Vitamin B3 may reduce lung inflammation in COPD patients, reveals study

We live longer and longer, and as we age, a lot of us develop a series of health issues and chronic diseases, including Chronic Obstructive Pulmonary Disease (COPD), which is found in around 600 million individuals globally. However, only half of them know they have the disease.

COPD patients often experience shortness of breath, persistent cough with mucus, wheezing and frequent respiratory infections, which can make everyday activities difficult.

Now a new study from the University of Copenhagen and Bispebjerg Hospital suggests that a form of vitamin B3 may be the key to improving quality of life for these patients.

“In the study, we show that nicotinamide riboside, also known as vitamin B3, can reduce lung inflammation in COPD patients,” says Associate Professor Morten Scheibye-Knudsen from the Center for Healthy Aging at the Department of Cellular and Molecular Medicine, University of Copenhagen, who has co-authored the new study.

“This is significant, because inflammation can lead to reduced lung function in these patients,” he says.

COPD patients have increased risk of respiratory infections and pneumonia. For instance, influenza can lead to serious lung infection and, at worst, death.

Reduced lung inflammation

The double-blinded, randomised, placebo-controlled study included 40 COPD patients and 20 healthy control subjects. The patients either received a placebo or the vitamin B3 in doses of two grams a day. The results showed a significant drop in the inflammation marker (interleukin 8 or IL 8) in patients treated with the vitamin B3. After six weeks, the researchers observed a drop in IL 8 levels of 53 per cent, and this effect increased by 63 per cent after another 12 weeks.

In other words, the group treated with vitamin B3 experienced reduced lung inflammation during the study.

“Even though the results are promising, we need to carry out more studies on larger populations to confirm our findings and to determine the long-term effects of nicotinamide riboside in treatment for COPD,” Morten Scheibye-Knudsen explains.

The researchers also found that COPD patients have lower levels of NAD in the blood, which is associated with accelerated ageing based on DNA methylation levels. Treatment with vitamin B3 resulted in higher NAD levels and showed signs of delaying cellular ageing.

“As we age, we seem to metabolize a molecule known as NAD. The loss of this molecule is also seen after DNA damage, for instance the type of damage associated with smoking,” Morten Scheibye-Knudsen says.

This means that the molecule may influence the ageing process, which makes it a possible target for future treatment – and, initially, for more studies.

It is important not to jump to conclusions about the role of NAD in the ageing process, though, as more research is required to fully understand the implications and possibilities of NAD.

“We hope this research will pave the way for new treatment options for COPD patients, but first we need to continue to analyse and validate the results in larger and more comprehensive studies. Only through thorough research will we be able to offer the best and most effective treatment to people suffering from this difficult disease,” he says.

Reference:

Norheim, K.L., Ben Ezra, M., Heckenbach, I. et al. Effect of nicotinamide riboside on airway inflammation in COPD: a randomized, placebo-controlled trial. Nat Aging (2024). https://doi.org/10.1038/s43587-024-00758-1.

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Updated guidance reaffirms CPR with breaths essential for cardiac arrest following drowning

Updated guidance reaffirms the recommendation for cardiopulmonary resuscitation (CPR) and highlights the importance of compressions with rescue breaths as a first step in responding to cardiac arrest following drowning, according to a new, focused update to Special Circumstances Guidelines from the American Heart Association and the American Academy of Pediatrics. The organizations have previously partnered on neonatal guidelines, however, this is the first collaboration on resuscitation after drowning. The recommendations are published today simultaneously in the flagship, peer-reviewed journals of each organization, Circulation and Pediatrics. The publication in Pediatrics focuses on resuscitation of children following drowning and references pediatric literature, while the publication in Circulation is for resuscitation of both adults and children and includes literature addressing both populations.

Drowning is the third-leading cause of death from unintentional injury worldwide. The World Health Organization estimates there are about 236,000 deaths due to drowning each year globally. According to the CDC, it’s the number one cause of death for children ages 1-4 years old in the U.S.

Disparities in access to swim lessons and other preventive strategies have created inequities; among children ages 17 and younger, U.S. drowning rates are highest among Black and American Indian and Alaska Native individuals.

“The focused update on drowning contains the most up-to-date, evidence-based recommendations on how to resuscitate someone who has drowned, offering practical guidance for health care professionals, trained rescuers, caregivers and families,” said writing group Co-Chair Tracy E. McCallin, M.D., FAAP, associate professor of pediatrics in the division of pediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland. “While we work on a daily basis to lower risks of drowning through education and community outreach on drowning prevention, we still need emergency preparedness training that can be used in tragic circumstances if a drowning occurs.”

Detailed in the new guideline update:

  • Anyone removed from the water without showing signs of normal breathing or consciousness should be presumed to be in cardiac arrest.
  • Rescuers should immediately initiate CPR that includes rescue breathing in addition to chest compressions. Multiple large studies over time show more people with cardiac arrest from non-cardiac causes such as drowning survive when CPR includes rescue breaths compared to Hands-Only CPR (calling 911 and pushing hard and fast in the center of the chest).

Drowning generally progresses quickly from initial respiratory arrest (when a person is unable to breathe) to cardiac arrest, meaning that the heart stops beating. As a result, blood cannot circulate properly throughout the body, and it is starved of oxygen.

“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group Co-Chair Cameron Dezfulian, M.D., FAHA, FAAP, senior faculty in pediatrics and critical care at Baylor College of Medicine in Houston.

“Cardiac arrest following drowning is most often due to severe hypoxia, or low blood oxygen levels,“ Dezfulian said. ”This differs from sudden cardiac arrest from a cardiac cause where the individual generally collapses with fully oxygenated blood.”

The updated guidance advises untrained rescuers and the public to:

  • Provide CPR with breaths and compressions to all people who have a cardiac arrest after drowning. If a person is untrained, unwilling, or unable to give breaths, they can provide chest compressions only until help arrives.
  • In-water rescue breathing should be given only by rescuers trained in this special skill if it doesn’t compromise their own safety. Trained rescuers should also provide supplemental oxygen if available.
  • The initiation of CPR should always be prioritized and begin as soon as possible as early lay responder CPR has been shown to improve outcomes from drowning.
  • The writing group recommends anautomated external defibrillator(AED) should be placed in public facilities where aquatic activities are present such as swimming pools or beaches. They can be used once the person is removed from the water, if available, yet should not delay initiation of CPR. If available, the AED should be connected to the patient to assess for shockable rhythms once CPR is ongoing. Although most cases of cardiac arrest following drowning do not have shockable rhythms, if a primary cardiac event such as a heart attack occurs while in the water, the best outcomes are when defibrillation is done quickly. AED use is safe and feasible in aquatic environments.
  • All individuals requiring any level of resuscitation following drowning, including those who only need rescue breaths, should be transported to a hospital for evaluation, monitoring and treatment.

In addition to the recommendations on drowning resuscitation, the guideline update also highlights the Drowning Chain of Survival, which includes the steps needed to improve chances of survival: prevention, recognition and safe rescue.

Prevention

It has been estimated that more than 90% of all drownings are preventable. Research has found most infants drown in bathtubs, and the majority of preschool-aged children drown in swimming pools. The American Heart Association and the American Academy of Pediatrics recommend being water aware and practicing water safety. A full review of prevention is outside the scope of this guideline, however, the topic is addressed in the American Academy of Pediatrics 2021 technical report, Prevention of Drowning, and in guidelines from the World Health Organization and the Wilderness Medical Society.

Recognition

Recognition of drowning may be challenging because someone who is drowning may not be able to verbalize distress or signal for help. Drowning happens quickly. People in distress will rapidly submerge, lose consciousness and may be hidden from anyone not actively seeking them.

Safe Rescue and Removal

The guideline update recommends that appropriately trained rescuers, such as lifeguards, swim instructors or first responders, should provide in-water rescue breathing to an unresponsive person who has drowned if it does not compromise their own safety. Previous studies have proven this leads to more favorable survival outcomes. A drowning person who is unconscious and likely in cardiac arrest should be removed from the water in a near-horizontal position, with the head maintained above body level and airway open. If the drowning individual is conscious, a more vertical position may be preferable to reduce the risk of vomiting.

In summary, “These updated guidelines are based on the latest available evidence and are designed to inform trained rescuers and the public how to proceed in resuscitating people who have drowned. Drowning can be fatal. Our recommendations maximize balancing the need for rapid rescue and resuscitation, while prioritizing rescuer safety,” Dezfulian said.

The American Heart Association urges all individuals to enroll in CPR training programs available through its online platform or local community centers. CPR education and training is offered for health care professionals, first responders, individuals, schools and communities. Provision of good rescue breathing requires hands on practice using a manikin or other simulation training.

This joint focused update was prepared by the volunteer writing group on behalf of the American Heart Association and the American Academy of Pediatrics. These updates to current clinical guidelines were developed with input from experts in drowning, pediatrics, adult and pediatric critical care, anesthesiology, emergency medicine, EMS and related fields. It is based on seven systematic reviews completed by the International Liaison Committee on Resuscitation Basic Life Support Task Force, used to generate updated treatment recommendations and good practice statements. This guideline update supersedes the American Heart Association’s prior recommendations for drowning issued in 2020 and serves as a complement to the American Academy of Pediatrics 2021 Prevention of Drowning technical report and the related 2019 Prevention of Drowning policy statement. All other recommendations and algorithms published in the 2020 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care remain the official clinical recommendations for resuscitation outside the special circumstance of drowning.

Reference:

Cameron Dezfulian, Tracy E. McCallin, Joost Bierens, 2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, https://doi.org/10.1161/CIR.0000000000001274

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Higher Blood Pressure Levels and Variability Linked to Faster Glaucoma Progression: JAMA

Researchers have found that higher mean blood pressure (BP) values and increased BP variability are correlated with higher speed of visual field progression in glaucoma patients. A new study was recently published in JAMA Ophthalmology which was conducted by Pham and colleagues.

Glaucoma is one of the leading causes of irreversible blindness. Its development is strongly influenced by risk factors related to systemic and ocular conditions. While intraocular pressure (IOP) is most commonly associated with increased risk, BP is very important as well. This prospective study aimed to analyze changes in BP levels, variability of BP, and visual field changes in patients with glaucoma over time.

The longitudinal data of this study followed participants from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. BP and visual field testing was offered to participants between November 2000 and December 2022.

Sample size: 985 adult patients (1,674 eyes).

Demographics: Mean age was 61.2 years, 57.2% were women, 61.7% were white, and 32.6% were Black.

BP measurements: Mean BP was 131.6/76.1 mm Hg.

Follow-up duration: Mean follow-up was 8 years.

Visual field progression: Mean deviation change rate was -0.13 dB/year.

Key findings of the study were:

Higher BP levels and visual field changes:

  • Mean arterial pressure: 0.02 dB/year per 1-mm Hg higher (P=0.001).

  • Diastolic arterial pressure: 0.02 dB/year per 1-mm Hg higher (P<0.001).

BP variability and IOP interaction:

  • Mean arterial pressure: 0.01 μm per 1-mm Hg higher (P=0.003).

  • Diastolic arterial pressure: 0.01 μm per 1-mm Hg higher (P=0.001).

Variability impact:

  • Patients with higher BP variability experienced more significant highs and lows, potentially compromising optic nerve perfusion.

Compared with previous observations, higher mean levels of BP and increased variability were significantly associated with more rapid deterioration of the visual field, thus demanding an integrated management of BP and IOP in the care of glaucoma patients. Further studies are required to define the impact of any strategies to manage BP on reducing glaucoma-related vision loss over the long-term.

Reference:

Pham, V. Q., Nishida, T., Moghimi, S., Girkin, C. A., Fazio, M. A., Liebmann, J. M., Zangwill, L. M., & Weinreb, R. N. (2024). Long-term blood pressure variability and visual field progression in glaucoma. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.4868

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No significant benefit of IV exenatide in reducing complications during cardiac surgery, finds GLORIOUS trial

A large-scale clinical trial found that intravenous infusion of exenatide, a glucagon-like peptide-1 (GLP-1) analog medication, during heart surgeries involving bypass did not significantly reduce the risk of death, stroke or organ failure. Researchers presented this preliminary late-breaking science trial today at the American Heart Association’s Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

Exenatide is a GLP-1-like (analog) medication primarily prescribed to treat Type 2 diabetes, approved by the U.S. Food and Drug Administration in 2005. The GLORIOUS trial tested whether intravenous infusion of exenatide could reduce complications during and after cardiac surgery that included the assistance of cardiopulmonary bypass.

Health care professionals frequently perform heart surgery with the assistance of cardiopulmonary bypass, also known as a heart-lung machine. During this procedure, the blood is drained from the veins through a pump, passed through an oxygenator that adds oxygen and removes carbon dioxide, and pumped back into the body through the aorta. The process allows the body and organs to continue to receive oxygen-rich blood and function, while the surgeon operates on a non-moving heart. While helpful, there are still risks to bypass, including death, stroke, kidney failure and new or worsening heart failure. Previous research has suggested that exenatide might have organ-protective effects, the authors noted.

“The evidence for perioperative treatment of patients undergoing cardiac surgery is limited,” said investigator Sebastian Wiberg, M.D., Ph.D., an anesthesiologist at The Heart Centre, Copenhagen University Hospital Rigshospitalet in Copenhagen, Denmark. “As such, there is a large unmet need for clinical trials investigating strategies to optimize treatment and reduce the risk of complications, such as organ injury, inflammation and the formation of blood clots.”

The GLORIOUS trial included approximately 1,400 adults who had cardiopulmonary bypass-assisted coronary bypass grafting and/or surgical aortic valve replacement at a heart center in Denmark between 2016 and 2021, with the final follow-up visit completed in June of 2024. The study was a randomized, double-blind, placebo-controlled clinical trial, meaning participants were randomly assigned to receive a test treatment or a sham/placebo treatment, and neither the researchers nor the participants knew which group participants were in. Patients were randomized to one of two groups: to receive either a six hour and 15-minute infusion of exenatide or a placebo prior to surgery.

The study found no significant differences in outcomes between the two groups during the average follow-up period of nearly six years:

  • 14% of patients who received exenatide died during the follow-up period vs. 13% of those who received the placebo.
  • 5.8% of patients in the exenatide group had a stroke vs. 4.8% of those in the placebo group.
  • 9.8% of patients who received exenatide had new or worsening heart failure after surgery vs. 10% of those who received the placebo.
  • 4.8% in the exenatide group had acute kidney injury during the initial hospital admission for surgery vs. 5.3% in the placebo group.

“We had hoped exenatide might protect patients from developing heart failure or other common complications after heart bypass surgery, however, the results suggest that this GLP-1 analog does not offer significant benefits. Of note, these findings provide important insights into what does and doesn’t work in the complex setting of cardiac surgery,” Wiberg said. “There is still a big gap in knowledge about how to best support patients on bypass during surgery, and there is an urgent need for more clinical trials to find ways to optimize patient health during and after bypass surgery.”

Wiberg emphasized that because the trial assessed the effects of a single treatment with exenatide over a relatively brief administration period at one heart center in Denmark, the results may not be generalizable to other medications among different patient populations. In addition, it’s possible that different GLP-1 analogs, administration for a longer period of time or a larger dose may potentially be beneficial for patients undergoing cardiopulmonary bypass-assisted cardiac surgery.

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Vellore’s Medical College MBBS Seat Scam- Modus operandi revealed

Chennai- In a recent update on the case of a man who allegedly pretended to be a priest to dupe people on the pretext of getting them MBBS seats, it has been reported that he used to take the parents of the students to Vellore and cheated them by showing them the medical college and its surrounding areas. He sent his colleague dressed as a bishop and approached the parents.

Medical Dialogues had earlier reported that the accused has been identified as Jacob Thomas, a resident of Koodal in Pathanamthitta. He was arrested the other day at the Chennai International Airport while he was trying to flee to Malaysia, where he also revealed his modus operandi of fraud to the police. Thomas presented himself as a gospel worker and convinced families in Kerala and other states that he had close ties with the Vellore’s Medical College and an Anglican bishop. He swindled money from people from Kerala and outside the state by introducing himself as a priest.

Also Read: MBBS seat scam busted! Man pretends to be a priest, dupes parents of crores promising admissions in Vellore’s Medical College

Meanwhile, Kerala Kaumudi has reported that the accused would come to the college with the parents and say that the church has a quota in Vellore Medical College and he will get them that seat. After asking the parents to wait outside the college, he used to go inside and come out after some time. The parents are taken to another place saying that they can meet and talk to the bishop. The bishop was one of the members of the pastor’s group identified as Paul Gladson, who used to dress as a bishop.

After meeting the fake Bishop, he assured the parents and suggested that this meeting is very confidential and not to tell anyone else. After that, the money is taken. However, after receiving the money the group disappears and there is no college admission notification either.

The matter came to light when some parents went directly to Vellore to enquire and found that no agency had been assigned to allot church seats and the seats were being given directly through church selection.

Thomas lived in seven states, including Bihar, Haryana, and Tamil Nadu, to evade arrest. During his stay in Thakkalai, Kanyakumari, he allegedly defrauded several people in Kerala. Victims have reported losing amounts ranging from Rs 60 lakh to Rs 80 lakh.

Also Read: Khyati Hospital PMJAY-Scam: 2 CEOs under investigation for multi-crore fraud, purchasing patient data

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Doctors at Mhaske Hospital Discover Stent Left in Man’s Stomach from 2022 Surgery

Pune: For two long years, a 73-year-old man unknowingly carried a life-threatening object inside his body—a stent that he had forgotten to get removed after a medical procedure. What was supposed to drain bile and treat issues in the pancreatic ducts became a source of severe health complications for him.

Stones developed in the bile duct of the man due to his failure to get it removed non-surgically through endoscopy on time. However, Doctors at Mhaske Hospital in Pune successfully removed the stent and the stones through laparoscopic surgery.

Although the patient recovered following the surgery, the incident came as shocking for doctors when they discovered the man living with the stent inside for two years after an Endoscopic Retrograde Cholangiopancreatography was performed in 2022.

Also read- Controversy after PG Opthalmology student hired at District Hospital performs 44 surgeries without completion of Degree

Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. Therefore, a stent was inserted to drain bile and treat issues in the pancreatic ducts of the man at a government hospital. 

The man had undergone the procedure at a government hospital and was instructed to return six weeks later, to get the stent removed. However, he allegedly forgot to return and the stent stayed in his body for two years.

The incident came to light when the man was suffering from stomach pain, bloating, fever, jaundice and decided to seek medical attention. Therefore he approached the doctors at Mhaske Hospital in Pune. After conducting an ultrasound, the doctors spotted the stent inside. 

Dr Chetan Mhaske, chief surgeon at Mhaske Hospital, who performed the laparoscopic surgery told TOI, “The man began complaining of stomach pain, bloating, and fever. He also had jaundice. After ruling out all possible reasons, we performed an ultrasound and to our shock, spotted the stent inside. He simply forgot about the follow-up in 2022.”

“That was the root cause of his problems. He had undergone the ERCP procedure at a govt hospital, during which the stent was placed to drain bile. This procedure combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. He was told to get the stent removed later, but likely forgot,” Dr Mhaske added.

Assistant surgeon Dr Anup Kamble said, “If the patient had followed up, the stent could have been removed non-surgically through endoscopy. But because it had been left in there for such a long time, stones developed in the bile duct. So we had to surgically intervene through laparoscopy. The surgery to remove the stent was carried out in Sept. There were follow-up medications and a procedure next month. He has since recovered. If it was just the stent, we would’ve removed it endoscopically, without surgery. But the two stones needed a surgical procedure.”

Also read- KIMSHEALTH Doctors perform posterior scoliosis correction surgery on 23-year-old Maldivian

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No ‘one size fits all’ treatment for type 1 diabetes, study finds

Factors beyond carbohydrates have a substantial influence on blood glucose levels meaning current automated insulin delivery systems miss vital information required for glucose regulation, a new study has found.

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Researchers identify potential genes linking depression to menstrual pain

Women are twice as likely as men to suffer from depression and often experience more severe physical symptoms. This gender difference is particularly evident during reproductive years and dramatically impacts the lives of hundreds of millions of people worldwide. However, although links between mental health and reproductive health have been found, the associations have remained underexplored.

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Scientists discover new details of gene regulation that control cell identity

Genes make up the blueprints and outline the process of building every living organism. To ensure that the right genes are activated in the right cells, and in the right amounts at the right time, genes are constantly being regulated by small molecular machines made of proteins. When gene regulation fails, or specific genes are altered through mutation, the body is more predisposed to diseases such as cancer, Alzheimer’s, and autoimmune disorders.

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Early-stage trial finds stem cell therapy for retinitis pigmentosa is safe

A team of UC Davis Health researchers has shown that CD34+ stem cells can be safely administered into retinitis pigmentosa (RP) patients’ eyes and may offer therapeutic benefits. The phase 1 trial also confirmed that these specialized cells can be readily isolated from the patient’s own bone marrow. The study was published in the journal Ophthalmology Science.

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