Delhi AIIMS Hosts SARANSH Workshop to Boost Evidence-Based Healthcare

New Delhi: The All India Institute of Medical Sciences (AIIMS), New Delhi, in collaboration with the Department of Health Research (DHR) under the Ministry of Health and Family Welfare (MoHFW), organized the SARANSH workshop, a key initiative aimed to enhance regional capabilities for conducting systematic reviews across the country.

The SARANSH (Systematic Reviews and Networking Support in Health) program is a flagship initiative by DHR aimed at building regional capacity for conducting systematic reviews across the country.

According to an ANI report, this workshop was inaugurated by Prof M Srinivas- Director, Prof KK Verma- Dean (Academics), and Prof. Govind Makharia- Associate Dean (Research) of AIIMS.

The workshop was conducted to empower medical facilities from seven northern states and Union Territories of India to undertake high-quality systematic reviews that can strengthen evidence-based healthcare practices in the region.

Also Read:AIIMS, CSIR join hands to advance medical research, healthcare delivery

The five-day event brought together clinicians, researchers, and academicians from Delhi, Haryana, Chandigarh, Punjab, Himachal Pradesh, Jammu and Kashmir, and also Ladakh.

The program focussed on hands-on training in systematic review methodology, which will serve as a critical tool for synthesizing and integrating clinical research findings to address key healthcare challenges in India.

The workshop was meticulously designed to train participants in conducting systematic reviews to inform clinical decision-making and health policy and enhance regional research capacities by creating a network of skilled professionals adept at synthesizing evidence. It also aimed to foster collaboration between clinical facilities and research institutions across northern states, news agency ANI reported.

The workshop was led by an eminent panel of experts from AIIMS, ICMR and DHR who shared insights into the conceptual and practical aspects of systematic reviews. Enthusiastic participants engaged in hands-on training, learning how to frame research questions, perform literature searches, assess the quality of evidence, and apply advanced statistical techniques.

The program was supported and sponsored by DHR, the initiative reaffirms the government’s commitment to strengthening India’s healthcare research ecosystem.

Participants praised the workshop as a much-needed step toward bridging the gap between research and practice.

The SARANSH workshop is a significant step forward in India’s journey toward achieving excellence in healthcare delivery through evidence-based practice. With its success, the stage is set for future initiatives to strengthen research and innovation in healthcare across the nation.

Also Read:AIIMS signs MoU with Wipro GE Healthcare to set up AI health innovation hub

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Semaglutide with Metformin Improves Liver Health and Pancreatic Function in T2DM and NAFLD: Study Reveals

China: A recent study revealed that combining semaglutide and metformin significantly improved liver inflammation, fibrosis, and pancreatic beta-cell function in patients with type 2 diabetes (T2DM) and non-alcoholic fatty liver disease (NAFLD).

“Compared to metformin alone, the combination therapy resulted in lower liver enzyme levels (ALT, AST), reduced fibrosis, better glycemic control (lower HbA1c), and enhanced beta-cell function,” the researchers reported. The findings were published online in the Journal of Diabetes and its Complications on December 9, 2024.

Type 2 diabetes mellitus and non-alcoholic fatty liver disease often coexist, driven by underlying insulin resistance and systemic inflammation. There is an urgent need for effective management strategies targeting both metabolic disorders. Keeping this in mind, Rong Ren, Department of Endocrinology, Shanxi Provincial Integrated TCM And WM Hospital, Taiyuan, China, and colleagues examined the impact of combining semaglutide, a glucagon-like peptide-1 receptor agonist, with metformin on liver inflammation and pancreatic beta-cell function in patients with T2DM and NAFLD.

For this purpose, the researchers conducted a retrospective analysis of 261 patients with T2DM and NAFLD treated at our institution between January 2021 and December 2023. The participants were categorized into two groups: 127 patients received metformin alone (M group), while 134 patients received a combination of semaglutide and metformin (SAM group).

Liver inflammation and fibrosis were evaluated using alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (γ-GTP), and the FIB-4 index. Pancreatic beta-cell function and insulin sensitivity were assessed based on the Matsuda index, HbA1c, fasting glucose, and the oral disposition index (DIo).

The investigation uncovered the following findings:

Post-treatment, the SAM group exhibited significantly greater improvements in liver inflammation markers compared to the M group:

• ALT levels: 23.59 ± 5.67 U/L in SAM vs. 25.56 ± 5.46 U/L in M

• AST levels: 18.97 ± 3.94 U/L in SAM vs. 20.15 ± 3.95 U/L in M

• The SAM group demonstrated reduced fibrosis as indicated by the FIB-4 index:

• FIB-4 index: 1.05 ± 0.44 in SAM vs. 1.16 ± 0.51 in M

• Enhanced beta-cell function was observed in the SAM group:

• Matsuda index: 5.18 ± 1.09 in SAM vs. 4.84 ± 1.15 in M

• DIo (oral disposition index): 0.18 ± 0.06 in SAM vs. 0.16 ± 0.05 in M

• Glycemic control was superior in the SAM group, as reflected by reduced HbA1c levels.

The authors highlight that combining semaglutide and metformin effectively improves liver inflammation, fibrosis, beta-cell function, and insulin sensitivity in patients with T2DM and NAFLD. Their findings suggest that the beneficial effects of semaglutide combined with metformin on liver function are independent of body weight loss and glycemic control.

“These results emphasize the potential role of semaglutide as a key therapeutic option in the comprehensive management of metabolic and liver-related disorders,” they concluded.

Reference:

Ren, R., Pei, Y., Kong, L., & Shi, Y. (2024). The effect of semaglutide combined with metformin on liver inflammation and pancreatic beta-cell function in patients with type 2 diabetes and non-alcoholic fatty liver disease. Journal of Diabetes and its Complications, 108932. https://doi.org/10.1016/j.jdiacomp.2024.108932

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Sacubitril-valsartan may help prevent heart damage related to chemotherapy, suggests study

A commonly prescribed medication for heart failure was linked to a lower risk of heart damage, or cardiotoxicity, among high-risk cancer patients undergoing chemotherapy treatment using anthracyclines, according to preliminary late-breaking science presented at the American Heart Association’s.

“We have identified a promising new strategy for protecting the heart during cancer treatment, with the potential to impact patient care significantly and future research in heart disease and cancer,” said study lead author Marcely Bonatto, M.D., a cardiologist and specialist in heart failure and heart transplantation at the Heart Institute, University of São Paulo in Curitiba, Brazil. “Importantly, our strategy enables early identification of people at high risk for developing heart dysfunction, allowing for timely interventions to prevent further loss of heart function.”

Heart failure occurs when damage prevents the heart from pumping blood well enough to supply the body with blood and nutrients. Anthracyclines are a class of chemotherapy medications used to treat many types of cancer, including breast cancer, leukemia, lymphoma and sarcoma. However, one of their potential side effects is cardiomyopathy, a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy is a form of cardiotoxicity that refers to heart damage caused by cancer treatments involving chemotherapy.

The SARAH clinical trial examined the effects of the heart-failure medication sacubitril-valsartan, an angiotensin receptor neprilysin inhibitor or ARNI, on preventing further heart damage among 114 patients undergoing chemotherapy treatment with anthracyclines for breast cancer, lymphoma, sarcoma or leukemia.

The study found:

  • Compared to a placebo, sacubitril/valsartan was associated with a 77% decrease in relative risk of further heart damage among people who already had signs of damage. Patients’ reduction in the incidence of cardiotoxicity was assessed from the moment treatment began until the end of the intervention—at 24 weeks.
  • Participants began with a 24/26 mg dose of sacubitril/valsartan twice daily, which was titrated every two weeks until they reached a target dose of 97/103 mg twice daily, or the highest dose that patients were able to tolerate without side effects. The medication was generally well tolerated, the researchers noted.
  • Compared to participants who received a placebo, those in the sacubitril/valsartan group were much less likely to develop additional heart damage by the end of the 24-week intervention period. Participants in the treatment group improved their GLS (global longitudinal strain), a marker of heart contractility, by an average of 2.55%, while participants in the placebo group experienced an average 6.65% decline in GLS.

“Our findings highlight the importance of identifying patients with high-risk who are most likely to benefit from heart protection, and therefore, minimize unnecessary side effects and health care costs for low-risk people,” Bonatto said. “Accurately identifying which people will benefit from these strategies remains a significant challenge.”

The study had several limitations, including that all participants were at high risk for heart damage and were receiving anthracyclines for chemotherapy-113 received doxorubicin and 1 received daunorubicin-so the findings may not apply to people with lower risk or those treated with different chemotherapy medications. Other limitations are that the study could not account for heart damage after the six-month follow-up and did not look at other factors like survival or quality of life. The study also took place in a single hospital in Brazil, so the findings may not apply to patients treated in other hospitals. Additional research is needed on more diverse patient groups because the study participants were mostly white and female.

Reference:

A common heart failure medication may help prevent heart damage related to chemotherapy, American Heart Association, Meeting:AHA Scientific Sessions 2024.

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Systolic BP of less than 120 mm Hg reduced CVD risk in adults with Type 2 diabetes, suggests study

An intensive treatment approach to lowering high systolic blood pressure in people with Type 2 diabetes led to a reduced risk of heart attack, stroke, heart failure and death due to cardiovascular disease when compared to a standard treatment approach, according to late-breaking science presented 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.

“We found that for most people with Type 2 diabetes, lowering systolic blood pressure to less than 120 mm Hg reduced the risk of major cardiovascular events,” said lead study author Guang Ning, M.D., Ph.D., an elected member of the Chinese Academy of Engineering and a professor at Ruijin Hospital at Shanghai Jiao Tong University School of Medicine in Shanghai, China. “These findings provide strong support for a more intensive systolic blood pressure target in people with Type 2 diabetes for the prevention of major cardiovascular events.”

A person living with Type 2 diabetes is twice as likely to have high blood pressure than someone without Type 2 diabetes. Elevated blood sugar levels can cause damage to blood vessels and impair kidney function, leading to elevated blood pressure. Almost three-fourths of adults with Type 2 diabetes are estimated to also have high blood pressure, according to the U.S. Centers for Disease Control and Prevention data, and when blood pressure levels are consistently elevated, lifestyle modification and medication are recommended. If unmanaged, high blood pressure can cause damage over time and increase the risk of heart attack, stroke, heart failure, kidney problems and more.

The goal of the BPROAD study was to determine whether an intensive systolic blood pressure reduction approach to a target of lower than 120 mm Hg was more effective in reducing the risk of major cardiovascular events, including non-fatal stroke, non-fatal myocardial infarction, treated or hospitalized heart failure, and cardiovascular death than a standard systolic blood pressure reduction approach to a target of lower than 140 mm Hg among people with Type 2 diabetes.

The BPROAD study included 12,821 adults at 145 study sites located in 25 provinces or municipalities across mainland China were enrolled in the study. All participants had Type 2 diabetes, elevated systolic blood pressure and an increased risk of cardiovascular disease. In this study, the criteria for elevated systolic blood pressure was ≥140 mm Hg without antihypertensive medications or ≥130 mm Hg and taking at least one anti-hypertensive medication.

The results found:

The mean systolic blood pressure levels of the participants at the four-year visit was 120.6 mm Hg in the intensive treatment group and 132.1 mm Hg in the standard treatment group.

The people who received the intensive treatment had a 21% lower relative risk of major cardiovascular events, compared with those who received the standard treatment during the follow-up period.

Non-fatal stroke, non-fatal heart attack, hospitalization or treatment for heart failure, or cardiovascular deaths occurred in 393 participants (1.65% per year) in the intensive treatment group and 492 participants (2.09% per year) in the standard treatment group.

Serious adverse events such as hospitalization were generally similar between the two treatment groups. However, blood pressure levels that were too low with symptoms (symptomatic hypotension) and high potassium levels (hyperkalemia) occurred more frequently among participants in the intensive treatment group.

“Our study results are consistent with another study of patients with hypertension but without diabetes, which found a significantly 27% reduction in the incidence of cardiovascular diseases,” said Ning. “Future clinical practice guidelines will hopefully consider these results when making recommendations for blood pressure targets for people with Type 2 diabetes. Beneficial future research could focus on profiling those with the largest benefit and the lowest harm in an intensive blood pressure treatment group.”

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Hypoalbuminemia excellent prognostic biomarker for mortality in status epilepticus unravels study

Researchers have established that hypoalbuminemia is an independent and strong predictor for both short- and long-term mortality in patients diagnosed with status epilepticus (SE). This accessible biomarker indicates the general condition of a patient and can greatly help improve the existing scoring models, such as the Status Epilepticus Severity Score (STESS). A recent study was conducted by Francesco and colleagues which was published in the European Journal of Neurology.

It was a prospective observational cohort study done at the University Hospital of Geneva, Switzerland, during 2015 to 2023, with an enrollment of 496 adults with non-hypoxic status epilepticus. The outcomes investigated were in-hospital and 6-month mortality. Hypoalbuminemia was correlated with demographic, comorbidities, and clinical outcomes. The association between hypoalbuminemia and mortality was established using binomial regression models. The study also conducted an exploratory analysis by replacing the age variable in STESS with hypoalbuminemia, creating the Albumin-STESS (A-STESS) score. The predictive performance of STESS and A-STESS was compared using the area under the curve (AUC).

Key Findings

Mortality Rates:

  • Among the 496 patients, 46 (9.3%) died during hospitalization.

  • Follow-up data at six months were available for 364 patients, and among them, 86 (23.6%) had died.

Hypoalbuminemia and Mortality:

  • Hypoalbuminemia independently correlated with in-hospital mortality (p=0.005, OR=3.35, 95% CI=1.43–7.86) and 6-month mortality (p=0.001, OR=3.59, 95% CI=1.75–7.35).

STESS vs. A-STESS:

  • The original STESS had an AUC of 0.754 (95% CI=0.656–0.836) for in-hospital mortality prediction and 0.684 (95% CI=0.613–0.755) for 6-month mortality.

  • A-STESS significantly improved predictive accuracy with an AUC of 0.837 (95% CI=0.760–0.916; p=0.002) for in-hospital mortality and 0.739 (95% CI=0.688–0.826; p=0.033) for 6-month mortality.

A-STESS Performance:

  • An A-STESS score of ≥3 showed optimal balance between sensitivity and specificity for mortality prediction:

  • In-hospital mortality: Sensitivity=0.88, Specificity=0.68, Accuracy=0.70

  • 6-month mortality: Sensitivity=0.67, Specificity=0.73, Accuracy=0.72

This study demonstrates that hypoalbuminemia is an excellent prognostic biomarker for mortality in status epilepticus. It was found that the integration of hypoalbuminemia into the STESS scoring system significantly increases the predictive power of STESS for both short and long-term outcomes. It would be useful to find therapeutic interventions like albumin supplementation that improve patient outcome in future research by validation of the A-STESS model.

Reference:

Misirocchi F, Quintard H, Rossetti AO, Florindo I, Sarbu OE, Kleinschmidt A, Schaller K, Seeck M, De Stefano P. Hypoalbuminemia in status epilepticus is a biomarker of short- and long-term mortality: A 9-year cohort study. Eur J Neurol. 2025 Jan;32(1):e16573. doi: 10.1111/ene.16573. PMID: 39711115; PMCID: PMC11664120.

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Gestational diabetes early in pregnancy tied to risk of postpartum glucose intolerance, finds study

Gestational diabetes early in pregnancy tied to risk of postpartum glucose intolerance finds a study published in the Journal of Diabetes Investigation.

A study was done to compare perinatal outcomes and postpartum glucose tolerance between women diagnosed with gestational diabetes mellitus (GDM) before 20 weeks of gestation (EGDM) and those diagnosed at or after 24 weeks of gestation (LGDM) in a Japanese population. Data were obtained from a prospective GDM registry. Multivariate analysis was conducted to examine the association between the timing of GDM diagnosis (EGDM vs LGDM) and perinatal outcomes (preterm birth, small for gestational age, large for gestational age, pregnancy-induced hypertension, and neonatal hypoglycemia), as well as postpartum glucose intolerance. Results: A total of 1,275 mother-infant pairs were analyzed for perinatal outcomes. Of these, 924 women underwent postpartum testing for glucose intolerance. No significant differences in perinatal outcomes were observed between the EGDM and LGDM groups, except that overweight/obese women with EGDM had 2.5-fold higher rate of preterm birth than those with LGDM. Postpartum glucose intolerance was 1.5 times more likely in the EGDM group than in the LGDM group. Women with EGDM had a significantly higher risk of postpartum glucose intolerance than those with LGDM, despite similar perinatal outcomes between the two groups.

Reference:

Yokoyama M, Miyakoshi K, Iwama N, Yamashita H, Yasuhi I, Kawasaki M, Arata N, Sato S, Imura Y, Waguri M, Kawaguchi H, Masaoka N, Nakajima Y, Hiramatsu Y, Sugiyama T; DREAMBee Study Gestational Diabetes Mellitus Group. Gestational diabetes in early pregnancy is associated with postpartum glucose intolerance: A perspective from the diabetes and pregnancy outcome for mother and baby study in Japan. J Diabetes Investig. 2024 Nov 28. doi: 10.1111/jdi.14368. Epub ahead of print. PMID: 39610144.

Keywords:

Gestational, diabetes, early, pregnancy, tied, risk, postpartum, glucose, intolerance, finds study, Journal of Diabetes Investigation, Gestational diabetes mellitus in early pregnancy; Overweight/obesity; Postpartum glucose intolerance, Yokoyama M, Miyakoshi K, Iwama N, Yamashita H, Yasuhi I, Kawasaki M, Arata N, Sato S, Imura Y, Waguri M, Kawaguchi H, Masaoka N, Nakajima Y, Hiramatsu Y, Sugiyama T

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Revolutionizing Hip Surgery Recovery: Enhancing Functional Outcomes Through Innovative Pain Management Strategies, study finds

In the past, hip surgeries concentrated on fixing surgical issues and managing pain around the operation, paying little attention to post-surgery functional improvement. Today, modern healthcare integrates Enhanced Recovery After Surgery (ERAS) protocols, focusing on pain relief, early mobility, and effective recovery post-surgery to enhance functional outcomes without significant postoperative limitations. Recent study aimed to compare the functional outcomes of the pericapsular nerve group (PENG) block and the supra-inguinal fascia iliaca (SIFI) block in hip surgery patients. Sixty patients undergoing hip surgeries were randomly assigned to receive either the PENG block or SIFI block postoperatively. The blocks were administered under ultrasound guidance using 0.2% ropivacaine and dexamethasone. Functional outcomes were assessed by measuring quadriceps muscle strength, weight-bearing capacity, and analgesic efficacy. The results showed that the PENG block group exhibited higher quadriceps strength at 24 and 48 hours post-surgery compared to the SIFI block group. Additionally, more patients in the PENG block group achieved superior weight-bearing grades at 24 hours post-surgery. The PENG block group also reported lower pain scores at 24 hours post-surgery, longer duration of analgesia, and lower opioid consumption compared to the SIFI block group.

Importance of Early Ambulation

The study highlighted the importance of early ambulation and functional recovery in hip surgery patients, emphasizing the need for improved postoperative outcomes. The PENG block was found to provide better functional outcomes in terms of quadriceps strength, weight-bearing capacity, and postoperative analgesia compared to the SIFI block. The study adhered to ethical guidelines, randomizing patients into groups and maintaining blinding during the block administration and outcome assessments. The use of 0.2% ropivacaine in both blocks supported early mobilization and safety postoperatively. The findings suggested that the PENG block may promote early ambulation, reduce pain, and improve motor function recovery, ultimately lowering the risk of complications associated with prolonged immobilization.

Study Conclusion

Overall, the study concluded that the PENG block demonstrated superior functional outcomes in hip surgeries compared to the SIFI block. This research contributes to enhancing the understanding of regional analgesia techniques in hip surgery and emphasizes the importance of optimizing postoperative functional recovery, pain management, and early ambulation in improving patient outcomes. Further research is recommended to evaluate the maximum weight-bearing capacity in patients undergoing hip surgeries with these blocks.

Key Points

1. The study aimed to compare functional outcomes between the pericapsular nerve group (PENG) block and the supra-inguinal fascia iliaca (SIFI) block in hip surgery patients. Sixty patients undergoing hip surgeries were randomly assigned to receive either the PENG or SIFI block postoperatively, with functional outcomes evaluated through quadriceps muscle strength, weight-bearing capacity, and analgesic efficacy measurements.

2. Results showed that the PENG block group had higher quadriceps strength at 24 and 48 hours post-surgery, superior weight-bearing at 24 hours post-surgery, lower pain scores at 24 hours post-surgery, longer duration of analgesia, and lower opioid consumption compared to the SIFI block group. These findings suggest the superiority of the PENG block in functional outcomes and pain management in hip surgery patients.

3. The importance of early ambulation and functional recovery in hip surgery patients was emphasized, underscoring the need for improved postoperative outcomes. The study highlighted that the PENG block provided better functional outcomes in terms of quadriceps strength, weight-bearing capacity, and postoperative analgesia compared to the SIFI block.

4. The study adhered to ethical guidelines by randomizing patients, maintaining blinding during block administration and outcome assessments, and utilizing 0.2% ropivacaine in both blocks to support early mobilization and safety postoperatively. These measures ensured the reliability and integrity of the study results.

5. The findings suggested that the PENG block may promote early ambulation, reduce pain, and enhance motor function recovery, potentially lowering the risk of complications associated with prolonged immobilization in hip surgery patients. The research indicated that optimizing postoperative functional recovery and pain management is crucial for improving patient outcomes in hip surgeries.

6. In conclusion, the study demonstrated that the PENG block yielded superior functional outcomes in hip surgeries compared to the SIFI block. The research contributes to advancing knowledge on regional analgesia techniques in hip surgery and emphasizes the significance of enhancing postoperative functional recovery, pain management, and early ambulation to optimize patient outcomes. Further research is recommended to assess the maximum weight-bearing capacity in hip surgery patients receiving these blocks, indicating a potential direction for future investigations in this field.

Reference –

Tanusha Saini et al. (2024). Pericapsular Nerve Group (PENG) Block Versus Supra-Inguinal Fascia Iliaca (SIFI) Block For Functional Outcome In Patients Undergoing Hip Surgeries – A Randomised Controlled Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_838_24.

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Study reveals CV Risk Profiles of Different Hormone Therapies and their Clinical Implications for Menopausal Treatment

A groundbreaking Swedish study
found that oral contraceptives are associated with an increased risk of cardiovascular
disease in women around the menopause period, as per results that were
published in the journal The BMJ.

Cardiovascular diseases are the leading
cause of death globally. Despite developing at a later stage than men, women
develop cardiovascular diseases during the midlife period that coincide with
the menopausal period. This phase of life is characterized by a decrease in estrogen
and an increase in follicle-stimulating hormone concentrations that affect the neuroendocrine
system. This condition is treated by systemic menopausal hormonal therapy. Systemic
menopausal therapy that contains estrogen mitigates the vasomotor symptoms. However,
research has shown that systemic menopausal therapy can affect cardiovascular
health. Due to knowledge gaps between the effects of menopausal therapy on
cardiovascular health, researchers conducted a trial to assess the impact of
contemporary menopausal hormone therapy on the risk of cardiovascular disease
according to the route of administration and combination of hormones.

Also Read: Study Reveals Increased Autoimmune Disease Risk in Women with Primary Ovarian Insufficiency

A Nationwide register-based
emulated target trial was carried out from Swedish national registries involving
9,19,614 women aged 50-58 who did not use hormone therapy in the previous two
years. A total of 138 nested trials were conducted beginning each month from
July 2007 until December 2018. For every trial, the prescription registry data of
that particular month was used to identify women who had not used hormone
therapy in the previous two years. These identified women were assigned to one
of eight treatment groups: oral combined continuous, oral combined sequential,
oral unopposed estrogen, oral estrogen with local progestin, tibolone,
transdermal combined, transdermal unopposed estrogen, or non-initiators of
menopausal hormone therapy.

Hazard ratios with 95% confidence
intervals were calculated for venous thromboembolism, ischemic heart disease,
cerebral infarction, and myocardial infarction, both individually and as part
of a composite cardiovascular disease outcome. Contrasting initiators assessed
treatment effects to non-initiators in observational analogs of
“intention-to-treat” analyses and continuous users to never users in
“per protocol” analyses.

Findings:

  • The trial included 77 512 women who were
    initiators of any menopausal hormone therapy and 842 102 women who were
    non-initiators.
  • Out of them, 24 089 women had an event recorded
    during the follow-up:

10 360 (43.0%)

ischemic heart disease event

4098 (17.0%)

cerebral infarction event

4312 (17.9%)

myocardial infarction event

9196 (38.2%) had a

venous thromboembolic event

  • When compared to non-initiators, tibolone was
    associated with an increased risk of cardiovascular disease in
    intention-to-treat analyses.
  • An increased risk of ischemic heart disease was
    seen with the initiators of tibolone or oral estrogen-progestin therapy.
  • Venous thromboembolism risk was increased in
    oral continuous estrogen-progestin therapy, sequential therapy, and
    estrogen-only therapy.
  • Tibolone usage was associated with an increased
    risk of cerebral infarction and myocardial infarction as per protocol analyses.
Also Read: Replacing animal products with plant-based foods tied to 92% reduction in hot flashes in postmenopausal women, finds new study

The study concluded that
menopausal therapy is associated with increased cardiovascular disease outcomes,
with estrogen-progestin therapy causing heart disease and venous
thromboembolism, while tibolone was associated with ischemic heart disease,
cerebral infarction, and myocardial infarction but not venous thromboembolism. The
choice of hormonal therapy should be individualized based on the patient’s
cardiovascular risk profile. Clinicians should consider cardiovascular health
and tailor it according to the patient’s needs.

Further reading: Contemporary
menopausal hormone therapy and risk of cardiovascular disease: Swedish
nationwide register based emulated target trial. doi:https://doi.org/10.1136/bmj-2023-078784.

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Cochlear implantations may improve speech and auditory outcomes in pediatric patients with sensorineural hearing loss: Study

A new study published in The Laryngoscope journal showed that possibilities for cochlear implantation (CI) are growing as research shows benefits in previously thought-inappropriate groups. Sensorineural hearing loss (SNHL) has an uncertain origin and pathophysiology and is the clinical manifestation of cochlear nerve deficit (CND), which is defined as a short or nonexistent cochlear branch of the vestibulocochlear nerve. The patients with congenital SNHL had a 2.5 to 21.2% incidence of CND.

It is challenging to distinguish the CN from other nerves in the internal acoustic meatus (IAM) because of the limits of the present MRI resolution. The use of cochlear implants in patients with CND is still debatable since some research on CI recipients with CND has shown very poor outcomes, while other studies have shown minimal speech discrimination and detection.

Based on MRI results of the IAM’s nerves and the CN’s size, this research has devised a new IAM nerve grading system and a CN classification system, as follows: Grades 0–III denoted aplasia, which is the observation of 0, 1, 2, and 3 nerve bundles in the IAM. Thereby, Susmita Chennareddy and colleagues undertook this study to investigate the speech and auditory outcomes of CI in young bilateral SNHL patients with radiographically confirmed CND before and after surgery.

The two primary databases (Embase and Ovid MEDLINE) were searched to find pre- and postoperative results of children with CND verified by magnetic resonance imaging who received CI. The variance in speech and auditory outcomes within and across studies was taken into consideration using a random-effects model.

A total of 16 studies, including 248 individuals with cochlear nerve hypoplasia or aplasia who had CI, were added for final inclusion following abstract screening of 818 different papers. The following tests of language development and speech perception were examined in various studies: Categories of Auditory Performance, Auditory Level, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, Speech Intelligibility Rating, Speech Perception Category and Speech Awareness Thresholds.

After CI, children patients with CND showed improved speech perception, according to pooled results. Overall, as studies show benefits in individuals previously considered unsuitable, the list of indications for CI is growing. In children with bilateral SNHL and CND, this study shows a worldwide improvement in speech and auditory outcomes with CI.

Reference:

Chennareddy, S., Liu, K. H., Mavrommatis, M. A., Kao, D. D., Govindan, A., Schwam, Z. G., & Cosetti, M. K. (2024). Cochlear Implantation in Pediatric Cochlear Nerve Deficiency: A Systematic Review and Meta‐Analysis. In The Laryngoscope. Wiley. https://doi.org/10.1002/lary.31888

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Can the heart heal itself? New study says it can

A research team co-led by a physician-scientist at the University of Arizona College of Medicine-Tucson’s Sarver Heart Center found that a subset of artificial heart patients can regenerate heart muscle, which may open the door to new ways to treat and perhaps someday cure heart failure. The results were published in the journal Circulation.

According to the Centers for Disease Control and Prevention, heart failure affects nearly 7 million U.S. adults and is responsible for 14% of deaths per year. There is no cure for heart failure, though medications can slow its progression. The only treatment for advanced heart failure, other than a transplant, is pump replacement through an artificial heart, called a left ventricular assist device, which can help the heart pump blood.

“Skeletal muscle has a significant ability to regenerate after injury. If you’re playing soccer and you tear a muscle, you need to rest it, and it heals,” said Hesham Sadek, MD, PhD, director of the Sarver Heart Center and chief of the Division of Cardiology at the U of A College of Medicine – Tucson’s Department of Medicine. “When a heart muscle is injured, it doesn’t grow back. We have nothing to reverse heart muscle loss.”

Sadek led a collaboration between international experts to investigate whether heart muscles can regenerate. The study was funded through a grant awarded to Sadek by the Leducq Foundation Transatlantic Networks of Excellence Program, which brings together American and European investigators to tackle big problems.

The project began with tissue from artificial heart patients provided by colleagues at the University of Utah Health and School of Medicine led by Stavros Drakos, MD, PhD, a pioneer in left ventricular assist device-mediated recovery.

Jonas Frisén, MD, PhD, and Olaf Bergmann, MD, PhD, of the Karolinska Institute in Stockholm, led teams in Sweden and Germany and used their own innovative method of carbon dating human heart tissue to track whether these samples contained newly generated cells.

The investigators found that patients with artificial hearts regenerated muscle cells at more than six times the rate of healthy hearts.

“This is the strongest evidence we have, so far, that human heart muscle cells can actually regenerate, which really is exciting, because it solidifies the notion that there is an intrinsic capacity of the human heart to regenerate,” Sadek said. “It also strongly supports the hypothesis that the inability of the heart muscle to ‘rest’ is a major driver of the heart’s lost ability to regenerate shortly after birth. It may be possible to target the molecular pathways involved in cell division to enhance the heart’s ability to regenerate.”

Finding better ways to treat heart failure is a top priority for Sadek and the Sarver Heart Center. This study builds on Sadek’s prior research into rest and heart muscle regeneration.

In 2011, Sadek published a paper in Science showing that while heart muscle cells actively divide in utero, they stop dividing shortly after birth to devote their energy to pumping blood through the body nonstop, with no time for breaks.

In 2014, he published evidence of cell division in patients with artificial hearts, hinting that their heart muscle cells might have been regenerating.

These findings, combined with other research teams’ observations that a minority of artificial heart patients could have their devices removed after experiencing a reversal of symptoms, led him to wonder if the artificial heart provides cardiac muscles the equivalent of bedrest in a person recovering from a soccer injury.

“The pump pushes blood into the aorta, bypassing the heart,” he said. “The heart is essentially resting.”

Sadek’s previous studies indicated that this rest might be beneficial for the heart muscle cells, but he needed to design an experiment to determine whether patients with artificial hearts were actually regenerating muscles.

“Irrefutable evidence of heart muscle regeneration has never been shown before in humans,” he said. “This study provided direct evidence.”

Next, Sadek wants to figure out why only about 25% of patients are “responders” to artificial hearts, meaning that their cardiac muscle regenerates.

“It’s not clear why some patients respond and some don’t, but it’s very clear that the ones who respond have the ability to regenerate heart muscle,” he said. “The exciting part now is to determine how we can make everyone a responder, because if you can, you can essentially cure heart failure. The beauty of this is that a mechanical heart is not a therapy we hope to deliver to our patients in the future – these devices are tried and true, and we’ve been using them for years.”

Reference:

Wouter Derks, Julian Rode, Sofia Collin, A Latent Cardiomyocyte Regeneration Potential in Human Heart Disease, Circulation, https://doi.org/10.1161/CIRCULATIONAHA.123.067156

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