Insomnia, lack of sleep linked to high blood pressure in teens, suggests research

Teenagers who do not get the recommended amount of sleep may be at an increased risk for high blood pressure, according to preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2025. The meeting will be held in New Orleans, March 6-9, 2025, and features the latest science on population-based health and wellness and implications for lifestyle.

Poor sleep is a known risk factor for cardiovascular disease, which claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the American Heart Association’s 2025 Statistical Update. Teenagers need 8 to 10 hours of sleep each night, according to the American Academy of Sleep Medicine, yet the average high school student is estimated to sleep only 6.5 hours per weeknight.

Researchers studied a diverse group of more than 400 teenagers from the Penn State Child Cohort. Participants in the study self-reported insomnia on a questionnaire prior to enrolling in the lab-based sleep study. In the nine-hour overnight sleep study, called a polysomnography, sensors were attached to each participant’s head, face and body to measure their sleep duration objectively. The study also included three consecutive blood pressure measurements taken on the night of the sleep study about two-to-three hours before lights were turned off in the lab.

“We know that disturbed and insufficient sleep is associated with high blood pressure in adults, particularly in adults who report insomnia and sleep objectively less than six hours, but we do not yet know if these associations exist in adolescents,” said senior study author Julio Fernandez-Mendoza, Ph.D., a professor of psychiatry, neuroscience and public health sciences and director of behavioral sleep medicine at Pennsylvania State University College of Medicine in Hershey, Pennsylvania.

The researchers defined insomnia as reporting difficulty falling and/or staying asleep and defined objective short sleep duration as less than 7.7 hours, based on the median total time asleep in the lab-based sleep study. Teenagers in the study were considered to have elevated blood pressure if they had a systolic, or top number, measurement of 120 mm Hg or higher and a diastolic, or bottom number, measurement of 80 mm Hg or lower. They were considered to have stage 2 hypertension if they had an average systolic blood pressure measurement of 140 mm Hg or higher and/or an average diastolic measure of 90 mm Hg or higher, which aligns with the Association’s 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

The researchers found:

  • Teenagers who self-reported insomnia and slept less than 7.7 hours in the lab were five times more likely to have clinical hypertension than “good sleepers“ (participants who did not report insomnia and obtained sufficient sleep in the lab, defined as 7.7 hours or more).
  • Teenagers who slept less than 7.7 hours in the lab but did not report insomnia had nearly three times the risk of elevated blood pressure compared to the good sleepers.
  • Teens who self-reported insomnia but obtained sufficient sleep in the lab did not appear to be at higher risk for elevated blood pressure or stage 2 hypertension.

These findings suggest the combination of insomnia and inadequate hours of sleep likely contributes to more severe conditions than lack of sleep alone, the researchers noted.

“While we need to explore this association in larger studies on teens, it is safe to say that sleep health matters for heart health, and we should not wait until adulthood to address it,” Fernandez-Mendoza said. “Not all teens who complain of insomnia symptoms are at risk for cardiovascular issues, however, monitoring their sleep duration objectively can help us identify those who have a more severe form of insomnia and are at-risk for heart problems.”

Improving one’s sleep health is something everyone can do to improve their cardiovascular health and is a key component of the Association’s Life’s Essential 8. The key components of Life’s Essential 8 include eating healthy food, being physically active, not smoking, getting enough sleep, maintaining a healthy weight and controlling cholesterol, blood sugar and blood pressure levels.

“Our findings are important because they call attention to the need to listen to teens who complain of disturbed sleep, to monitor and assess their sleep objectively and help them improve it in order to prevent heart problems early,” said the study’s first author Axel Robinson, a 17-year-old senior at Pelham Memorial High School in Pelham, New York.

Robinson, whose high school offers a four-year science research program, read one of Fernandez-Mendoza’s scientific articles when he was in ninth grade and reached out to Fernandez-Mendoza, asking him to become his research mentor. “I have always been personally interested in insomnia, so I pursued two internships with Dr. Fernandez-Mendoza with the goal of learning more about the disorder. Insomnia had bothered me my entire life and I was able to overcome it thanks to what I learned and a therapist he recommended,” he said.

Study details, background and design:

  • The study group included 421 participants (54% boys and 46% girls, average age 16.5 years) from three school districts in the Harrisburg, Pennsylvania, metropolitan area. 77% of participants self-identified as white; 13% self-identified as Black; 7% self-identified as Hispanic; and 3% selected “Other.”
  • The overnight sleep study and blood pressure measurements occurred between 2010 and 2013, and data analyses were conducted between 2023 and 2024.
  • Of the participants, 35% reported difficulty falling and/or staying asleep (insomnia symptoms) and 50% slept less than 7.7 hours in the lab (objective short sleep duration).
  • Data was collected between 2010 and 2013 through self-reported questionnaires, a polysomnography (a sleep study conducted in a lab) and seated blood pressure measurements collected in the lab the same evening of the sleep studies.
  • The Penn State Child Cohort is ongoing and collecting data from the same participants, now ages 20 to 33 years old.

The study’s limitations include that it was conducted in a sleep lab, so participants might not have slept as well as if they were at home. Additionally, because all data collection took place between 2010 and 2013, “It is uncertain whether there may be post-COVID increases in adolescent insomnia, depression and anxiety that could impact the results of other studies when replicated now,” Fernandez-Mendoza noted.

“This study adds to the limited knowledge base about the relation between poor sleep and risk of hypertension during a crucial life stage of development,” said Brooke Aggarwal, Ed.D., M.S., FAHA, an assistant professor of medical sciences in the department of medicine’s division of cardiology at Columbia University Medical Center and a member of the Association’s Lifestyle Sleep Health Science Committee.

“Prevention of heart disease is key, and it begins with the adoption of a healthy lifestyle in childhood and adolescence, including optimal sleep. Setting healthy sleep patterns during the teenage years could carry over into adulthood. Similarly, sleep problems that occur during the teen years tend to persist over time and could predispose individuals to increased cardiovascular risk later in life,” said Aggarwal, who was not involved in the study.

“Besides treatment for any clinical sleep disorders, teens can also practice good sleep hygiene, including creating relaxing bedtime routines, limiting electronics use in the hours before bedtime, avoiding heavy meals before bed, restricting caffeine and participating in daily physical activity.”

This year, daylight saving time begins on Sunday, March 9. Daylight saving time is the practice of setting the clocks an hour ahead of standard time to achieve longer evening daylight in the summer months. Following good sleep hygiene, as well as getting as much natural light as possible each day and winding down earlier in the evenings ahead, can help to get ahead of the time change.

“Many people, including teens, struggle to adjust and their sleep suffers. Before we all spring ahead, I’d encourage parents and teens to talk about the importance of sleep and make a plan to adjust schedules to ensure everyone gets adequate sleep,” Aggarwal said.

Reference:

Insomnia, lack of sleep linked to high blood pressure in teens, American Heart Association, Meeting: AHA Epidemiology Lifestyle Scientific Sessions 2025.

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Study Suggests Shorter Driving Restrictions After STEMI, Challenges Outdated Guidelines

Canada: A new study highlights that the guidance patients receive from physicians regarding resuming driving after a ST-segment elevation myocardial infarction (STEMI) may be outdated despite its personal and economic significance.

Findings from the DRIVE-STEMI study indicate that the risk of death within the first year after hospital discharge remains below 5%, with low incidence rates of cardiac events such as cardiac arrest, syncope, stroke, MI, and hospitalization for rhythm disturbances. The DRIVE-STEMI study was initially presented as a poster at the American College of Cardiology (ACC) 2024 Scientific Session and later published as a research letter in Circulation on January 21, 2025.

The researchers note that several countries, including Canada, the United Kingdom, and Australia, have established guidelines to help medical professionals advise patients on resuming driving after a STEMI. However, in the absence of randomized trials on driving fitness, these recommendations rely largely on observational data from patients with various medical conditions. Suggested waiting periods vary widely, ranging from a few days to four weeks, and many guidelines use sudden cardiac death as a surrogate endpoint.

According to the researchers, the new study is the first to evaluate a composite of clinical outcomes under the term “sudden cardiac incapacitation” as an indicator of driving fitness.

For the study, Luiz F. Ybarra, Western University, London, Canada, and colleagues utilized administrative health databases to establish a cohort of 24,890 STEMI patients (mean age 63 years; 27% women) discharged between April 2017 and March 2021.

The following were the key findings of the study:

  • Within the first year, 4.9% of patients died, 0.6% experienced cardiac arrest, 1.7% had syncope, 0.7% suffered a stroke, and 2.7% had a myocardial infarction.
  • Hospitalization or emergency department visits occurred in 2.1% of patients for sustained arrhythmia and 0.3% for ventricular tachyarrhythmia.
  • Most events took place within the first 15 days after discharge.
  • The primary composite endpoint, including death, cardiac arrest, syncope, stroke, MI, and hospitalization or emergency visit for sustained arrhythmia, occurred in 11% of the cohort at one year.
  • The secondary composite endpoint, which included death, cardiac arrest, syncope, stroke, or sustained ventricular tachyarrhythmia, was observed in 7.4% of patients.
  • Among patients aged 65 or younger, the primary endpoint was seen in 6.7%, compared to 16.8% in those older than 65.
  • The secondary endpoint was observed in 3.9% of patients aged 65 or younger and in 12.1% of those over 65.
  • The difference between age groups was mainly driven by a higher all-cause mortality rate in older patients (9.1%) compared to younger patients (1.9%), with all comparisons showing statistical significance.

The researchers suggest that the optimal driving restriction period for the entire cohort is one month based on the primary endpoint, while the secondary endpoint indicates a shorter restriction of just two weeks. For younger patients, a two-week restriction may be appropriate according to the primary endpoint, with no restriction needed based on the secondary endpoint.

Since the primary difference between age groups was all-cause mortality, which may have led to an overestimation of sudden cardiovascular incapacitation risk, the researchers believe that the ideal driving restriction for patients over 65 years could be even shorter than the endpoint-based estimates.

Reference:

Singer Z, Wijeysundera HC, Qiu F, et al. Driving restrictions and incapacitation vulnerability evaluation after ST-segment elevation myocardial infarction: DRIVE-STEMI study. Circulation. 2025;151:282-284.

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Children with Well-Managed Type 1 Diabetes Show Arterial Changes: Research Stresses Early Intervention

Sweden: A study published in eClinicalMedicine reported that children with well-managed type 1 diabetes exhibited greater intima thickness in certain arteries than their healthy counterparts. The research, conducted on 45 children with diabetes and 37 without, utilized ultra-high-frequency ultrasound to identify early vascular changes, underscoring the crucial role of maintaining normoglycemia in preventing cardiovascular complications.   

The authors emphasized that maintaining normoglycemia is crucial for cardiovascular prevention in children with type 1 diabetes, alongside early monitoring and potential pharmaceutical intervention for hypertension and hyperlipidemia. They highlighted the need for sensitive methods to detect and evaluate vascular changes over time, particularly in well-controlled pediatric diabetes populations like the study cohort.

The researchers note that cardiovascular complications remain a major concern in type 1 diabetes, with early atherosclerosis linked to hyperglycemia, hypertension, and dyslipidemia. Despite advances in diabetes management, children with type 1 diabetes continue to exhibit modifiable cardiovascular risk factors, highlighting the need for individualized prevention strategies.

To address this, Ebba Bergdahl, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues used ultra-high-frequency ultrasound (UHFUS) to detect subtle vascular changes in children with well-regulated diabetes, aiming to explore associations with glycemic and metabolic markers for early intervention.

For this purpose, the researchers conducted a cross-sectional case-control study at Queen Silvia Children’s Hospital, Gothenburg, Sweden, involving children with type 1 diabetes (CWD) aged 6–15.99 years with a diabetes duration of at least five years. Age- and sex-matched healthy controls were included for comparison. Participants with other medical conditions, treatments beyond insulin, abnormal findings, or difficulty undergoing examinations were excluded. UHFUS assessed the radial, dorsal pedal, and carotid arteries. Blood samples, blood pressure, BMI z-scores, and glucometrics were collected to evaluate vascular changes and metabolic markers.

Based on the study, the researchers reported the following findings:

  • The study was conducted from February 25, 2019, to June 28, 2022, and included 50 children with diabetes (CWD) and 41 healthy controls. After exclusions, data analysis included 45 CWD (22 girls, 23 boys; mean age 12.0 years) and 37 healthy controls (19 girls, 18 boys; mean age 11.3 years).
  • CWD had a mean HbA1c of 6.6% (48.1 mmol/mol).
  • There were higher diastolic blood pressure (DBP) z-scores in CWD.
  • CWD had significantly increased dorsal pedal (DP) intima thickness (IT), DP intima-media thickness (IMT), and radial IT compared to controls.
  • In CWD, carotid IT was negatively correlated with time in range (r = −0.47) and time in tight range (r = −0.64), while it was positively correlated with glucose variability (r = 0.40).
  • Time in tight range and longitudinal HbA1c were the strongest determinants for carotid IT in CWD.
  • Type 1 diabetes diagnosis was the strongest determinant of IT across all arteries.

The researchers found that children with well-regulated type 1 diabetes exhibit early vascular changes in the radial and dorsal pedal arteries. Regression analyses highlighted strong associations between intima thickness and hyperglycemia and type 1 diabetes diagnosis, suggesting that structural arterial changes originate in the intima.

“Their findings reinforce the importance of maintaining normoglycemia to prevent cardiovascular complications. We emphasize the need for larger studies to validate these results and further explore their clinical implications,” the researchers concluded.

Reference:

Bergdahl, E., Forsander, G., Sundberg, F., Milkovic, L., & Dangardt, F. (2025). Investigating the presence and detectability of structural peripheral arterial changes in children with well-regulated type 1 diabetes versus healthy controls using ultra-high frequency ultrasound: A single-centre cross-sectional and case-control study. EClinicalMedicine, 81, 103097. https://doi.org/10.1016/j.eclinm.2025.103097

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Liver cirrhosis increases the risk of osteoporosis and fractures: BMC Study

A new study published in the journal of BMC Gasteroenterology found that patients with the liver cirrhosis had higher risk of osteoporosis and a more than 2-fold higher risk of fractures when compared to people without liver cirrhosis.

Low bone mass (bone mineral density (BMD) T-score <− 2.5) and bone tissue structural abnormalities are hallmarks of osteoporosis, which increases the risk of fractures and skeletal fragility. There are 2 types of osteoporosis one being primary, which occurs in menopausal women and the elderly, and the secondary, which can be brought on by a number of illnesses or drugs.

One of the diseases linked to secondary osteoporosis is hepatic cirrhosis. Hospitalizations, incidence fractures, recovery times, morbidity and mortality, and medical expenses can all rise as a result of osteoporosis. These issues can significantly impair the quality of life for those who have cirrhosis as well as the healthcare system, which emphasizes how critical it is to comprehend and treat bone health in this group. The objective of this study was to examine the risk of osteoporosis, fractures, and alterations in bone mineral density between patients with hepatic cirrhosis and healthy, non-cirrhotic controls.

Studies from MEDLINE/PubMed, Web of Science, Scopus, and Embase up until July 2024 were sourced in accordance with PRISMA criteria. These included observational studies that evaluated osteoporosis, fracture, and BMD in individuals with cirrhosis as opposed to those without. Standardized mean differences (SMD) and odds ratios (OR) of outcomes were computed for meta-analyses. To investigate the robustness and sources of heterogeneity, sensitivity analyses and meta-regression were also carried out.

Almost, 21 studies including 6,95,330 control individuals and 76,521 cirrhotic patients were included in the study. The patients with cirrhosis had noticeably greater probabilities of developing osteoporosis. With an OR of 2.30 for cirrhotic individuals, fracture was noticeably higher.

Both the lumbar spine and the femoral neck showed decreases in BMD. These results were validated by sensitivity analyses, and meta-regression showed that the presence of men affected these correlations in different ways. Overall, considering hepatic cirrhosis is linked to a markedly elevated risk of osteoporosis and fractures, it is crucial to incorporate cirrhosis into clinical fracture-risk models as well as focused screening and prevention initiatives.

Reference:

Shirinezhad, A., Eshlaghi, F. M., Salabat, D., Azarboo, A., Ardakani, Z. F., Esmaeili, S., Amir Human Hoveidaei, & Ghaseminejad-Raeini, A. (2025). Prevalent osteoporosis and fracture risk in patients with hepatic cirrhosis: a systematic review and meta-analysis. BMC Gastroenterology, 25(1). https://doi.org/10.1186/s12876-025-03720-6

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Removal of desflurane vaporisers and staff training significantly reduces emissions of anaesthesia department: Study

Recent study focuses on the impact of reducing desflurane use in anaesthetic clinics to lower greenhouse gas emissions. By implementing interventions like dismounting desflurane vaporisers and educating staff members, the study aimed to assess the effectiveness of reducing emissions without restricting desflurane use. Conducted in a German university hospital over a 12-month period, the study found a significant reduction of 86% in hypnotic-related emissions per anaesthetic procedure compared to the year before interventions. Interestingly, there was already a 52.1% reduction in emissions in the year preceding the study. The study highlighted the importance of addressing the environmental impact of volatile anaesthetics like desflurane, which can contribute significantly to greenhouse gas emissions in healthcare settings.

Success of Emission Reduction

The findings indicated that removing desflurane vaporisers and providing staff education resulted in substantial emission reduction without compromising the quality of care. The study also observed a decrease in hypnotic-related costs by €14,549, with no significant changes in the use of sevoflurane or propofol. Moreover, the study emphasized the potential for rapid and substantial emission reductions through proactive measures in anaesthesiology departments. Notably, the elimination of desflurane usage led to a remarkable decrease in greenhouse gas emissions, highlighting the significance of addressing environmental concerns within healthcare systems.

Pharmacological Considerations and Economic Benefits

Furthermore, the study discussed the pharmacological differences between desflurane and sevoflurane, underscoring the need to consider alternatives that offer similar efficacy. The authors highlighted the economic benefits of reducing volatile anaesthetics consumption and emphasized the importance of timely implementation of strategies to mitigate greenhouse gas emissions. The study also addressed the limitations, such as the lack of a randomized control group and the influence of external factors like the COVID-19 pandemic on healthcare routines.

Conclusion and Implications

In conclusion, the study demonstrated that by implementing simple interventions like removing desflurane vaporisers and raising awareness among staff members, significant reductions in greenhouse gas emissions can be achieved in anaesthesia departments. The results underscore the importance of proactive measures to address environmental concerns and drive sustainable practices in healthcare settings, ultimately contributing to a greener and more cost-effective healthcare system.

Key Points

– The study aimed to reduce greenhouse gas emissions in anaesthetic clinics by implementing interventions like removing desflurane vaporisers and educating staff members.

– A significant reduction of 86% in hypnotic-related emissions per anaesthetic procedure was observed after implementing the interventions, showcasing the effectiveness of the approach.

– There was a substantial decrease in hypnotic-related costs by €14,549 without compromising the quality of care, demonstrating the economic benefits of emission reduction efforts.

– The study emphasized the importance of addressing the environmental impact of volatile anaesthetics like desflurane, which have a notable contribution to greenhouse gas emissions in healthcare settings. – Removal of desflurane vaporisers led to a remarkable decrease in greenhouse gas emissions, reinforcing the significance of proactive measures in anaesthesiology departments for emission reduction.

– The findings highlighted the need to consider alternatives with similar efficacy to desflurane, the economic benefits of reducing volatile anaesthetics usage, and the importance of timely implementation of strategies to mitigate greenhouse gas emissions in healthcare settings.

Reference –

Lehmann, F., Mader, J., Koch, C. et al. Minimising the usage of desflurane only by education and removal of the vaporisers – a before-and-after-trial. BMC Anesthesiol 25, 108 (2025). https://doi.org/10.1186/s12871-025-02982-7

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Diabetes Patients with Kidney Disease Face Higher Psoriasis Risk, Study Finds

South Korea: A Korean population-based study has revealed a significant association between chronic renal disease and an increased risk of psoriasis in diabetes patients. The findings showed that diabetic patients with chronic kidney disease (CKD) are at an increased risk of developing psoriasis.

“Among 840,000 participants, those with an eGFR below 30 faced a 17% higher risk, while severe proteinuria heightened the likelihood by up to 50%. These findings highlight the potential of eGFR and proteinuria as predictive markers, emphasizing the importance of early screening and proactive management,” the researchers reported in the Indian Journal of Dermatology, Venereology, and Leprology.

Diabetes mellitus (DM) is known to be associated with various complications, including kidney disease and inflammatory skin disorders such as psoriasis. Multiple studies have established a positive correlation between psoriasis and type 2 diabetes mellitus. Recognizing the psoriasis risk in diabetic patients is crucial, as it enables early intervention and provides valuable insights into the shared underlying mechanisms of both conditions.

Against the above background, Seung Ah Yoo, Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea, and colleagues examined psoriasis risk in diabetic patients based on estimated glomerular filtration rate (eGFR) and proteinuria levels using population-based data from Korea.

For this purpose, the researchers conducted a retrospective cohort study using nationwide data through exploratory data analysis. A total of 927,234 diabetic patients were included, excluding those under 20 years of age, individuals with pre-existing psoriasis or psoriasis diagnosed within one year, and cases with missing data. The primary outcome was the development of psoriasis, monitored over a follow-up period of 7.83 ± 1.68 years.

The study led to the following findings:

  • Among the 840,395 participants, 28,010 (3.33%) developed psoriasis.
  • Diabetic patients with severely reduced kidney function (eGFR < 30) had a 17.3% higher risk of psoriasis compared to those with normal kidney function (eGFR 60–90).
  • The presence of proteinuria further increased the risk of psoriasis, with higher proteinuria levels linked to greater risk.
  • Patients with moderate proteinuria (2+) had a 16.4% higher risk, while those with severe proteinuria (3+ and 4+) had a 43.3% and 50.8% higher risk, respectively, compared to those without proteinuria.

The researchers highlight that declining eGFR and worsening proteinuria significantly increase the risk of psoriasis in diabetic patients, emphasizing the need for early detection and intervention. Since psoriasis management becomes more challenging in individuals with impaired kidney function due to limitations in systemic immunosuppressive treatments, proactive monitoring of renal health is crucial. Additionally, CKD elevates mortality risk in psoriasis patients, further underscoring the importance of preventive strategies.

“While the study provides valuable insights, it does not assess psoriasis severity or consider the impact of oral hypoglycemic agents. Nonetheless, the findings support the role of eGFR and proteinuria as key predictive markers for targeted intervention,” the researchers wrote.

Reference:

Yoo SA, Sayo MIA, Lee JH. Association between chronic renal disease and psoriasis risk in diabetes patients: A Korean population-based study. Indian J Dermatol Venereol Leprol. 2025;91:152-7. doi: 10.25259/IJDVL_669_2023

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Recurrent Intracerebral Hemorrhage Often Strikes Close to Initial Site, Study Finds

Switzerland: A recent study published in JAMA Neurology has highlighted key factors influencing the recurrence of nontraumatic intracerebral hemorrhage (ICH), focusing on location and timing. The study revealed that approximately 46% of recurrent cases occurred in regions adjacent to the initial bleed. The average time to recurrence was 1.25 years for adjacent hemorrhages, notably shorter than the 2.21 years observed for remote recurrences.

“The findings also indicated that lobar ICH and cerebral amyloid angiopathy significantly increased the likelihood of adjacent recurrence, nearly doubling the risk. In contrast, cerebellar ICH was associated with a lower risk of recurrence. These results emphasize the influence of localized vasculopathic changes in the recurrence of ICH,” the researchers reported.

The researchers note that intracerebral hemorrhage, a severe type of stroke, often leads to long-term neurological impairments and increased mortality. While recurrence is a well-recognized challenge, understanding whether subsequent hemorrhages occur in the same or nearby locations remains crucial for clinical decision-making. Considering this, Martina B. Goeldlin, Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland, and colleagues aimed to evaluate the timing and location of recurrent ICH events about the initial ICH, distinguishing between adjacent ICH (adjICH) and remote ICH (remICH).

For this purpose, the researchers conducted a pooled analysis of individual cohort studies from 2002 to 2021, focusing on hospital-based European cohorts. The study included patients who had experienced at least two clinically distinguishable small vessel disease–related intracerebral hemorrhage (ICH) events. Data analysis was carried out from December 2023 to December 2024.

Researchers examined ICH location and underlying small vessel disease type, with adjacent ICH (adjICH) as the primary outcome and time to recurrence as the secondary outcome. Multivariable regression analyses were performed, adjusting for factors such as ICH location, cerebral amyloid angiopathy, hypertension, and antihypertensive treatment.

The key findings of the study were as follows:

  • The study included 733 patients with a median age of 72.4 years, of whom 47.2% were female.
  • 1,616 ICH events were recorded, including 733 initial (index) and 883 recurrent events, with patients experiencing up to six recurrences.
  • Over a median follow-up of 2.53 years, 46.4% of patients had adjacent ICH (adjICH), while 53.6% had remote ICH (remICH).
  • Among recurrent cases, 476 were adjICH, and 407 were remICH.
  • Lobar index ICH (aOR 2.08) and cerebral amyloid angiopathy (aOR 2.21) were linked to a higher risk of adjICH.
  • Cerebellar index ICH was associated with lower odds of adjICH (aOR 0.25).
  • The median time to recurrence was 1.25 years for adjICH and 2.21 years for remICH.
  • Previous lobar or convexity subarachnoid hemorrhage, adjICH, and a higher number of prior ICH events were independently linked to a shorter time to recurrence.

The researchers found that early recurrence and characteristics of cerebral amyloid angiopathy were strongly associated with adjacent ICH. Their findings indicate that regional, tissue-based factors may contribute to recurrence, with spatial and temporal clustering suggesting localized vulnerabilities.

“By identifying and targeting these vasculopathic changes, our study highlights potential novel treatment approaches to reduce the risk of recurrent ICH,” they concluded.

Reference:

Goeldlin MB, Fandler-Höfler S, Pezzini A, et al. Location and Timing of Recurrent, Nontraumatic Intracerebral Hemorrhage. JAMA Neurol. Published online March 03, 2025. doi:10.1001/jamaneurol.2025.0026

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Thrombocytopenia Linked to Worse Outcomes in Pneumonia, COPD, and Asthma: Study

A new study published in Cureus has identified that patients with pneumonia (PNA), asthma, and chronic obstructive pulmonary disease (COPD) who also have thrombocytopenia have much poorer in-hospital outcomes, such as increased mortality, increased hospital stays, and enhanced resource utilization. Thrombocytopenia, a condition of low platelet counts, is frequently seen in hospital patients, but its role in hospitalized patients for respiratory diseases has not been thoroughly investigated. This study was conducted by Christian S. and colleagues.

Data from the National Inpatient Sample Database were used from the years 2016 to 2020. Adult patients hospitalized with a principal diagnosis of PNA, COPD, or asthma were enrolled, and secondary diagnosis of thrombocytopenia was ascertained through ICD-10-CM codes. The main outcome measured was all-cause mortality, whereas secondary outcomes were length of stay, resource utilization, and hospital intubation. Statistical analysis was conducted with STATA v.13 using multivariate adjustment for variables such as age, gender, race, Charlson comorbidity index, location of the hospital, size, region, teaching status, and insurance status. Statistical significance was established at p<0.05.

Key Findings

  • 2,993,792 patients were admitted with PNA, and 148,260 (4.95%) of them had thrombocytopenia.

  • Of 2,637,483 admissions for COPD, 77,160 (2.92%) had thrombocytopenia.

  • Of 491,990 asthma admissions, 6,300 (1.28%) had thrombocytopenia.

Thrombocytopenia was strongly linked with increased in-hospital mortality in all three conditions:

  • PNA: Odds Ratio (OR) 2.31, p<0.001

  • COPD: OR 2.99, p<0.001

  • Asthma: OR 7.26, p<0.001

  • The patients with asthma and thrombocytopenia had 626% greater in-hospital mortality than the patients without thrombocytopenia.

  • Hospital stay was longer in the patients with thrombocytopenia in all conditions.

  • Resource use was much greater in the affected patients.

  • Intubation rates were higher in thrombocytopenic patients.

Researchers concluded that PNA, COPD, and asthma patients with thrombocytopenia have significantly poorer hospital outcomes, such as increased mortality, increased length of stay, greater resource use, and increased rates of intubation. The results highlight the necessity for additional studies to see if the resolution of thrombocytopenia can abate these risks and enhance patient outcomes overall.

Reference:

Siochi, C., Durodola, B., Ali, F., Patel, V. K., Nwachukwu, C., Lerman, B., Canuto Miller, A., & Jesmajian, S. (2025). Impact of thrombocytopenia on outcomes in hospitalized patients with pneumonia, chronic obstructive pulmonary disease, and asthma: A nationwide study (2016–2020). Cureus. https://doi.org/10.7759/cureus.80037

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Tranexamic Acid in Trauma: Case of a Young Woman Highlights Risk of Acute Renal Cortical Necrosis

France: A recent case published in BMC Nephrology highlights the possible role of tranexamic acid (TXA) in precipitating acute bilateral renal cortical necrosis (RCN) in a young trauma patient, raising concerns about its administration, especially in the presence of additional thrombotic risk factors.

The researchers note that TXA is used widely as an antifibrinolytic agent in managing postpartum hemorrhage and severe traumatic bleeding. However, its potential association with renal cortical necrosis remains unclear, with only a few reported cases in non-obstetric settings. Previous reports on TXA-induced RCN suggest a rapid onset of acute kidney injury (AKI), with most cases requiring hemodialysis. The recovery of renal function varies, with some patients remaining dialysis-dependent.

Manal Mazloum, University of Montpellier, Montpellier, France, and colleagues describe the case of a 24-year-old woman with no prior medical history who was admitted to intensive care following a high-energy car accident. Despite stable hemodynamics and the absence of active arterial hemorrhage, she received an initial 1 g dose of TXA along with supportive therapy. Shortly after administration, her blood pressure dropped, necessitating norepinephrine support, which was quickly tapered. Laboratory investigations ruled out disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA), but 48 hours later, she developed AKI with anuria and rising serum creatinine levels, requiring hemodialysis.

A contrast-enhanced CT scan revealed diffuse cortical enhancement defects in both kidneys, confirming the diagnosis of acute bilateral RCN. According to the authors, some cortical areas remained perfused, particularly in the subcapsular and juxtamedullary regions. Over time, her renal function partially recovered, and she was weaned off dialysis after two months. However, at one-year follow-up, her estimated glomerular filtration rate (eGFR) remained at 40 ml/min/1.73 m².

“The involvement of TXA in RCN development remains a subject of debate, particularly in trauma patients with concurrent bleeding. While TXA has been shown to reduce mortality in trauma patients, its prothrombotic effects cannot be ignored,” the researchers wrote. “In this case, several factors point toward TXA as a potential culprit, given the relatively mild bleeding, stable hemodynamics, and the exclusion of other thrombotic conditions. Additionally, the patient was on hormonal contraception, which may have contributed to the thrombotic event.”

“This case highlights the importance of considering TXA’s potential risks, particularly in patients with additional thrombotic risk factors. It also underscores the predictive value of kidney imaging in assessing RCN severity and guiding prognosis. To mitigate the risk of severe renal complications, further research is needed to establish clear guidelines for TXA use in non-obstetric bleeding scenarios,” they concluded.

Reference:

Berri, J., Quintrec Donnette, M., Millet, I. et al. Tranexamic acid-induced acute bilateral renal cortical necrosis in a young trauma patient: a case report and literature review. BMC Nephrol 26, 95 (2025). https://doi.org/10.1186/s12882-025-03982-y

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Music-based therapy may improve depressive symptoms in people with dementia, suggests study

A new Cochrane review has found evidence that music-based therapy may benefit people living with dementia, particularly by improving symptoms of depression.

Dementia is a collective term for progressive degenerative brain syndromes that affect memory, thinking, behaviour and emotion. Alzheimer’s Disease International reported that there were 55 million people with dementia worldwide in 2019, a figure predicted to increase to 139 million by 2050. While some medicines are available, the therapeutic use of music is considered a relatively simple and inexpensive approach that remains accessible even in the later stages of dementia.

The research team from several institutions in the Netherlands examined evidence from 30 studies involving 1,720 people. The studies investigated the effects of music-based therapeutic interventions on emotional well-being including quality of life, mood disturbance, behavioural problems, social behaviour, and cognition. Most participants were in care homes, with interventions delivered either individually or in group settings.

The trials were primarily conducted in high-income countries, including Australia, Taiwan, the US, and various European countries. Almost all the therapies included active elements (such as playing instruments), often combined with receptive elements (such as listening to live music provided by a therapist).

“This review increases our understanding of the effects of music therapy and strengthens the case for incorporating music in dementia care, particularly in care home settings,” says lead author Jenny van der Steen from Leiden University Medical Center and Radboudumc Alzheimer Center. “Music therapy offers benefits beyond those of other group activities, helping to support mood and behaviour in a way that is engaging and accessible, even in later stages of dementia. Care home managers should consider integrating structured musical sessions as part of a person-centred approach to dementia care.”

The findings suggest that music-based therapy probably improves depressive symptoms and may improve overall behavioural problems by the end of treatment. Music therapy is unlikely to significantly impact agitation, aggression, emotional well-being, or cognition but, when compared to other interventions, there is some evidence that it may improve social behaviour and could decrease anxiety.

Long-term effects, beyond four weeks after treatment, may be smaller but remain uncertain due to the limited number of trials monitoring effects after treatment ends.

The review also highlights the growing recognition of non-pharmacological interventions in dementia care.

“Music therapy is a drug-free way of helping people feel less sad and less anxious,” says co-author Annemieke Vink from ArtEZ University of the Arts who has first-hand experience delivering music therapy to people with dementia. “We hope that the higher quality of recent studies and increasing evidence-base will result in more attention being given to music therapy and other non-pharmacological approaches.”

She continues, “Looking at the effect sizes, music therapy is a reasonable alternative to pharmacological approaches and is much more person-centred.”

The review underscores the need for further research into the long-term effects of music-based therapy particularly in community settings. Much of the existing evidence comes from care homes, so expanding studies to community-based environments could provide valuable insights into how music therapy can be integrated into everyday life for people living with dementia.

Reference:

Music-based therapy may improve depressive symptoms in people with dementia, Cochrane Database of Systematic Reviews (2025). DOI: 10.1002/14651858.CD003477.

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