gamerro, R.; Paolone, G.; Mandurino, M.; Dioguardi, M.; Roggia, A.; Scotti, N, direct pulp capping; indirect pulp capping; self-etch adhesive; mineral trioxide aggregate; resin-based glass ionomer; pulp vitality,Journal of Clincial Medicine

Powered by WPeMatico

Ciclosporin A 0.1% emulsion effective in patients with severe dry eye disease: Study

A new study published in the Graefe’s Archive for Clinical and Experimental Ophthalmology found that ciclosporin A (CsA) 0.1% cationic emulsion may be safe, efficient, and well-tolerated when used in clinical settings to treat severe dry eye disease. It can be difficult to identify and treat dry eye disease (DED), often referred to as keratoconjunctivitis sicca, in clinical practice. DED is a chronic, multifactorial, and complicated ocular disorder that requires long-term care. The effectiveness, safety, and tolerability of ciclosporin A (CsA) 0.1% cationic emulsion (CE) in regular clinical practice as a remedy for adults with severe keratitis and dry eye disease that continued inadequately controlled with artificial tears were assessed in the PERSPECTIVE study. Thus, Ines Lanzl and colleagues analyzed the data from German ophthalmology clinics to offer additional detailed information on CsA 0.1% CE.

Adults beginning CsA 0.1% CE (one drop in each eye before bed) were the subjects of the study, and they were monitored at Weeks 4, 12, and 24 as well as Month 12. Mean shift from baseline in corneal fluorescein staining (CFS) score (Oxford Grade Scale) at Month 12 was the main outcome. Secondary endpoints looked at adverse events (AEs) and the intensity of ocular signs and symptoms.

A total of 236 patients from 20 German ophthalmology clinics took part in the PERSPECTIVE research. After receiving CsA 0.1% CE, CFS scores of patients significantly decreased starting in Week 4 and continued to do so until Month 12 (P<0.0001). By Month 12, 81.6% of patients had improved their CFS score from baseline.

Significant improvements in the intensity of subjective ocular symptoms (all P ≤ 0.015) and eyelid and conjunctival erythema at month 12 were seen with CsA 0.1% CE (P < 0.001) when compared to baseline. The safety statistics aligned with the established safety profile of 0.1% CE CsA. 95.7% of patients and 97.2% of doctors assessed tolerability as “satisfactory,” “good,” or “very good.”

Overall, a country-level sub-analysis of the PERSPECTIVE study data from German ophthalmology clinics revealed results that are comparable to those reported for the entire study population which are indicative of the treatment outcomes that ophthalmologists may look forward with CsA 0.1% CE treatment in real-life clinical practice. Beginning with Week 4 and continuing through Month 12, CsA 0.1% CE significantly decreased the severity of keratitis and DED signs and symptoms.

Source:

Lanzl, I., Deuter, C. M. E., Lorenz, K., & Geerling, G. (2024). Real-world insights and outcomes related to ciclosporin A 0.1% cationic emulsion for the long-term treatment of dry eye disease in Germany: Country-level sub-analysis of the PERSPECTIVE study. In Graefe’s Archive for Clinical and Experimental Ophthalmology (Vol. 262, Issue 10, pp. 3261–3271). Springer Science and Business Media LLC. https://doi.org/10.1007/s00417-024-06414-z

Powered by WPeMatico

Digital technology may play transformative role in diabetes prevention and management, claims research

Scientists at Pennington Biomedical Research Center, along with a colleague from Peking University People’s Hospital in China, have been leading a special collection and published an editorial in Frontiers in Endocrinology, emphasizing the transformative role digital health technologies play in diabetes management and prevention.

Highlighting studies that underscore how digital technology innovations enable improved self-management, personalized treatments, and seamless communication between patients and healthcare providers, the editorial was authored by Dr. Gang Hu and Dr. Yun Shen of Pennington Biomedical and Dr. Xiantong Zou of Peking University.

“Digital tools offer unprecedented opportunities to improve patient outcomes through better monitoring, individualized care, and more efficient communication between patients and healthcare providers,” the authors wrote.

Digital health tools promise to make diabetes care more accessible, effective, and adaptable to patients’ individual needs. Advancements in wearable devices, mobile applications, and telemedicine can support patient self-management, personalize treatment, and improve health outcomes. The editorial addresses key challenges with these technologies, including data privacy and accessibility, and encourages ongoing research and development in this promising field.

“As the field advances, digital health innovations are poised to play an increasingly critical role in the prevention and management of diabetes, paving the way for more efficient and equitable healthcare delivery,” the authors concluded.

Dr. Hu is professor and director of the Chronic Disease Epidemiology Laboratory, and Dr. Shen is assistant professor-research in chronic disease epidemiology at Pennington Biomedical. Dr. Zou is attending physician and associate professor at Peking University People’s Hospital.

“This editorial provides insight into the pivotal role digital technologies are playing in our everyday lives, and especially how these technologies can be used in disease management and treatments,” said Dr. John Kirwan, executive director of Pennington Biomedical. “The work being done by Dr. Shen and Dr. Hu here at Pennington Biomedical, in partnership with colleagues across the globe showcases the collaborative mindset of Pennington Biomedical and the commitment we have to advance healthcare through innovative research.”

Powered by WPeMatico

New pancreatic cancer treatment proves effective in shrinking, clearing tumors, unravels research

Researchers at the University of Massachusetts Amherst and UMass Chan Medical School have demonstrated in mice a new method to combat pancreatic cancer. The study, published in Science Translational Medicine, outlines the synergistic effects of a novel nanoparticle drug-delivery system to activate an immune pathway in combination with tumor-targeting agents.

Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer. With a dismal,13% five-year survival rate, it is the third leading cause of cancer deaths.

One major challenge is the microenvironment surrounding the tumor. This environment is characterized by dense tissue creating a barrier around the tumor that inhibits blood vessel formation and blocks immune infiltration.

“Drug delivery is a huge challenge due to the architecture of these difficult-to-treat tumors’ microenvironment,” says Prabhani Atukorale, assistant professor of biomedical engineering at UMass Amherst and one of the corresponding authors of the paper. She adds that the environment also blocks the activation of the body’s immune cells and their penetration into the tumor.

“Pancreas cancer, unfortunately, doesn’t respond to most conventional therapies like chemotherapy, or even immunotherapy, which has revolutionized a lot of cancer therapy in the last 10 years,” says Marcus Ruscetti, assistant professor of molecular, cell and cancer biology at UMass Chan Medical School, and the other corresponding author.

Ruscetti’s previous research demonstrated that two cancer drugs (MEK inhibitor trametinib and CDK4/6 inhibitor palbociclib, or T/P) can promote blood vessel development, enabling greater T cell (as well as chemotherapy) delivery into the tumor. However, the cancer “tricks” the immune system into thinking that the tumor is just a regular, healthy clump of cells. Since the T cells aren’t activated, simply having more of them present won’t clear the cancer.

Here’s where the researchers want to implement a trick of their own. The first pathway is called the stimulator of interferon genes (STING) pathway. STING recognizes viral infections in the body. “If we can trick the immune system into thinking that there is a viral-type infection, then we harness a very robust anti-tumor immune response to bring in for tumor immunotherapy,” Atukorale explains.

The researchers also wanted to activate the TRL4 pathway because it boosts the effects of STING activation. They use agonists, which are any chemicals that can trigger a biological response; in this case, in immune stimulatory pathways. But getting these immunity-triggering chemicals through the tumor’s microenvironment is still a challenge.

The researchers’ solution: encapsulating the STING and TRL4 agonists in a novel design of lipid-based nanoparticles. The nanoparticles have several benefits. First, the research demonstrated that they are highly effective at delivering the agonists into the challenging tumor microenvironment.

The design also allows both of the agonists to be packaged together-a challenge since these two mix as well as oil and water. “It ensures that they are carried within the blood circulation together, they reach the same target cell together and are taken up together by the same target cell,” says Atukorale.

“We’re using biocompatible, lipid-based materials to encapsulate drugs that functionally work together, but don’t like to be next to each other, and then we are able to use engineering capabilities to build in various functionalities to direct them where they need to go,” she says.

The synergistic effect of the two agonists plus the T/P therapy proved effective: eight out of nine of the mice saw tumor necrosis and shrinkage. “And we had two mice that had complete responses, meaning the tumors completely went away, which is pretty striking,” says Ruscetti. “We’ve never seen that in this model before.”

There is still work to be done because the tumors returned after the mice were taken off of the treatment, but Ruscetti says it is still a very encouraging step toward a cure.

“If you go beyond pancreas cancer to other cancer types, you need a combination therapy to target the tumor and to target the immune system,” he adds. “This is a strategy to be able to do that.” Treatments for cancers like PDAC that could be derived from this study include mutations of colon cancer, lung cancer, liver cancer and cholangiocarcinoma (cancer of the bile ducts).

Prabhani adds that the modular nature of this design allows for therapies that can be easily personalized for patients. “It’s sort of plug and play,” she says. “We can tailor the agonist ratios, the drug combinations, the targeting molecules, but keeping essentially the same platform. This is what will make it hopefully translational, but also tunable on a per patient basis, because many of these cancer therapies need to be personalized.”

Finally, she nods to the power of collaboration between the two UMass institutions, saying, “This type of system is easily built when you have complementary, but multidisciplinary and cross-disciplinary, expertise.” 

Reference:

Loretah Chibaya et al. ,Nanoparticle delivery of innate immune agonists combined with senescence-inducing agents promotes T cell control of pancreatic cancer.Sci. Transl. Med.16,eadj9366(2024).DOI:10.1126/scitranslmed.adj9366.

Powered by WPeMatico

Weight loss interventions associated with improvements in several symptoms of PCOS: Study

A systematic review of randomized controlled trials (RCTs) found that weight loss interventions were associated with improvements in some polycystic ovary syndrome (PCOS) symptoms, including improvement in menstrual frequency, and could be considered a routine treatment option for patients with PCOS.

According to the researchers, this is the first review to also show that weight loss interventions were associated with a clinically significant improvement in menstrual frequency, an important outcome identified by those living with PCOS and an indicator for subsequent fertility. This study is published in Annals of Internal Medicine.

Researchers at the University of Oxford comprehensively searched several scientific research databases for RCTs from database inception until June 2024 comparing interventions aiming to reduce weight against usual care or low-intensity weight-loss interventions in people with PCOS.

The researchers conducted this review to address the gap in evidence quantifying the impact of weight loss on the management of PCOS, which makes it particularly challenging for clinicians to advise the potential impacts of weight loss interventions.

Pairs of independent reviewers screened the studies and analyzed the impact of weight-intervention on metabolic markers, hormonal markers, gynecological markers and quality of life compared to offering no additional care, usual care (metformin, oral contraceptives, standard advice) or a lower-intensity weight loss intervention (advice for weight loss without support). Interventions included behavioral interventions (diet or physical activity), current or previously licensed weight loss pharmacotherapy (or those which share a class-effect), bariatric surgery, or combinations of such interventions.

The researchers also spoke with 36 women who have PCOS to better inform their selection of primary outcomes and presentation of findings. The researchers found that weight loss interventions were associated with greater reductions in glycemic control and hormonal markers including the free androgen index (FAI). These findings indicate that weight loss interventions may be an effective tool for PCOS management in applied clinical settings, and clinicians could use these results to counsel patients with PCOS on the improvements in PCOS markers after weight loss and direct them towards appropriate interventions. 

Reference:

Jadine Scragg, Alice Hobson, Lia Willis, MSc, Kathryn S. Taylor, Effect of Weight Loss Interventions on the Symptomatic Burden and Biomarkers of Polycystic Ovary Syndrome: A Systematic Review of Randomized Controlled Trials, Annals of Internal Medicine, https://doi.org/10.7326/M23-3179

Powered by WPeMatico

Ankle-GO score valid and robust score to predict return to sport in patients after lateral ankle sprain: Study

Lateral ankle sprain (LAS) is the most common sports-related injury. However, there are currently no published evidence-based criteria to guide the patient’s return to sport (RTS) and this decision is generally time-based.

Picot et al conducted a study to assess the psychometric properties of a new score (Ankle-GO) and its predictive ability for RTS at the same level of play after LAS. The article has been published in ‘Sport health’ journal.

The Ankle-GO was administered to 30 healthy participants and 64 patients at 2 and 4 months after LAS. The score was calculated as the sum of 6 tests for a maximum of 25 points. Construct validity, internal consistency, discriminant validity, and test-retest reliability were used to validate the score. The predictive value for the RTS was also validated based on the receiver operating characteristic (ROC) curve.

Ankle-GO is a composite score based on the sum of 7 components for an objective evaluation of the main deficits associated with LAS or CAI and which can result in a risk of reinjury.It was calculated from 4 functional tests: the single leg stance test (SLS) on a firm surface, the modified star excursion balance test (mSEBT), the side hop test (SHT), and the figure-of-8 test (F8T). In addition, 2 patient self-reported questionnaires were used: the Foot and Ankle Ability Measure, involving 2 subscales evaluating activities in daily life (FAAM adl) and sports (FAAMsport ), and the Ankle Ligament Reconstruction- Return to Sport after Injury (ALR-RSI).

Key findings of the study were:

• The internal consistency of the score was good (Cronbach’s alpha coefficient of 0.79) with no ceiling or floor effect.

• Test-retest reliability was excellent (intraclass coefficient correlation = 0.99) with a minimum detectable change of 1.2 points.

• The 2-month scores were significantly lower than 4-month and control group scores (7.7 ± 4, 13.9 ± 4.6, and 19.6 ± 3.4 points, respectively, P < 0.01).

• Ankle-GO values were also significantly higher in patients who returned to their preinjury level at 4 months compared with those who did not (P < 0.01).

• The predictive value of the 2-month Ankle-GO score was fair for a RTS at the same or higher than preinjury level at 4 months (area under ROC curve, 0.77; 95% CI, 0.65-0.89; P < 0.01).

Clinical Relevance: Ankle-GO is the first objective score to help in the decision-making of the RTS after LAS. At 2 months, patients with an Ankle-GO score <8 points are unlikely to RTS at the same preinjury level.

The authors concluded that – “Ankle-GO is a valid and reliable score when assessing patients after LAS during the RTS continuum. This inexpensive clinical tool composed of functional test and self-reported questionnaires seems relevant to discriminate and predict the level of RTS. At 2 months after injury, a patient exhibiting an Ankle-GO score <8 points are unlikely to resume at the same preinjury level at 4 months.”

Prospective diagnostic study

Level of Evidence: Level 2.

Key Words: ankle sprain, decision, functional testing, psychological readiness, return to sport, Picot et al, SPORTS HEALTH, Ankle-GO Score.

Further reading:

Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain

Picot et al

SPORTS HEALTH

DOI: 10.1177/19417381231183647

Powered by WPeMatico