CAMH develops potential new drug treatment for multiple sclerosis

CAMH-led pre-clinical studies using a small molecule drug have shown promise as a potential new treatment for multiple sclerosis (MS). The results have been published today in the journal Science Advances.

Expanding on Dr. Fang Liu’s earlier work that identified a novel drug target for the treatment of MS, she and her team have now created a small molecule compound that is effective in two different animal models of MS. This represents a key advancement that brings this MS research closer to the clinic to impact patient care.

MS is a progressive neurological disease that currently has no cure. It is associated with a wide-range of debilitating symptoms, including problems with coordination, cognition, muscle weakness and depression. For unknown reasons, it is more common in northern latitudes and more than twice as common in women.

It is known that MS damages myelin, a protective sheath that forms around nerves in the brain and spinal cord. As the myelin damage is triggered by inflammation in the immune system, up until now all current drug treatments for MS target the immune system.

In this study, CAMH Senior Scientist Dr. Fang Liu and her team treated MS in a completely different way-targeting the glutamate system. Study results showed that the newly synthesized lead compound not only reduced MS-like symptoms, it also may repair the damaged myelin in two different pre-clinical models of MS.

“Our compound had a stunning effect on rescuing myelin and motor function in the lab models, and I hope these effects will translate to the clinic to add to current treatments and bring new hope to patients with MS,” said Dr. Liu. “As with cancer chemotherapy drug cocktails, simultaneous targeting of the MS disease pathway at multiple points can have synergistic effects and result in better outcomes.”

Dr. Iain Greig, Reader in Medicinal Chemistry at the University of Aberdeen, alongside his team, are working to turn the molecules identified by Dr. Liu into advanced “drug-like” molecules suitable for continued development towards clinical use in patients. He added: “In all my years as a medicinal chemist, I have never seen a more promising starting point for a drug development project. It has been a huge pleasure to be involved in this program and I am looking forward to continuing to drive it towards to the clinic.”

Much of the funding for this novel treatment for MS, which Dr. Fang and her team have been investigating for over a decade, has come from the Multiple Sclerosis Society of Canada and the National Multiple Sclerosis Society USA’s Fast Forward commercial research program.

“We are pleased to have helped enable the early development of a novel neuroprotective strategy for MS, and look forward to seeing it progress through the critical next stages needed to determine its potential benefits for people living with MS,” said Walt Kostich, PhD, head of the National MS Society (USA)’s Fast Forward commercial research program.

Dr. Liu believes that the evidence of efficacy and tolerability generated in this study for the small molecule drug makes it a good candidate to be developed for human trials. The next steps in drug development will involve some further pre-clinical research, including investigating safety and stability of the compound. CAMH and the University of Aberdeen have already filed patent applications to protect this research and are actively seeking industry partners to further advance this work towards clinical trials over the next few years.

Reference:

Dongxu Zhai et al. ,Small-molecule targeting AMPA-mediated excitotoxicity has therapeutic effects in mouse models for multiple sclerosis.Sci. Adv.9,eadj6187(2023).DOI:10.1126/sciadv.adj6187.

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Routine Premolar extraction as part of orthodontic treatment may impact mandibular kinematics

Austria: Findings from a recent study published in the European Journal of Dentistry support the notion of discouraging the routine practice of premolar extraction as part of orthodontic treatment.

The researchers showed that premolar extraction altered mandibular kinematics in at least 25% of the cases within the study sample, and the transversal discrepancy between retrusive and protrusive tracings was even predictive of group affiliation.

The practice of premolar extraction in orthodontics remains controversial owing to its potentially detrimental effects on the stomatognathic system. However, there is no proper understanding of how premolar extraction affects mandibular function. Alejandra Londoño, Department of Research in Occlusion Medicine, Vienna School of Interdisciplinary Dentistry — VieSID, Klosterneuburg, Austria, and colleagues, therefore, aimed to assess the impact of premolar extraction on mandibular kinematics by evaluating axiographic tracings.

For this purpose, the researchers compared forty-five orthodontically treated patients with premolar teeth extraction with 45 paired untreated controls, selected for the absence of malocclusions. Mandibular movements were recorded by systematic three-dimensional axiography for protrusive–retrusive movements and speech. The transversal deviations, length of the movements, and rotation angle were recorded for both sides during the speech.

The permutation test and Wilcoxon rank-sum test were used to analyze the differences between the axiographic variables. Linear regression was performed to test whether axiographic parameters predicted group affiliation. Dot plots were used to explore the distribution of each of the axiographic outcomes. Isometric principal component analysis was used to assess the differences between the cumulative effects of premolar extraction on jaw motion.

The study led to the following findings:

  • The mandibular lateral translation in protrusion–retrusion and speech, the amount of rotation as well and the length of mandibular movements during speech were significantly higher in the treated subjects than in the controls, while retral stability did not differ.
  • The linear regression yielded significant results for the mandibular lateral translation in protrusion–retrusion.
  • The isometric principal component analysis showed higher values of the axiographic variables for 11 out of 45 individuals in the study sample compared with the control group.

“These results support the notion that the routine practice of premolar extraction as part of the orthodontic treatment should be discouraged,” the researchers wrote.

Additionally, the team suggests recommending the evaluation of mandibular movements as an integral part of diagnostic and follow-up assessment of treatment outcomes.

“To assess whether a disrupted kinematics of the mandible is associated with temporomandibular disorders, it is compelling to perform further studies,” they concluded.

Reference:

Londoño A, Assis M, Fornai C, Greven M. Premolar Extraction Affects Mandibular Kinematics. Eur J Dent. 2023 Jul;17(3):756-764. doi: 10.1055/s-0042-1755629. Epub 2022 Sep 27. PMID: 36167318; PMCID: PMC10569881.

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Use of calcium channel blockers tied to more severe actinic keratosis on face and scalp: Study

Brazil: New research published in the International Journal of Dermatology has confirmed lower skin phototype classifications, older age, and a personal history of skin cancer as severity risk factors for actinic keratosis (AK). The use of calcium channel blockers (CCBs) was associated with more severe AK.

Actinic keratosis is a skin condition associated with sun exposure, age, and immunosuppression. Certain drugs, such as calcium channel blockers and photosensitizing medications have been linked to AK. Ingrid S. Gioppo, Hospital Geral de Curitiba, Curitiba, Brazil, and colleagues explored the impact of behavioural, individual, and exposure factors on the severity of AKs on the scalp and face in a multicenter cross-sectional study.

The study involved immunocompetent individuals with at least one actinic keratosis on their scalp or face and assessed sun exposure and protection, demographic factors, history of skin cancer, and use of medications within the last six months. The primary outcome of the study was determined as the Actinic Keratosis Area and Severity Index (AKASI) score, and the variation in AKASI scores was evaluated using a hierarchical generalized linear model, adjusting for age, gender, and skin prototype. A total of two hundred seventy subjects between 39 and 92 years were evaluated.

The study revealed the following findings:

· The majority had phototype I or II (77%), male gender (51%), low adherence to sunscreen use (29%), and personal history of skin cancer (55%).

· The use of photosensitizing medications was reported by 61%.

· Through multivariate analysis, older age (βSE = 0.14), lighter skin phototype (βSE = 0.15), sunburning (βSE = 0.12), history of skin cancer (βSE = 0.12), and use of CCBs (βSE = 0.11) were identified as independent risk factors for AK severity.

· Photosensitizing drugs were not identified as risk factors.

“We confirmed lower skin phototype classifications, older age, and a personal history of skin cancer as severity risk factors for actinic keratosis, while CCB use was associated with more severe AK,” the researchers concluded.

Reference:

Gioppo, I. S., Martins, C., Santos, S. S., R. Preto, J. F., Miola, A. C., & Miot, H. A. (2023). Association between calcium channel blockers and the severity of actinic keratosis on face and scalp: A cross-sectional study. International Journal of Dermatology, 62(12), 1511-1519. https://doi.org/10.1111/ijd.16871

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Young age at menarche tied to elevated risk of diabetes in mid-life: BMJ

USA: A recent study published in BMJ Nutrition Prevention & Health reveals an association between earlier age at menarche and type 2 diabetes among young and middle-aged women and with stroke complications among these women with diabetes.

“Starting menstrual cycles at a young age before the age of 13 is linked to a heightened risk of developing type 2 diabetes in mid-life,” the US study stated. 

It also seems to be associated with an increased risk of having a stroke before the age of 65 in those with the disease, particularly those who started having periods before the age of 10 or younger, the findings indicate.

Diabetes and its complications are on the rise among young and middle-aged US adults, while the age at which women start having periods is falling worldwide, note the researchers.

They therefore wanted to find out if there might be a link between these two phenomena in younger women, and drew on responses to the nationally representative National Health and Nutrition Examination Survey (NHANES) 1999–2018.

Some 17,377 women aged between 20 and 65 were included in the study, all of whom specified the age at which they had had their first menstrual cycle. This was categorised as 10 or younger, 11, 12, 13, 14 and 15 and older.

Of the total, 1773 (10%) reported a diagnosis of type 2 diabetes. And of these, 205 (11.5%) reported some type of cardiovascular disease.

Starting periods before the average age of 13 was associated with a heightened risk of type 2 diabetes, after accounting for a range of potentially influential factors, including age, race/ethnicity, education, motherhood, menopausal status and family history of diabetes, smoking, physical activity, alcohol consumption and weight (BMI).

This ranged from 32% greater (10 or younger) through 14% greater (age 11) to 29% greater (age 12).

Among women with diabetes, earlier age at first menstrual cycle was associated with a heightened risk of stroke, although not cardiovascular disease in general, after accounting for the same set of potentially influential factors.

Very early age at first menstrual cycle-10 or younger-was associated with a more than doubling in stroke risk among women below the age of 65 with diabetes, after similar adjustments for influential factors.

This risk fell in tandem with increasing age: 81% among those with their first menstrual bleed at the age of 11, to 32% at the age of 12, and to 15% at the age of 14.

This is an observational study, and as such, can’t establish causal factors. But, suggest the researchers: “Earlier age at [first menstrual cycle] may be one of early life indicators of the cardiometabolic disease trajectory in women.”

They explain: “One potential pathway explanation may be that [such] women are exposed to oestrogen for longer periods of time, and early [menstruation] has been associated with higher oestrogen levels.”

They point out that while the observed associations between age at first menstrual cycle and stroke complications weakened slightly after accounting for weight, these still remained statistically significant.

“Therefore, adiposity may also play a role in the observed association between early age at [first menstrual cycle] and stroke complications, as higher childhood adiposity is associated with earlier age at [menstruation] and with cardiometabolic diseases later in life,” they suggest.

“These findings add another dimension to the potentially less well understood determinants of cardiometabolic risk, particularly in women who have been relatively underrepresented in this area of research,” comments Professor Sumantra Ray, Executive Director of the NNEdPro Global Centre for Nutrition & Health, which co-owns BMJ Nutrition Prevention & Health.

“And they provide a clear steer on the need to design interventional studies looking at the prevention of cardiometabolic disease in ethnically diverse groups of women who start menstruating at a young age,” he adds.

Reference:

Santos MP, Li Y, Bazzano LA, et alAge at menarche, type 2 diabetes and cardiovascular disease complications in US women aged under 65 years: NHANES 1999–2018BMJ Nutrition, Prevention & Health 2023;e000632. doi: 10.1136/bmjnph-2023-000632.

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Novel X-ray shield cuts radiation exposure to the operator by greater than 80 per cent: Study

Norway: Radiation shielding is necessary during cardiac catheterization, but there is a need to improve ease of use and efficacy. A recent study published in Circulation: Cardiovascular Interventions sought to evaluate the shielding effect and user feedback for a novel flexible multiconfiguration x-ray shield (FMX).

The researchers found that the reusable and flexible radiation shield that lays across the patient like a blanket can reduce tradition to operators in that cath lab by as much as 84% compared with routine protection strategies.

“The reductions in radiation dose to the operators were similar for diagnostic angiography and PCI and similar in female and male operators,” reported Cedric Davidsen, Haukeland University Hospital, Bergen, Norway, and colleagues. According to them, the novel device they developed and tested offered protection against scatter that may be missed by table- and ceiling-mounted shields.

“The FMX was designed to maintain ease of use and protection across a variety of patients, procedure types, and access sites,” the study stated. “The system can be fully and immediately removed or repositioned in seconds according to clinical need.”

The 0.5-mm Pb equivalent FMX can be configured selectively to accommodate for variations in access site, patient morphology, and type of procedure with maintained visualization, shielding, and vascular access. Relative operator dose (operator dose indexed for given dose) was measured during 103 consecutive procedures randomized in the proportion of 1:1 to the current routine setup or FMX+routine, to evaluate the efficacy. User feedback was collected on relevance, function, and likelihood of adoption into clinical practice.

The study revealed the following findings:

  • The median relative operator dose was 3.63 μSv/µGy·m2×10-3 with routine setup and 0.57 μSv/µGy·m2×10-3 with FMX+routine, which amounts to an 84.4% reduction.
  • For 500 procedures/year, this corresponds to an estimated yearly dose reduction from 3.6 to 0.7 mSv.
  • User feedback regarding size, ease of use, functionality, likelihood to use, critical issues, draping, shielding, vascular access, procedure time, patient discomfort, and risk was 99% positive.
  • No critical issues were identified. There was no significant difference in patient radiation exposure.

“The FMX considerably reduced radiation exposure and represents an attractive and effective solution for radiation protection that can easily be implemented in existing workflow,” the researchers wrote.

“FMX has the potential for general use with maintained visualization, shielding, and vascular access in routine cardiac catheterization,” they concluded.

Reference:

Davidsen C, Ytre-Hauge K, Samnøy AT, Vikenes K, Lancellotti P, Tuseth V. Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial. Circ Cardiovasc Interv. 2023 Nov 13:e013199. doi: 10.1161/CIRCINTERVENTIONS.123.013199. Epub ahead of print. PMID: 37955163.

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Omega-3 Fatty Acids fail to provide protection against retinopathy among diabetes patients

Omega-3 Fatty Acids fail to provide protection against retinopathy among diabetes patients suggests a new study published in the Ophthalmology.

Results from a substudy of the ASCEND trial suggest that the use of omega-3 fatty acids had no clinically meaningful benefit compared to placebo for the development of diabetic retinopathy.

“Preclinical studies demonstrate a protective role for omega-3 fatty acids in diabetic retinopathy, but these observations have not been confirmed in randomized trials,” the researchers write.

The safety and effectiveness of omega-3 fatty acids on health has been under the microscope of cardiometabolic health study participants for a decade. Although much of the attention has been devoted to the REDUCE-IT and STRENGTH studies, which examined icosapent ethyl (Vascepa) and an EPA/DHA agent, respectively, several other studies have been initiated to further explore the associations between different forms of omega to study -3 fatty acids, like the ASCEND study.

In a double-blind, randomized, placebo-controlled trial of adult patients aged 40 years and older with diabetes but no apparent cardiovascular disease, the A Study of Cardiovascular Events in Diabetes (ASCEND), 15,480 patients were randomized to a 1st course -gram capsule containing 460 mg eicosapentaenoic acid and 380 mg docosahexaenoic acid or equivalent placebo with olive oil daily. The study’s primary outcome of interest was first major vascular event and median follow-up duration of 7.4 years.

The results of the study indicate that a major vascular event occurred in 8.9% of the omega-3 fatty acid group and 9.2% of the placebo group (rate ratio). [RR], 0.97; 95% confidence interval [CI]0.87 to 1.08; P=.55). Further analysis showed that all-cause deaths occurred in 9.7% of the omega-3 fatty acid group and 10.2% of the placebo group (RR: 0.95; 95% CI: 0.86 to 1, 05).

In a substudy of the ASCEND trial called ASCEND-EYE, a team of researchers led by Jane Armitage, FRCP, FFPH, from the Nuffield Department of Public Health, used linked data from the records of the NHS Diabetic Eye Screening Program in England and Wales to To identify participants from the study who developed diabetic retinopathy. The investigators noted that ocular events reported were assessed through medical record review.

The primary efficacy outcome of interest for the subsidy was time to first record of a communicable disease after randomization, which researchers defined as a combination of communicable retinopathy or communicable maculopathy based on evaluation criteria established by the UK National Screening Committee . The sub-study also included several secondary and tertiary outcomes, such as: B. Transferable disease outcomes stratified by baseline DR severity, any progression of retinopathy grade, and incident diabetic maculopathy.

A total of 7360 participants with linkage data were included in the current study, representing 48% of those randomized in ASCEND. At baseline, this cohort had a mean age of 63.5 (standard deviation: 8.9) years, 62% of the group were male, 96% were white, and 95% had type 2 diabetes. The median follow-up duration in this cohort was 6.5 years.1.4

In the analysis, 14.8% of the omega-3 fatty acid group and 13.9% of the placebo group experienced a transmissible disease event (RR: 1.07; 95% CI: 0.95-1.20 ; P=.29). Further analysis revealed that there were no statistically significant differences between groups in

the proportion of events for the secondary or tertiary endpoints.

Reference:

Sammons EL, Buck G, Bowman LJ, et al. ASCEND-Eye: Effects of Omega-3 Fatty Acids on Diabetic Retinopathy. Ophthalmology. Published online December 3, 2023. doi:10.1016/j.ophtha.2023.11.030

Keywords:

Omega-3, Fatty, Acids, fail, provide, protection, against, retinopathy, among, diabetes, patients, Sammons EL, Buck G, Bowman LJ, Ophthalmology

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Smartwatches to detect abnormal heart rhythms in kids

Smart watch is a fashion in recent times, it keeps you notified on your daily routine and your fitness schedule. Smart watches can help physicians detect and diagnose irregular heart rhythms in children, according to a new study from the Stanford School of Medicine.

The finding comes from a survey of electronic medical records for pediatric cardiology patients receiving care at Stanford Medicine Children’s Health. The study published online Dec. 13 in Communications Medicine.

Over a four-year period, patients’ medical records mentioned “Apple Watch” 145 times. Among patients whose medical records mentioned the smartwatch, 41 had abnormal heart rhythms confirmed by traditional diagnostic methods; of these, 29 children had their arrythmias diagnosed for the first time.

The Stanford Medicine research team plans to conduct a study to further assess the utility of the Apple Watch for detecting children’s heart problems. The study will measure whether, in kids, heart rate and heart rhythm measurements from the watches match measurements from standard diagnostic devices.

The study is open only to children who are already cardiology patients at Stanford Medicine Children’s Health. Apple’s Irregular Rhythm Notification and ECG app are cleared by the Food and Drug Administration for use by people 22 years of age or older. The high heart rate notification is available only to users 13 years of age or older

 “I was surprised by how often our standard monitoring didn’t pick up arrythmias and the watch did,” said senior study author Scott Ceresnak, MD, professor of pediatrics. Ceresnak is a pediatric cardiologist who treats patients at Stanford Medicine. “It’s awesome to see that newer technology can really make a difference in how we’re able to care for patients.”

The study’s lead author is Aydin Zahedivash, MD, a clinical instructor in pediatrics.

Most of the abnormal rhythms detected were not life-threatening, Ceresnak said. However, he added that the arrythmias detected can cause distressing symptoms such as a racing heartbeat, dizziness and fainting. Skipping a beat, sometimes doctors face two challenges in diagnosing children’s cardiac arrythmias, or heart rhythm abnormalities.

The first is that cardiac diagnostic devices, though they have improved in recent years, still aren’t ideal for kids. Ten to 20 years ago, a child had to wear, for 24 to 48 hours, a Holter monitor consisting of a device about the size of a smartphone attached by wires to five electrodes that were adhered to the child’s chest. Patients can now wear event monitors-in the form of a single sticker placed on the chest-for a few weeks. Although the event monitors are more comfortable and can be worn longer than a Holter monitor, they sometimes fall off early or cause problems such as skin irritation from adhesives.

The second challenge is that even a few weeks of continuous monitoring may not capture the heart’s erratic behavior, as children experience arrythmias unpredictably. Kids may go months between episodes, making it tricky for their doctors to determine what’s going on.

From 145 mentions of the smartwatch in patient records, 41 patients had arrythmias confirmed. Of these, 18 patients had collected an ECG with their watches, and 23 patients had received a notification from the watch about a high heart rate.

The information from the smartwatches prompted the children’s physicians to conduct medical workups, from which 29 children received new arrythmia diagnoses. In 10 patients, the smartwatch diagnosed arrythmias that traditional monitoring methods never picked up.

 “The wearable market is exploding, and our kids are going to use them,” Ceresnak said. “We want to make sure the data we get from these devices is reliable and accurate for children. Down the road, we’d love to help develop pediatric-specific algorithms for monitoring heart rhythm.”

“These irregular heartbeats are not life-threatening, but they make kids feel terrible,” Ceresnak said. “They can be a problem and they’re scary, and if wearable devices can help us get to the bottom of what this arrythmia is, that’s super helpful.”

Reference: Smartwatches can pick up abnormal heart rhythms in kids, Stanford Medicine study finds; STANFORD MEDICINE, Communications Medicine

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Extra-low dose levothyroxine improves pregnancy outcomes in women with subclinical hypothyroidism undergoing IVF

Extra-low dose levothyroxine improves pregnancy outcomes in women with subclinical hypothyroidism undergoing IVF suggests a new study published in the Taiwanese Journal of Obstetrics and Gynecology

This study was undertaken to test the therapeutic effect of extra-low dose of levothyroxine (LT4; 25 mcg/day) to preconception and pregnant women with subclinical hypothyroidism (SCH).

This is a retrospective study, SCH women who succeeded in their first in vitro fertilization (IVF) cycle between January 1, 2018, to December 31, 2020 were included. SCH is defined as normal serum free thyroxine (T4) level and an elevated serum thyroid stimulating hormone (TSH) level >4 mIU/L. Extra-low dose of levothyroxine (LT4; 25 mcg/day) was prescribed to the SCH women from the establish of diagnosis of SCH to the end of pregnancy. The pregnancy outcomes (miscarriage, live birth, preterm birth, and small for gestational age baby) were compared to the euthyroid pregnant women.

Results:

Totally, 589 women were screened, and 317 cases received their first time IVF treatment. 167 women were clinically pregnant after IVF treatment, 155 of them were euthyroid and 12 of these women were diagnosed to have SCH. The average age of the participants was 35 years old. There were no significant differences in age, body mass index (BMI), anti-müllerian hormone (AMH), types of embryo transfer, number of embryos to transfer, or embryo stage during transfer between two groups. The live birth rate, miscarriage rate, and preterm birth rate in women with SCH supplemented with extra-low dose of LT4 were non-inferior to euthyroid patients (miscarriage rate: P = 0.7112; live birth rate: P = 0.7028; preterm delivery: P = 0.2419; small for gestational age: P = 0.2419).

The result demonstrated that supplementation with extra-low dose of levothyroxine at 25 mcg/day to SCH women can produce the comparable obstetrical and neonatal outcome as that in euthyroid pregnant women. Accordingly, we suggest extra-low-dose of levothyroxine may be considered as a safe and effective alternative for those SCH pregnant women who were not tolerated to the standard dose of levothyroxine.

Reference:

Chen YT, Ho CH, Chung MT, Wen JY, Lin YL, Hsiao TW, Tsai YC. Effect of extra-low dose levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism undergoing in vitro fertilization and embryo transfer. Taiwan J Obstet Gynecol. 2023 Nov;62(6):869-873. doi: 10.1016/j.tjog.2023.05.014. PMID: 38008507.

Keywords:

Extra-low, dose, levothyroxine, improves, ancy, outcomes, women, subclinical, hypothyroidism, undergoing, IVF, Chen YT, Ho CH, Chung MT, Wen JY, Lin YL, Hsiao TW, Tsai YC, Infertility; In vitro fertilization and embryo transfer; Levothyroxine; Pregnancy outcome; Subclinical hypothyroidism.

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Fetuin A significantly decreased in patients with calcific aortic valve disease

Pakistan: A recent meta-analysis published in Atherosclerosis Plus has shown a significant reduction in fetuin-A in patients with known calcific aortic valve disease (CAVD).

The research, however, revealed no association between fetuin-A and calcific aortic valve disease in kidney disease patients. The investigator Muhammad Omar Larik from Dow International Medical College in Karachi, Pakistan, suggest the need for further research to arrive at a robust conclusion regarding fetuin-A use as a diagnostic biomarker for calcific aortic valve disease.

Calcific aortic valve disease is a common valvular disease that is particularly prevalent within the older age groups. The potential use of biomarkers in diagnosing and assessing CAVD severity in supplementation with imaging techniques has recently gained momentum within the field of cardiovascular medicine. Therefore, Dr. Omar Larik performed a meta-analysis to assess the association between the fetuin-A levels and the presence of CAVD.

For this purpose, online databases were searched from inception to April 2023. The Newcastle-Ottawa scale was utilized for bias assessment to determine the quality of the included studies. The initial search revealed fourteen potentially relevant studies. Nine studies (including 3,280 patients with CAVD and 7,505 patients as controls) were selected after a comprehensive full-text screening.

The researchers reported the following findings:

  • A total of 3,280 patients with CAVD and 7,505 patients as control were included in the analysis, resulting in the pooling of 10,785 patients in this meta-analysis.
  • It was observed that the circulating levels of fetuin-A were significantly lowered in patients with CAVD (SMD: -0.20).
  • The analysis revealed that fetuin-A levels had no significant association with CAVD in patients suffering from kidney disease (SMD: 0.20).

“While initial results showed the potential effectiveness,” the study stated, “there is a need for further research is essential to arrive at a robust conclusion regarding fetuin-A use as a diagnostic biomarker for calcific aortic valve disease.”

Limitations include the unadjusted data that may account for some inconsistencies, as populations of certain studies were subject to a variation of comorbidities when compared to other studies, such as the presence of diabetes mellitus, hypertension, or smoking history. Also, the mata-analysis was performed exclusively using observation studies accounting for an increased level of heterogeneity.

Reference:

Larik, M. O. (2023). Fetuin-A levels in association with calcific aortic valve disease: A meta-analysis. Atherosclerosis Plus, 54, 27-29. https://doi.org/10.1016/j.athplu.2023.09.004

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Bariatric Surgery Associated with Lower Pregnancy Weight Gain: JAMA

A recent study has uncovered the significant insights into the association between bariatric surgery and pregnancy outcomes. Researchers have found in a new study that Bariatric Surgery is Associated with Lower Pregnancy Weight Gain among women.

The findings of the study were published in Journal of American Medical Association.

The research conducted in Sweden from 2014 to 2021 involved 12,776 pregnancies. This study aimed to compare pregnancy weight gain among women with a history of bariatric surgery and those without, looking into potential variations based on surgical procedures and time intervals.

The findings reveal that women with a history of bariatric surgery experienced lower pregnancy weight gain across all early-pregnancy BMI strata when compared to their matched counterparts. The differences in pregnancy weight gain were notable, with a decrease observed in normal weight, overweight, and obese classes I, II, and III.

The findings indicates that pregnancy weight gain did not significantly differ based on the specific bariatric surgical procedure. A shorter surgery-to-conception interval, particularly within one year, or lower surgery-to-conception weight loss was correlated with reduced pregnancy weight gain. This highlights the nuanced factors influencing maternal health post-bariatric surgery.

The study emphasized the importance of these findings understanding that state the impact of bariatric surgery on pregnancy outcomes is crucial for healthcare providers and expectant mothers. The study contributes valuable information to guide personalized maternal care for women with a history of bariatric surgery.

This extensive study helps in understanding the complex relationship between bariatric surgery and pregnancy but also underscores the significance of tailoring healthcare interventions based on individual patient characteristics. More studies like these will play a vital role in enhancing the understanding and improving outcomes for mothers and their offspring.

Source:

Xu, H., Holowko, N., Näslund, I., Ottosson, J., Arkema, E. V., Neovius, M., Stephansson, O., & Johansson, K. (2023). Pregnancy Weight Gain After Gastric Bypass or Sleeve Gastrectomy. In JAMA Network Open (Vol. 6, Issue 12, p. e2346228). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.46228

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