Archive for month: November, 2024

The autotransplant of third molars to replace missing teeth is gaining attention. This study aimed to analyze factors influencing the success, survival, and inflammatory root resorption (IRR) of autotransplanted third molars with completely formed roots. A total of 160 patients who underwent autotransplant of third molars with completely formed roots were evaluated retrospectively, involving 168 teeth. Preoperative, intraoperative, and postoperative variables were assessed to identify prognostic factors for success, survival, and IRR. Results: The average (SD) follow-up was 5.21 (1.99) years. The success, survival, and IRR rates were 75.0%, 91.1%, and 17.3%, respectively. Cox proportional hazards regression analysis revealed that both apical resection and retrofilling (ARR) (P < .001) and donor tooth replicas (P < .001 for success and IRR; P = .013 for survival) were associated significantly with success, survival, and IRR. Furthermore, root canal treatment timing and patient age significantly affected success and survival, respectively (P = .006 and P = .036). The use of donor tooth replicas significantly reduced both the surgical time (P < .001) and extraoral time of the donor tooth (P < .001), whereas ARR increased the extraoral time of the donor tooth (P = .002). The use of a single root donor tooth was associated with a reduced surgical time (P = .003). Using donor tooth replicas and avoiding ARR contributed to increased success and survival rates and prevented IRR. Third molars with completely formed roots are suitable donors for replacing missing teeth, provided that appropriate preoperative, intraoperative, and postoperative indications are considered.

Reference:

Xia J, Ge Z, Zhang Y, Shi J, Xie Z. Prognostic factors for autotransplanted third molars with completely formed roots: A retrospective cohort study. J Am Dent Assoc. 2024 Nov 23:S0002-8177(24)00588-9. doi: 10.1016/j.adaj.2024.10.004. Epub ahead of print. PMID: 39580736.

Keywords:

Autotransplantation, third, molars, fully, formed, roots, promising, solution, replacing, missing, teeth, finds, study, Journal of the American Dental Association, Autotransplantation; inflammatory root resorption; success rate; survival analysis; survival rate; third molar, Xia J, Ge Z, Zhang Y, Shi J, Xie Z

More time spent sitting, reclining or lying down during the day may increase the risk of cardiovascular disease (CVD) and death, according to a study in JACC, the flagship journal of the American College of Cardiology, and presented at the American Heart Association’s Scientific Sessions 2024.

More than roughly 10-and-a-half hours of sedentary behavior per day was significantly linked with future heart failure (HF) and cardiovascular (CV) death, even among people meeting recommended levels of exercise.

“Our findings support cutting back on sedentary time to reduce cardiovascular risk, with 10.6 hours a day marking a potentially key threshold tied to higher heart failure and cardiovascular mortality,” said Shaan Khurshid, MD, MPH, a cardiologist at the Massachusetts General Hospital and co-senior author of the study. “Too much sitting or lying down can be harmful for heart health, even for those who are active.”

Insufficient exercise is a known risk factor for cardiovascular disease (CVD). Over 150 minutes of moderate-to-vigorous physical activity per week is recommended by current guidelines to promote heart health. However, study experts say exercise is only a small fraction of overall daily activity, and the current guidelines don’t provide specific guidance on sedentary behavior which accounts for a much larger portion of daily activity, despite evidence that it’s directly linked with CVD risk.

This study examined the amount of sedentary time at which CVD risk is greatest and explored how sedentary behavior and physical activity together impact the chances of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and CV mortality.

Among the 89,530 study participants of the UK biobank, the average age was 62 years and 56.4% were women. Participants submitted data from a wrist-worn triaxial accelerometer that captured movement over seven days. The average sedentary time per day was 9.4 hours.

After an average follow-up of eight years, 3,638 individuals (4.9%) developed incident AF, 1,854 (2.1%) developed incident HF, 1,610 (1.84%) developed indecent MI and 846 (0.94%) died of CV causes, respectively.

The effects of sedentary time varied by outcome. For AF and MI, the risk increased steadily over time without major shifts. For HF and CV mortality, increase in risk was minimal until sedentary time exceeded about 10.6 hours a day, at which point risk rose significantly, showing a “threshold” effect for the behavior.

For study participants who met the recommended 150 minutes of moderate-to-vigorous physical activity or more, the effects of sedentary behavior on AF and MI risks were substantially reduced, but effects on higher risk of HF and CV mortality remained prominent.

“Future guidelines and public health efforts should stress the importance of cutting down on sedentary time,” Khurshid said. “Avoiding more than 10.6 hours per day may be a realistic minimal target for better heart health.”

In an accompanying editorial comment, Charles Eaton, MD, MS, Director of the Brown University Department of Family Medicine, said the use of wearable accelerometers has shown that exercise is significantly over-estimated by self-report and sedentary behavior is under-estimated.

Eaton said that replacing just 30 minutes of excessive sitting time each day with any type of physical activity can lower heart health risks. Adding moderate-to-vigorous activity cut the risk of HF by 15% and CV mortality by 10%, and even light activity made a difference by reducing HF risk by 6% and CV mortality by 9%.

“This study adds to the growing evidence of a strong link between sedentary behavior and cardiovascular health,” said Harlan M. Krumholz, MD, SM, Harold H. Hines Jr. Professor at Yale School of Medicine and Editor-in-Chief of JACC. “The findings strongly suggest that we need to get people moving to promote better health.”

There are several limitations of the study, including the inability to know details on where or why people are sitting or lying down for extended periods, such as at the workplace, which could have different impacts on CV risks. Accelerometers worn on the wrist are imperfect at detecting posture and therefore may misclassify standing time as sedentary time. A longer monitoring period may provide more accurate data on activity habits and patterns.

Other limitations include the potential for confounders in study results, selection bias, the inability to measure the actual effects of reallocating sedentary time to other activities, and differences between data from wrist-worn accelerometers versus thigh-worn accelerometers.

References: Ezimamaka Ajufo MD a b, Shinwan Kany MD, MSc b c d, Joel T. Rämö MD, PhD b e, Timothy W. Churchill MD f g, J. Sawalla Guseh MD f g, Krishna G. Aragam MD, MS b f g, Patrick T. Ellinor MD, PhD b f h ∗ , Shaan Khurshid MD, MPH https://doi.org/10.1016/j.jacc.2024.10.065

The management of epilepsy during pregnancy is well aided by the administration of antiseizure medications but their teratogenic potential threatens the neurodevelopment of the fetus. Historically, evidence has been shown to exist for dose-dependent effects of antiseizure medications (ASMs) on cognitive outcomes, culminating in concerns about their safe use. While folate supplementation has proven to improve pregnancy outcomes, increased doses have been surrounded by potential risks. This present study aimed at assessing verbal abilities in children of women with epilepsy (WWE) compared to healthy women (HW), in addition to examining the effects of third-trimester ASM exposures and folate use.

Between 2012 and 2016, the prospective, nonrandomized clinical trial recruited 456 pregnant women from 20 US epilepsy centers. Children were evaluated at 6 years of age between 2019 and 2022. A total of 298 children of WWE and 89 children of HW were included in the final analysis. Verbal Index Scores, calculated from multiple neuropsychological assessments, served as the main outcome measure. The study further assessed ASM blood concentrations and folate supplementation in relation to cognitive outcomes.

The key findings of the study were:

Participant Demographics:

• Children of WWE: 298 participants (mean age 6.4 ± 4.2 years), with 158 females (53.0%) and 140 males (47.0%).

• Children of HW: 89 participants, with a mean age of 6.4 ± 4.2 years, 41 females (46.1%), and 48 males (53.9%).

Verbal Abilities:

• There were no notable differences in Verbal Index Scores between children of WWE and HW (parameter estimate: −0.6; 95% CI: −3.2 to 1.9; p= 0.64).

ASM Exposure:

• Exposure-based outcomes differed depending on the ASM.

• 78% of WWE (232/298) received lamotrigine or levetiracetam, either separately or in combination, such that other ASMs could not reliably be ascertained.

Folate Supplementation:

• Folate use during the first 12 weeks of pregnancy was associated with cognitive and behavioral outcomes in favorable ways.

• Higher doses of folate did not reveal any adverse effects.

This study concludes that the verbal abilities of children of WWE are not different from those of HW, which reinforces the importance of ASM management tailored during pregnancy. Early folate supplementation holds substantial benefits for cognitive and behavioral outcomes, supporting its use as a cornerstone of prenatal care for WWE.

Reference:

Meador, K. J., Cohen, M. J., Loring, D. W., Matthews, A. G., Brown, C., Robalino, C. P., Carmack, A., Birnbaum, A. K., Voinescu, P. E., Gerard, E. E., Kalayjian, L. A., Gedzelman, E. R., Hanna, J., Cavitt, J., Sam, M., Hwang, S., Pack, A. M., French, J. A., Tsai, J. J., … Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) Investigator Group. (2024). Neuropsychological outcomes in 6-year-old children of women with epilepsy: A prospective nonrandomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.3982

Existing literature has identified various factors
contributing to disparities in access to fertility care across racial groups,
including societal, economic, and geographic variables, which can result in
delays in care for affected patients. Compared with White women, African
American and Hispanic women face greater challenges in securing appointments,
missing work for treatments, and covering costs. Moreover, African American and
Hispanic women are more likely to be self-referred or referred by friends or
family and are more likely to experience longer duration of infertility before
receiving fertility care than White women. An investigation by Dongarwar et al.
highlighted similar concerns and showed that compared with non-Hispanic White
women, non-Hispanic Asian women had a 7% lower likelihood and non-Hispanic
Black and Hispanic women had a 70% lower likelihood of receiving any
infertility treatment. Although these studies have provided valuable insights,
there has been limited investigation into how these factors specifically impact
patients with PCOS.

To investigate the factors at play for those with PCOS,
Applebaum et al. explored the critical question: where do disparities in
fertility treatment lie for those with PCOS across racial and socioeconomic lines?
Their comprehensive analysis delved into both patient and physician factors
that could contribute to inequities.

By focusing on the use of clomiphene citrate, letrozole, and
injectable gonadotropins, the study revealed that Black patients, those with
household incomes below the federal poverty line, and those with public
insurance were significantly less likely to be prescribed these fertility
medications compared with White patients, those with household incomes above
the national median, and those with commercial insurance. These findings add to
the existing literature, underscoring the urgent need to address the
disparities that continue to undermine the quality of care for patients with
PCOS.

The study also sheds light on disparities in the provision
of treatment on the basis of the type of healthcare provider. Patients were
less likely to be prescribed these fertility medications from general
obstetrician-gynecologists and family medicine and internal medicine physicians
compared with those from reproductive endocrinologists. This finding highlights
the need for proactive measures within the field of reproductive medicine. For
many patients with PCOS, the first point of contact is their primary care
provider or general obstetrician-gynecologist. Enhancing collaboration between
these providers and reproductive endocrinologists, coupled with robust support
and education initiatives, is essential to ensure that patients have access to
the comprehensive and equitable care they deserve.

Only five patients in the study were uninsured, and <3%
had incomes below the federal poverty line. This limited representation of some
of the most vulnerable populations underscores two important points. First, the
study’s findings may only begin to reveal the full extent of inequity affecting
these groups. Second, the low percentage of such patients may reflect existing
barriers to healthcare access, emphasizing the need for expanded access through
improved insurance coverage and care availability. To better understand and
address these disparities, future research should prioritize the inclusion of
low-income and uninsured individuals to further assess the barriers to care
faced by this population.

The findings of Applebaum et al. highlight the need for
targeted interventions to bridge the gap in fertility care across racial and
socioeconomic groups affected by PCOS. Establishing these interventions will
require a multifaceted approach involving policy changes, community outreach,
and the development of culturally competent care models that address the unique
needs of this population.

Source: Stephanie Hallisey, M.D. Lawrence Engmann, M.D.;FertSert;
VOL. 122 NO. 5 / NOVEMBER 2024

https://doi.org/10.1016/j.fertnstert.2024.08.341

The findings, published in JAMA Network Open, indicate that, alongside the known risks linked to kidney impairment, gabapentinoids should be prescribed with caution in patients at higher risk of hip fractures, particularly those who are frail.

Gabapentinoids, which include drugs like gabapentin and pregabalin, are widely used to treat conditions such as neuropathic pain, fibromyalgia, and seizure disorders. While effective for these purposes, previous studies have hinted at side effects like dizziness, drowsiness, and impaired coordination. These side effects can lead to an increased risk of falls, but the connection to hip fractures has not been thoroughly explored until now.

Against the above background, Miriam T. Y. Leung, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia, and colleagues aimed to examine the overall relationship between gabapentinoid use and the risk of hip fractures, and how this association varies across different age groups, frailty levels, and histories of chronic kidney disease.

For this purpose, the researchers conducted a case-case-time-control study involving patients hospitalized for hip fractures in Victoria, Australia, between March 2013 and June 2018, who had at least one prescription for a gabapentinoid before the fracture. They used conditional logistic regression to estimate the odds ratio for gabapentinoid use during the 1-60 days before the fracture compared to 121-180 days prior.

Each case was matched with up to five controls based on age and sex. Subgroup analyses were conducted based on CKD, frailty status, and frailty scores. Data analysis was performed between November 2023 and April 2024.

The study led to the following findings:

• Of the 28,293 patients hospitalized for hip fractures, 10.4% had been dispensed with a gabapentinoid before the fracture.
• Among those, 59.5% were aged 80 or older, and 71.2% were female.
• Gabapentinoid use was associated with nearly double the odds of hip fractures (OR 1.96).
• The odds remained elevated (OR 1.30) after adjusting for exposure-time trends and using other central nervous system medications.
• The association was stronger in patients with frailty scores of 5 or higher (OR 1.75) and those with chronic kidney disease (OR 2.41).

“The findings showed that in Australian adults hospitalized for a first hip fracture, the use of gabapentinoids was linked to an increased risk of hip fractures, particularly in frail patients or those with chronic kidney disease. Alongside the established risk associated with kidney impairment, frailty status may also be a significant factor to consider when prescribing gabapentinoids,” the researchers concluded.

Reference:

Leung MTY, Turner JP, Marquina C, et al. Gabapentinoids and Risk of Hip Fracture. JAMA Netw Open. 2024;7(11):e2444488. doi:10.1001/jamanetworkopen.2024.44488