Advanced Hybrid Closed-Loop Therapy Improves Glycemic Control During Pregnancy and Postpartum in Type 1 Diabetes: Study

Belgium: A new analysis from the CRISTAL randomized controlled trial highlights the benefits of advanced hybrid closed-loop (AHCL) therapy in women with type 1 diabetes during the intrapartum and early postpartum periods. The secondary observational study compared AHCL with standard insulin therapy, focusing on glycemic control during these critical times when insulin requirements fluctuate significantly.

The study, published in Diabetes Care, found that AHCL effectively maintains tight glycemic control during labor and the early postpartum period, and it can be safely used during rapidly fluctuating insulin needs.

The AHCL system, which integrates real-time continuous glucose monitoring with automated insulin delivery, was evaluated for its effectiveness and safety. Katrien Benhalima, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium, and colleagues aimed to assess the efficacy and safety of advanced hybrid closed-loop therapy during labor and early postpartum, compared to standard insulin therapy, in pregnant women with type 1 diabetes (T1D).

For this purpose, the researchers conducted the CRISTAL trial, a double-arm, open-label, randomized controlled study in Belgium and the Netherlands. The trial enrolled 95 pregnant participants with type 1 diabetes (T1D), randomly assigning them 1:1 to either the MiniMed 780G AHCL system (n = 46) or standard insulin therapy (n = 49).

The prespecified, secondary observational analysis compared glycemic control and safety outcomes between participants from the original AHCL group who continued using the system intrapartum (n = 27) and/or early postpartum (n = 37, until hospital discharge) and those from the standard insulin therapy group who used standard insulin therapy intrapartum (n = 45) and/or early postpartum (n = 34).

The study revealed the following findings:

  • Of the 43 participants in the AHCL group and 46 in the standard insulin therapy group who completed the trial, 62.8% in the AHCL group continued AHCL, and 97.8% in the standard insulin therapy group continued standard insulin therapy intrapartum.
  • Intrapartum, AHCL was associated with more time in range (3.5–7.8 mmol/L) than standard insulin therapy (71.5 ± 17.7% versus 63.1 ± 17.0%).
  • AHCL also showed a numerically lower time above range (>7.8 mmol/L) compared to standard insulin therapy (27.3 ± 17.4% versus 35.3 ± 17.5%), without an increase in time below range (<3.5 mmol/L) (1.1 ± 2.4% versus 1.5 ± 2.3%).
  • In the early postpartum period, 37 (86.0%) participants randomized to AHCL continued use, with a median increase in insulin-to-carbohydrate ratios of 67%.
  • Similar tight glycemic control was observed in the early postpartum period with AHCL versus standard insulin therapy (3.9–10.0 mmol/L: 86.8 ± 6.7% versus 83.8 ± 8.1%).
  • No severe hypoglycemia or diabetic ketoacidosis was reported in either group.

“The findings showed that the use of AHCL therapy during pregnancy leads to a greater improvement in glycemic control compared to standard insulin therapy,” the researchers concluded.

Reference:

Kaat Beunen, Pieter Gillard, Nancy Van Wilder, Dominique Ballaux, Gerd Vanhaverbeke, Youri Taes, Xavier-Philippe Aers, Frank Nobels, Liesbeth Van Huffel, Joke Marlier, Dahae Lee, Joke Cuypers, Vanessa Preumont, Sarah E. Siegelaar, Rebecca C. Painter, Annouschka Laenen, Chantal Mathieu, Katrien Benhalima; Advanced Hybrid Closed-Loop Therapy Compared With Standard Insulin Therapy Intrapartum and Early Postpartum in Women With Type 1 Diabetes: A Secondary Observational Analysis From the CRISTAL Randomized Controlled Trial. Diabetes Care 21 October 2024; 47 (11): 2002–2011. https://doi.org/10.2337/dc24-1320

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Rare Case of Dermal Filler-Induced Hair Loss, Highlights Importance of Early Intervention

Saudi Arabia: A recent case report and literature review published in the Journal of Cosmetic Dermatology highlight a rare but concerning complication of dermal filler injections: filler-induced alopecia. While dermal fillers are widely used in aesthetic medicine to enhance facial features and reduce signs of aging, complications like hair loss at the injection site are infrequent, but require serious consideration among practitioners.

“Although filler-induced alopecia is rare, it requires increased awareness among dermatologists and aesthetic practitioners. By following proper injection techniques and dosages, and using ultrasound guidance when appropriate, the risk of this complication can be minimized, enhancing patient safety,” the researchers wrote.

Filler-induced alopecia occurs when the injection of dermal filler material into the skin inadvertently causes hair loss, typically in areas where the filler is injected, such as around the eyebrows or temples. This condition can be distressing for patients, particularly as hair loss can have a significant impact on appearance and self-esteem. While the exact mechanisms behind this complication are still being studied, the literature suggests that the inflammatory response triggered by the filler material may disrupt hair follicles, leading to temporary or even permanent alopecia in some cases.

Khalid Nabil Nagshabandi, Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, and colleagues aimed to shed light on the clinical presentation, diagnostic approach, and multidisciplinary management of filler-induced alopecia, the study contributes to the existing literature by providing a comprehensive review of previously reported cases.

The case concerns a 21-year-old female who presented with localized skin necrosis and alopecia four days after receiving 7 mL of hyaluronic acid (HA) filler injections in the temples, tear troughs, and eyebrow glabella regions. Trichoscopy revealed follicular dropout and white dots, indicative of ischemic hair loss. Treatment consisted of 1500 units of hyaluronidase injections, intralesional corticosteroids, topical minoxidil, and CO2 laser therapy. After one year of follow-up, the patient experienced complete hair regrowth and resolution of facial scarring.

The researchers note that only 16 cases of filler-induced alopecia have been documented, with the majority involving hyaluronic acid (HA) fillers. The case highlights the critical importance of early recognition and timely intervention with hyaluronidase to prevent ischemic damage. The multidisciplinary approach used in this instance demonstrates the potential for complete cosmetic recovery.

“Filler-induced ischemic alopecia and skin necrosis are uncommon but significant complications. Ongoing vigilance and heightened awareness among dermatologists and cosmetic practitioners are essential to reducing the risk of permanent alopecia in patients undergoing filler procedures,” the researchers wrote.

“Early identification, coupled with a multidisciplinary treatment approach—such as hyaluronidase, corticosteroid injections, and topical or oral minoxidil—can lead to successful management, including hair regrowth and cosmetic skin recovery,” they concluded.

Reference:

Albargawi, S., Nagshabandi, K. N., & Shadid, A. Dermal Filler-Induced Alopecia: A Case Report and Literature Review. Journal of Cosmetic Dermatology, e16684. https://doi.org/10.1111/jocd.16684

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WHO Issues Updated Guidelines for Managing Non-Severe Hypertension in Pregnancy

USA: Hypertensive disorders during pregnancy are a significant global health challenge, contributing to approximately 14% of all maternal deaths worldwide. These conditions not only endanger the lives of pregnant women but also pose risks to their babies, leading to long-term disability and increased healthcare costs. As part of the global effort to improve maternal health outcomes and reduce morbidity and mortality, the World Health Organization (WHO) has released updated recommendations for managing non-severe hypertension during pregnancy, focusing on the use of antihypertensive drugs.

Hypertension during pregnancy, particularly mild to moderate cases, is characterized by systolic blood pressure ranging from 140 to 159 mmHg and/or diastolic blood pressure between 90 and 109 mmHg. If left untreated, hypertension can lead to severe complications like preeclampsia, organ damage, or fetal growth restriction. To mitigate these risks, WHO’s updated guidelines offer clear, evidence-based recommendations for healthcare providers managing pregnant women with non-severe hypertension.

The new WHO guidelines were developed by the Executive Guideline Steering Group (GSG) on maternal and perinatal health based on important new evidence and aimed at improving clinical practices globally. These guidelines are particularly crucial for healthcare providers involved in maternal and child health, including obstetricians, midwives, nurses, general practitioners, and policy-makers. The recommendations are designed to help reduce health disparities in maternal and perinatal health, a key component of the Sustainable Development Goals (SDGs).

A major update in the guidelines is the emphasis on treating non-severe hypertension with antihypertensive medications, particularly in the context of quality antenatal care follow-up. According to the guidelines, oral alpha-agonist drugs, such as methyldopa and beta-blockers, should be considered as effective treatment options for non-severe hypertension during pregnancy. These medications help lower blood pressure, thereby reducing the risks of complications for both the mother and the baby.

Developing these recommendations involved a rigorous process, guided by standard operating procedures of the WHO. A systematic review of existing evidence, including the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, was conducted to assess the benefits and potential harms of antihypertensive treatments. Experts from around the world, including obstetricians, public health professionals, and policy-makers, met to review the findings and finalize the recommendations.

The WHO also considered the feasibility, cost-effectiveness, and acceptability of the recommended treatments. The goal is to ensure that these recommendations can be applied in various healthcare settings globally, from well-resourced hospitals to rural health clinics. Healthcare providers are encouraged to carefully evaluate each case before initiating treatment, considering the patient’s specific circumstances and available resources.

Overall, the WHO’s new guidelines on antihypertensive treatment for non-severe hypertension in pregnancy provide a critical framework for reducing maternal and perinatal mortality and morbidity. By promoting the use of effective antihypertensive medications such as methyldopa and beta-blockers, and ensuring that pregnant women receive proper antenatal care, the WHO hopes to improve the health outcomes of mothers and babies worldwide. The update represents a significant step towards achieving the global health targets set by the SDGs and addressing inequities in maternal and child health.

Reference:

WHO recommendations on drug treatment for non-severe hypertension in pregnancy. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO

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Continuous adjustment of tracheal tube cuff pressure benefits patients undergoing laparoscopic resection of colorectal neoplasms: Study

Laparoscopic procedures are a frequently chosen option for removing colorectal growths. During these surgeries, the use of carbon dioxide pneumoperitoneum and Trendelenburg positioning can substantially raise airway pressure if endotracheal tube cuff pressure is not supervised. Recent prospective observational study conducted by Cai et al. aimed to evaluate the indicators, changes, and correlation factors of endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms. The study included 122 patients scheduled for laparoscopic surgery under total intravenous anesthesia with orotracheal intubation. Tracheal tube cuff pressure was continuously monitored using calibrated pressure transducers. The study found that waist-to-hip ratio had the highest predictive ability for out-of-range tracheal cuff pressure, with a cuff pressure of 41.0 cmH2O at the start. Throughout the surgery, cuff pressure significantly increased to 33.7 ± 2.9 cmH2O at 15 minutes post-insufflation.

Associations and Predictors of Cuff Pressure

Multiple linear regression analysis showed that tracheal tube cuff pressure was associated with peak airway pressure. It was concluded that patients with normal BMI undergoing laparoscopic resection require continuous monitoring and timely adjustment of cuff pressure. Waist-to-hip ratio was identified as a better predictor of cuff pressure than BMI. The study indicated that tracheal tube cuff pressure could rise significantly during laparoscopic surgery, potentially leading to airway complications if not monitored and adjusted properly. The study highlighted the importance of monitoring cuff pressure to prevent complications associated with overinflation, such as tracheal mucosa ischemia, sore throat, and tracheal wall perfusion issues. The results emphasize the need for continuous monitoring and adjustment of cuff pressure, especially during pneumoperitoneum. Peak airway pressure was found to be significantly higher during this period and was associated with changes in cuff pressure.

Detailed Measurements and Recommendations

The study provided detailed measurements and time points for cuff pressure, peak airway pressure, and tidal volume during different stages of the surgery. The findings suggest that patients with larger waist circumference and smaller hip circumference may be more prone to exceeding recommended cuff pressures, leading to potential respiratory compliance issues. Future multicenter studies and investigations into longer procedures are suggested to further validate the study’s findings and implications for clinical practice.

Key Points

1. The study by Cai et al. focused on assessing endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms in 122 patients under total intravenous anesthesia. Monitoring cuff pressure was done using calibrated pressure transducers, with a starting cuff pressure of 41.0 cmH2O which significantly increased to 33.7 ± 2.9 cmH2O at 15 minutes post-insufflation.

2. Waist-to-hip ratio was identified as the most predictive indicator of out-of-range cuff pressure, suggesting that patients with abnormal waist-to-hip ratios may be at higher risk of complications related to cuff pressure during laparoscopic surgery.

3. The study revealed a significant association between tracheal tube cuff pressure and peak airway pressure, highlighting the importance of continuous monitoring and adjustment of cuff pressure, especially in patients with normal BMI undergoing laparoscopic resection to prevent potential airway complications.

4. Overinflation of cuff pressure during laparoscopic surgery may lead to adverse effects like tracheal mucosa ischemia, sore throat, and tracheal wall perfusion issues, underscoring the critical need for vigilant monitoring and timely adjustment of cuff pressure to mitigate these risks.

5. Detailed measurements and time points for cuff pressure, peak airway pressure, and tidal volume were provided, indicating that patients with larger waist circumference and smaller hip circumference may be more susceptible to exceeding recommended cuff pressures, potentially resulting in respiratory compliance challenges.

6. The study concludes by recommending future multicenter studies and investigations focusing on longer procedures to validate the findings and implications for clinical practice, emphasizing the necessity of continuous monitoring and adjustment of cuff pressure, particularly during pneumoperitoneum when peak airway pressure is significantly higher and influences cuff pressure changes.

Reference –

Cai, S., Wang, X., Zhang, J. et al. Changes of endotracheal tube cuff pressure and its indicators in laparoscopic resection of colorectal neoplasms: an observational prospective clinical trial. BMC Anesthesiol 24, 413 (2024). https://doi.org/10.1186/s12871-024-02802-4

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Study reveals Pathogenic role of dental caries-causing bacteria in IgA nephropathy

The kidneys act as a filtering system in the human body that help in the removal of excess fluids and unwanted wastes from the bloodstream. Inflammation of “glomeruli” or the tiny filtering units within the kidneys, also known as “glomerulonephritis,” results in the alteration to the functioning of kidneys. IgA nephropathy (IgAN) is the most common type of primary glomerulonephritis with deposition of the antibody-immunoglobulin A (IgA) in the glomerular region. The underlying disease progression is complex and multifactorial, and 30-40% of patients develop terminal kidney failure. Given the intractable nature of the disease, there is a need to understand specific pathological mechanisms contributing to IgAN, and develop targeted treatments.

Tonsillitis (inflammation or immune response of the tonsils) and bacteria related to dental caries and periodontal disease have been implicated in IgAN pathogenesis. This is likely due to the entry of the pathogen into circulation during invasive dental procedures. Streptococcus mutans is one such bacterial caries-causing pathogen, known to cause bacterial sepsis (extreme response of immune system to an infection leading to death) and infective endocarditis (inflammation of the inner lining of the heart). Moreover, S. mutans expressing a surface collagen-binding protein (Cnm) has been found more frequently in patients with IgAN than in healthy individuals. The precise role in IgAN development is, however, unclear.

A research team led by Dr. Shuhei Naka, including co-first author, Professor Michiyo Matsumoto-Nakano from Department of Pediatric Dentistry, Okayama University, Professor Kazuhiko Nakano from the Department of Pediatric Dentistry, Osaka University, Dr. Taro Misaki from the Seirei Hamamatsu General Hospital, and Assistant Professor Daiki Matsuoka from the Department of Pediatric Dentistry, Okayama University, Japan, were involved in this study.

The team of researchers sought to uncover the potential virulent role of Cnm from S. mutans in the progression of IgAN disease. “Until now, oral pathogens and kidney disease have been studied independently. We have been able to obtain useful research results over 10 years by establishing a collaboration between clinicians and researchers in oral pathogens and kidney diseases,” says Dr. Naka as a personal motivation behind the study. The team has previously shown that injection of a Cnm-expressing S. mutans strain in rats induces the formation of IgA-like renal lesions following intensive caries and simulation of invasive dental procedures. The potential link between the oral pathogen and renal lesions prompted the researchers to assess the role of the Cnm protein itself.

Explaining the rationale behind their current work published in Communications Biology, on 14 September, 2024, Dr. Naka, the corresponding author of the article, says, “Collagen-binding protein, one of the proteins present on the surface of dental caries, may be associated with the development of IgA nephropathy. Future development of research through medical-dental collaborations may lead to the development of a fundamental treatment for IgA nephropathy.”

They injected a Cnm-positive strain of S. mutans isolated from the oral cavity of a patient with severe IgAN, a Cnm-deficient strain, a complementation strain (with a similar genetic makeup as Cnm positive), and recombinant Cnm protein ([rCnm], a genetically modified variant), intravenously in rats. Next, they went on to assess the clinical features of IgAN, namely proteinuria (presence of protein in urine), hematuria (presence of blood in urine), and renal function in the animals.

Notably, while there was no change in proteinuria and renal function across the experimental animals, hematuria was significantly higher in the Cnm-positive, Cnm complementation groups, and rCnm groups, compared to the negative controls. This finding suggests that Cnm protein or Cnm-expressing S. mutans may induce hematuria in the early stages of IgAN.

Next, the researchers evaluated stained tissue sections of kidneys isolated from the treated animals. Mesangial cell and matrix proliferation (types of cells in the kidney tissue which are altered in IgAN present in the supporting medium known as mesangial matrix) were significantly higher in the Cnm-positive and rCnm groups compared to Cnm-negative groups. Furthermore, tissue sections obtained from Cnm-positive rats showed higher deposition of IgA, complement C3, and IgG (a prominent feature of IgAN) in the mesangial region of the glomerulus. The researchers also noted the presence of Cnm protein in the mesangial region —another hallmark feature of IgAN—in animals injected with rCnm. Given that both Cnm-expressing S. mutans and rCnm induce IgA-like nephropathy, the Cnm protein by itself may have a pathogenic role in the development of IgAN.

The researchers also highlight that the amount of Cnm protein present in one milligram of dental plaque is equivalent to the amount injected in the rat model. Therefore, invasive dental procedures which allow the entry of Cnm-expressing S. mutans can trigger IgAN-like nephropathy. Furthermore, Cnm deposition may independently, or in combination with IgA and/or IgG, contribute to the development of an IgAN.

Talking to us about the long-term implications of these findings, Dr. Naka says “Our findings suggest that the kidneys’ condition may be improved by reducing carious bacteria through a preventive dental approach in patients with IgAN. We intend to further advance this project and obtain results that can be delivered to clinical settings.”

Reference:

Naka, S., Matsuoka, D., Misaki, T. et al. Contribution of collagen-binding protein Cnm of Streptococcus mutans to induced IgA nephropathy-like nephritis in rats. Commun Biol 7, 1141 (2024). https://doi.org/10.1038/s42003-024-06826-x

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Retrograde intrarenal surgery and mini PCNL for 10-20 mm renal stones carry similar risk of bleeding: Study

Researchers have determined that retrograde intrarenal surgery (RIRS) and minimally invasive miniaturized percutaneous nephrolithotomy (mini-PCNL) expose patients to similar risks of clinically significant bleeding when renal stones have a diameter of 10–20 mm. A recent study was conducted by Davide P. and colleagues published in the journal BJU International.

Renal stones of 10-20 mm require effective interventions that reduce complications, particularly bleeding. Traditionally, percutaneous procedures have been thought to carry a risk for higher complications, such as bleeding, compared to endoscopic approaches, such as RIRS. A lot of caregivers, though, have believed otherwise, and this study looked to determine validity of the hypothesis that the assumption is incorrect, by scoring outcomes regarding bleeding following a standardized scoring method of evaluating stone size and hardness.

Total 176 patients who had renal stones with a size between 10 and 20 mm were enrolled in the study. The Stone Management According to Size-Hardness (SMASH) score=(Hounsfield units × stone maximum size in cm)/100 was used to guide the treatment to either group A or group B.

  • Group A: RIRS, (n = 90) Patients with SMASH score <15.

  • Group B: mini-PCNL, (n = 86) Patients with SMASH score ≥15.

Both groups received treatment with the Cyber Ho laser. Statistical comparisons were made for preoperative characteristics, stone-free rates, complication rates, and outcomes regarding bleeding.

The key findings of the study were:

Comparable Preoperative Features:

  • Mean stone size: 17.1 mm (RIRS) vs 16.8 mm (mini-PCNL) (P = 0.13).

Efficacy:

  • Stone-free rate: 87.8% (RIRS) vs 95.3% (mini-PCNL) (P = 0.07).

Complication Rates:

  • Overall complication rate: 14.4% (RIRS) vs 18.6% (mini-PCNL) (P = 0.09).

Bleeding Risk:

  • Gross hematuria: 5.5% (RIRS) vs 8.1% (mini-PCNL) (P = 0.07).

Mean hemoglobin drop:

  • Day 1: 12 g/L (RIRS) vs 17 g/L (mini-PCNL) (P = 0.06).

  • Day 3: 2 g/L (RIRS) vs 3 g/L (mini-PCNL) (P = 0.21).

  • No blood transfusions or renal embolizations were required.

The management of renal stones between 10 and 20 mm with RIRS and mini-PCNL seems to be equivalent in terms of efficacy and shows a very low incidence of clinically significant bleeding. Such results support the use of SMASH scores for individualized selection of the best treatment for the patient.

Reference:

Perri, D., Besana, U., Maltagliati, M., Pacchetti, A., Calcagnile, T., Pastore, A. L., Romero-Otero, J., Micali, S., Govorov, A., Somani, B., Liatsikos, E., Knoll, T., Rocco, B., & Bozzini, G. (2024b). Risk of bleeding after retrograde intrarenal surgery vs miniaturised percutaneous nephrolithotomy for 10-20 mm renal stones: a not so different safety profile. BJU International. https://doi.org/10.1111/bju.16585

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Spironolactone Fails to Lower Heart Failure and Cardiovascular Deaths in Acute MI Patients: CLEAR SYNERGY trial

USA: Spironolactone administered to patients after percutaneous coronary intervention (PCI) for acute myocardial infarction does not reduce cardiovascular mortality or the incidence of various cardiovascular events, including new or worsening heart failure, findings from the CLEAR SYNERGY trial have shown.

The CLEAR SYNERGY trial has dealt a second setback to the 2×2 factorial design study. Following the disappointing results from the colchicine arm last month—where the anti-inflammatory agent failed to reduce major cardiovascular (CV) events after acute myocardial infarction (MI)—new findings from the spironolactone arm show a similar lack of impact.

Dr. Sanjit Jolly from Hamilton Health Sciences/Population Health Research Institute, Canada, presented the latest data at the American Heart Association (AHA) 2024 Scientific Sessions. These results were simultaneously published in the New England Journal of Medicine alongside the full colchicine trial results.

Despite hopes that a mineralocorticoid receptor antagonist (MRA) like spironolactone might show benefits where colchicine did not, the trial results were disappointing. Dr. Jolly referenced previous studies like EPHESUS, which demonstrated that eplerenone, another MRA, reduced all-cause mortality in patients with heart failure (HF) following MI. However, two other conflicting trials, REMINDER and ALBATROSS, left the potential benefits of early MRA use in modern settings unclear.

In the current study, 7,062 patients from 14 countries were randomized to receive either spironolactone or a placebo immediately after PCI for STEMI or large NSTEMI. Less than 1% had prior heart failure, as noted by Dr. Jolly. While there was a numerically lower incidence of cardiovascular deaths and new or worsening HF in the spironolactone group over three years (183 vs. 220 events), the difference was not statistically significant. Similarly, there were no significant differences in the first occurrence of MI, stroke, new or worsening heart failure, or cardiovascular death (280 versus 294 events; HR 0.95).

Discontinuation of treatment was a notable issue in the trial, mirroring what was observed in the colchicine arm, with 26% of patients stopping their medication. Serious adverse events occurred in around 7% of patients in both the spironolactone and placebo groups. In the spironolactone group, 1.1% of patients discontinued treatment due to hyperkalemia, while 2.3% developed gynecomastia.

Given the high rate of discontinuations, the investigators performed an on-treatment analysis, which revealed what Dr. Jolly described as an “exploratory and hypothesis-generating” signal. In the analysis, patients treated with spironolactone showed better outcomes than the placebo group, particularly due to a reduction in new or worsening heart failure.

“In patients with myocardial infarction, spironolactone did not lower the rates of cardiovascular death, new or worsening heart failure, or the combined incidence of cardiovascular death, myocardial infarction, stroke, or new or worsening heart failure,” the researchers concluded.

Reference:

DOI: 10.1056/NEJMoa2405923

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Increased risk of venous thromboembolism observed in children with IBD: Study

A new study published in the journal of Inflammatory Bowel Disorder showed that children with inflammatory bowel disease (IBD) are more likely to get venous thromboembolism (VTE) when compared to children without IBD. Venous thromboembolism is more common in patients with inflammatory bowel disease. Adult studies have demonstrated that IBD is a risk factor for VTE on its own, increasing the risk by up to 15 times during an exacerbation and by three times overall.

It has been demonstrated that hospital stays carry a significant risk of VTE. Guidelines advise that hospitalized adult patients with IBD get thromboprophylaxis because to the substantial morbidity and mortality associated with VTE. With an estimated frequency of 0.09% to 1.9%, pediatric patients with IBD are likewise at higher risk for VTE, despite its lower prevalence in children. Children with inflammatory bowel illness have a higher risk of venous thromboembolism, according to recent research. However, there are few cases and inconsistent risk estimates. In order to give national estimates of the risk of VTE in children with IBD, Philip Harvey and his team carried out this study.

Between 2001 and 2019, individuals diagnosed with either VTE or IBD before turning 18 were identified using hospital episode statistics. The risks of acquiring VTE in the general population and IBD populations were computed, and populations and subgroups are detailed.

Children with VTE who had been diagnosed with IBD or during the last 6 months, as well as those without IBD, were the subjects of the study. Children with IBD had an absolute risk of 9.42 per 10,000 patient-years, while children without IBD had an absolute risk of 0.18. The largest absolute risk period for VTE was six months before and one year after an IBD diagnosis.

Younger patient groups had the highest relative risk of VTE among children with IBD compared to the ones without. The risk was 96.5 for the ones aged 0 to 8 and 153.1 for those aged 9 to 11 vs 14.3 for those aged 15 to 17. When compared to 4.2% in children, cerebral venous sinus thrombosis accounted for 17.6% of pediatric VTE occurrences in IBD patients without IBD.  Overall, based on the findings of this study, children with IBD had a higher chance of getting a VTE, with the risk being highest around the time of diagnosis. 

Source:

Harvey, P. R., McNulty, D., Coupland, B., Kemos, P., Croft, N. M., & Trudgill, N. J. (2024). The Risk of Venous Thromboembolism in Children With Inflammatory Bowel Disease. In Inflammatory Bowel Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ibd/izae249

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High LDL cholesterol associated with elevated risk of hand osteoarthritis among females, finds study

A study published in the BMC Musculoskeletal Disorders found that high LDL cholesterol is associated with an elevated risk of hand osteoarthritis among females.

A study was done to determine whether obesity and markers of lipid metabolism are associated with radiological hand osteoarthritis (OA) in the Halland County Osteoarthritis (HALLOA) cohort. In this cross-sectional study, we included 231 participants aged 30–65 from the HALLOA cohort, which began in 2017 and is ongoing. Hand OA was defined as ≥ 2 joint groups (distal interphalangeal, proximal interphalangeal, and carpometacarpal I) with Kellgren-Lawrence grade ≥ 2. The severity of hand OA was classified in terms of the number of affected joint groups (moderate hand OA 2–4 joint groups, severe hand OA 5–6 joint groups). Metabolic profile, including body mass index (BMI), bioimpedance, waist circumference, blood pressure, serum leptin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, were obtained. Multicollinearity was assessed with Pearson’s correlation and associations with logistic regression analyses adjusting for age, HDL-cholesterol, and central obesity. Results: Two-thirds of the participants were women, and 91 (39%) had hand OA. We found a relationship between LDL-cholesterol and prevalent hand OA in women with an odds ratio of 1.7 (95% CI 1.1–2.6) and an association between LDL-cholesterol and severity of hand OA in women; odds ratio for no hand OA vs. moderate hand OA was 1.6 (95% CI 1.0-2.4) and for no hand OA vs. severe hand OA 2.5 (95% CI 1.2–4.9). There were no significant relationships between hand OA and obesity or serum leptin levels. A Circulating LDL-cholesterol levels were associated with the prevalence and severity of hand OA in women but not men.

Reference:

Brogren, E., Andersson, M., Westenius, M. et al. Associations between hand osteoarthritis, obesity and lipid metabolism: a cross-sectional study of the Halland County Osteoarthritis (HALLOA) cohort. BMC Musculoskelet Disord 25, 944 (2024). https://doi.org/10.1186/s12891-024-08073-x

Keywords:

High, LDL, cholesterol, associated, elevated risk, hand, osteoarthritis, among, females, BMC Musculoskeletal Disorders, Brogren, E., Andersson, M., Westenius, M, Osteoarthritis, Body mass index, Cholesterol, LDL, Cholesterol, HDL, Lipid metabolism, Obestity, Abdominal

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Standing at work can be detrimental to blood pressure, suggests study

A Finnish study found that prolonged standing at work had a negative impact on the research participants’ 24-hour blood pressure. In contrast, spending more time sitting at work was associated with better blood pressure. The study suggests that activity behaviour during working hours may be more relevant to 24-hour blood pressure than recreational physical activity.

Regular exercise is important for controlling blood pressure. In particular, more vigorous, aerobic exercise is effective for lowering blood pressure, but also everyday physical activity can have a beneficial impact. Previous studies have shown that exercise in leisure time is more beneficial for the cardiovascular system than physical activity at work, which can even be detrimental to health.

24-hour blood pressure important for cardiovascular health

In the Finnish Retirement and Aging study (FIREA) conducted at the University of Turku, the physical activity of municipal employees approaching retirement age was measured using thigh-worn accelerometers during working hours, leisure time, and days off. In addition, the research participants used a portable blood pressure monitor that automatically measured their blood pressure every 30 minutes for 24 hours.

“Rather than any single measurement, 24-hour blood pressure is a better indication of how blood pressure stresses the heart and blood vessels throughout the day and night. If blood pressure is slightly high throughout the day and does not fall sufficiently even at night, blood vessels start to stiffen and the heart has to work harder to cope with the increased pressure. Over the years, this can lead to the development of cardiovascular disease,” says Doctoral Researcher Jooa Norha.

Take a break from standing during the workday

The latest results confirm previous findings that physical activity at work can be harmful to the heart and circulatory system. In particular, prolonged standing can raise blood pressure as the body boosts circulation to the lower limbs by constricting blood vessels and increasing the pumping power of the heart.

“A standing desk can provide a nice change from sitting at the office, but too much standing can be harmful. It’s a good idea to take a break from standing during the work day, either by walking every half an hour or sitting for some parts of the day,” Norha recommends.

Recreational physical activity is also needed

In addition, the results of the study suggest that sedentary work in itself is not necessarily harmful to blood pressure. Instead, researchers stress the importance of recreational physical activity for both office and construction workers.

“It is good to remember that being physically active at work is not enough on its own. Engaging in diverse physical exercise during leisure time helps to maintain fitness, making work-related strain more manageable. Similarly, employees with predominantly sedentary jobs should ensure that they get enough exercise during their leisure time,” Norha highlights.

Reference:

Norha, Jooa1; Suorsa, Kristin2,3; Heinonen, Olli J.4; Niiranen, Teemu5,6; Kalliokoski, Kari K.1; Heinonen, Ilkka H.A.1; Stenholm, Sari2,3,7. Associations between Leisure and Work Time Activity Behavior and 24 H Ambulatory Blood Pressure among Aging Workers. Medicine & Science in Sports & Exercise ():10.1249/MSS.0000000000003594, November 6, 2024. | DOI: 10.1249/MSS.0000000000003594

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