Zonisamide another option for reducing migraine attacks in children, suggests study

For children and teens living with migraine, there may be a new preventive treatment, according to a preliminary study released today, February 26, 2025, that will be presented at the American Academy of Neurology’s 77th Annual Meeting taking place April 5–9, 2025, in San Diego and online. Researchers found the drug zonisamide, which has been used to treat seizures, may reduce migraine days in this age group. This study does not prove that zonisamide reduces migraine days; it only shows an association.

“Migraine disease is debilitating and can lead to kids having to miss school and other activities,” said author Anisa Kelley, MD, of Northwestern University Feinberg School of Medicine in Chicago. “Currently, there is only one FDA-approved migraine preventative medication for this age group. Our results are encouraging, showing zonisamide may be another option for reducing migraine attacks.”

For the study, researchers reviewed health records at one institution. They identified 256 children and teens who had been diagnosed with migraine and prescribed preventative zonisamide. Of these participants, 28% had difficult-to-treat migraine, which was defined as having migraine disease unsuccessfully treated with two or more previous medications. Researchers documented the number of headache days per month for each participant both before and after starting zonisamide.

They then divided participants into three subgroups based on how long they took the medication before a follow-up visit with a physician. The first group followed up in the first month, the second group within two to six months and the third group, after six months.

For all participants, the median number of headache days per month reduced from 18 to six at the first follow-up visit. When comparing between the groups, the subgroup that followed up within two to six months had the largest reduction with a median decrease of six headache days per month. Kelley noted that the data suggested the drug was most effective after at least two months of use.

The data also suggested that the drug was effective for both those with difficult-to-treat migraine disease and those without.

“It’s very exciting that we may have an effective way to treat difficult migraine disease in children and teens, however it’s important to note that our study did have limitations,” said Kelley. “For instance, our study did not compare people taking the medication to people who did not take the medication. Future studies are needed with control groups to confirm our results.”

Reference:

Drug may prevent some migraine attacks in children and teens, American Academy of Neurology, Meeting: AAN Annual Meeting

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Autologous Corneal Stem Cell Transplant Shows High Success in Repairing Corneal Injuries, Finds Study

USA: A clinical study has demonstrated that transplanted autologous corneal stem cells effectively repaired irreversible corneal injuries, restoring at least partial vision in over 90% of patients. The procedure was deemed safe, with no serious adverse events reported.

“transplanted epithelial stem cells from a healthy eye successfully repaired irreversible corneal injury, restoring at least partial vision in over 90% of patients. Within three months, seven out of 14 patients had fully restored corneas, which increased to 11 by the 12-month mark,” the researchers reported in Nature Communications. “By 12 and 18 months, more than 90% of the patients showed successful outcomes, including complete and partial improvements, demonstrating the potential of this approach in treating corneal damage.”

The researchers note that limbal stem cell deficiency (LSCD) is a serious ocular condition caused by damage or loss of limbal stem cells, leading to vision impairment, chronic pain, and corneal scarring. Current treatment options are limited, and many involve donor tissues that carry the risk of immune rejection.

Against the above background, Ula V. Jurkunas, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA, and colleagues developed a two-stage manufacturing process using cultivated autologous limbal epithelial cells (CALEC), introducing the first xenobiotic-free, serum-free, and antibiotic-free protocol in the United States to treat blindness caused by unilateral limbal stem cell deficiency. They conducted a single-center, single-arm Phase I/II clinical trial to evaluate its safety and feasibility.

The primary outcomes assessed were feasibility, determined by meeting release criteria, and safety, evaluated based on ocular infection, corneal perforation, or graft detachment. Eligible participants included males and females aged 18 to under 90 years with LSCD who could provide written informed consent. National Eye Institute of the National Institutes of Health funded the study.

Key Findings:

  • CALEC grafts met release criteria in 14 out of 15 participants (93%) by the trial’s end.
  • Intracellular adenosine triphosphate levels after the first stage of manufacturing correlated with colony-forming efficiency (r = 0.65).
  • One bacterial infection occurred, but it was unrelated to the treatment, and no other primary safety events were reported.
  • Efficacy was assessed based on corneal epithelial surface integrity (complete success) or improving corneal vascularization and/or participant symptoms measured by OSDI and SANDI (partial success).
  • Success rates (complete or partial) were 86% at 3 months, 93% at 12 months, and 92% at 18 months.

“The findings strongly support the safety and feasibility of CALEC transplantation, highlighting the need for further studies to assess its therapeutic effectiveness,” the researchers concluded.

Reference:

Jurkunas, U. V., Kaufman, A. R., Yin, J., Ayala, A., Maguire, M., Samarakoon, L., Johns, L. K., Parekh, M., Li, S., Gauthier, A., Negre, H., Shaw, K. L., Hernandez Rodriguez, D. E., Daley, H., Dana, R., Armant, M., & Ritz, J. (2025). Cultivated autologous limbal epithelial cell (CALEC) transplantation for limbal tem cell deficiency: A phase I/II clinical trial of the first xenobiotic-free, serum-free, antibiotic-free manufacturing protocol developed in the US. Nature Communications, 16(1), 1-12. https://doi.org/10.1038/s41467-025-56461-1

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IUD placement within 48 hours after second-trimester abortion non inferior to placement after 2 to 4 weeks: Study

Researchers have found that intrauterine device (IUD) placement within 48 hours of a second-trimester medical abortion is associated with increased expulsion rates and lower long-term use compared with placement at 2 to 4 weeks. A recent study was conducted by Sara H. and colleagues published in the American Journal of Obstetrics and Gynecology.

The aim of the research was to establish whether IUD placement within 48 hours would yield higher proportions of women using IUDs at six months post abortion without compromising safety and comfort compared with placement at 2 to 4 weeks postabortion. Eligible study participants were women aged 18 years or older who presented for a second-trimester medical abortion and consented to an IUD. Participants were randomly allocated to receive an IUD within 48 hours of abortion completion or at a later interval, 2 to 4 weeks postabortion. To assess the outcomes, the study made use of modified intention-to-treat and per-protocol analyses, using statistical tests to compare differences.

  • Six months after placement, more women continued using the IUD in the delayed-placement group (48 of 67) compared with the early-placement group (34 of 67; P.02). The difference was 20.9% (95% CI, 4.4%–35.9%).

  • The principal negative consequence of early placement was an expulsion rate that was markedly higher than that in the control group.

  • Compared with the control group (2.9%, or 2 of 70), 30.1% of patients (22 of 73) in the intervention group had IUD expulsion within 48 hours, leading to premature study termination when rates exceeded the prespecified threshold of 20% (P<.001).

  • While there was a difficulty experienced during expulsion, adverse events and complications were few, with good acceptability in participants across both groups.

  • It indicates that though the danger of expulsion is more where it is placed early on, it can still remain a choice for women that intend to start on their contraceptives right away but after proper counseling for risk.

There was no six-month usage rate benefit for sixteenth-week abortion followed by the placement of an intrauterine device within 48 hours compared with 2 to 4 weeks after the placement. A postabortion contraceptive plan, therefore, must be individualized so that timing is both in accordance with medical recommendations and with the patient’s needs.

Reference:

Hogmark, S., Rydelius, J., Envall, N., Teleman, P., Gemzell-Danielsson, K., & Kopp Kallner, H. (2024). Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial. American Journal of Obstetrics and Gynecology, 231(5), 530.e1-530.e8. https://doi.org/10.1016/j.ajog.2024.05.041

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Putting weight on ankles less than three weeks after surgical intervention safe, suggests study

A new study from the University of Missouri School of Medicine suggests putting weight on an ankle – also known as weight bearing – within three weeks of recovering from a surgically repaired fracture is safe.

There are no set guidelines to follow on when patients can start putting weight on fractured ankle bones, and past research had conflicting results. MU researchers conducted their own study, evaluating the outcomes of 233 patients and sorted them into groups based on how long they were non-weight bearing. They found nothing suggesting the risk of complications is higher in patients who bear weight early.

“The point of this study was to examine if early weight bearing after an ankle fracture was safe,” study author Dr. Kyle Schweser said. “Early weight bearing can help speed up a patient’s recovery by preventing muscle deconditioning, improving joint range of motion and allowing an earlier return to independence.”

Evidence also shows patients prefer early weight bearing and less restrictions, as it increases their independence while reducing the need for walking aids.

While the researchers found no significant differences with the chances of complications, there are several potential explanations for this. In the data, patients with other health conditions were more likely to have delayed weight bearing, which means more than six weeks of rest.

“Because we were looking at past data, we could not correct for selection bias. A disproportionate number of patients with diabetes and neuropathy were in the delayed weight bearing group,” Schweser said. “We can at least say that healthy patients can weight bear early, and that physicians can use discretion to be more aggressive in sicker patients.”

Patients with diabetes and neuropathy are usually more likely to have complications; however, the research team did not observe this in the data. More information is needed before definitively saying whether early weight bearing is safe in high-risk populations, but this is something that can be explored in future research.

“Clinically, at MU Health Care, we recommend early weight bearing for all patients with ankle fractures, except for those with certain conditions,” Schweser said. “Patients are typically very happy to walk earlier and begin the process of returning to normalcy. Most patients stop using crutches and other aids quickly and are more satisfied with their care.”

Reference:

Haralson, Warren G. et al.,Early weight bearing is not associated with short-term complications in ankle fractures, The Journal of Foot & Ankle Surgery, DOI:10.1053/j.jfas.2025.01.008 

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Are higher doses of folic acid safe in pregnancy?

Taking a higher dose of folic acid during the first trimester of pregnancy was safe and associated with improved verbal abilities in children at age six as well as improved behavior skills, according to a preliminary study released today, March 4, 2025, that will be presented at the American Academy of Neurology’s 77th Annual Meeting taking place April 5–9, 2025, in San Diego and online.

“Folic acid during pregnancy has been shown to reduce deformities and improve intellectual abilities in children, but the best dose of folic acid is unknown,” said study author Kimford J. Meador, MD, PhD, of Stanford University in Palo Alto, California, and a Fellow of the American Academy of Neurology. “Our study provides new information showing a positive connection between taking folic acid during early pregnancy and brain health outcomes in children, with no evidence of negative effects at higher doses.”

The study looked at 345 children when they were six years old. Of the participants, 262 were children of women with epilepsy and 83 were children of women without epilepsy.

Researchers recorded doses of folic acid taken by their mothers during the first 12 weeks of pregnancy and divided the children into five groups based on average dosage: no folic acid, folic acid up to 0.4 milligrams (mg) per day; more than 0.4 to 1.0 mg per day; more than 1.0 to 4.0 mg per day; and more than 4.0 mg per day. The current recommended dose during pregnancy for the general population is 0.4 mg per day, while women with epilepsy may be prescribed a higher dose.

Children were given multiple tests to assess verbal skills. For example, for one vocabulary test, participants were asked to describe objects, actions or concepts presented in each picture using one word. For the general population, scores for these verbal tests range from 70 to 130, with a mean of 100, with higher scores indicating better abilities.

Parents also completed questionnaires to assess the children’s behaviors like communication skills, social skills and daily living skills. Results from these tests were combined for an overall standardized behavioral score. For the general population, scores range from 70 to 130, with a mean of 100, with higher scores indicating better abilities.

After adjusting for factors such as mother’s IQ, epilepsy medications, and pregnancy complications, researchers found the average verbal score for children of women who took folic acid was 108 compared to 96 for children of women who did not take folic acid. The average behavioral score for children of women who took folic acid was 102 compared to 82 for children of women who did not take folic acid.

When looking only at children whose mothers took folic acid during pregnancy, researchers found scores were similar across low to high doses of folic acid. Children of mothers who took a low dose had a similar average verbal score of 110 compared to 108 for children of mothers who took a high dose. Children of those who took a low dose and children of those who took a high dose both had average behavioral scores of 103.

“While previous studies have found risks with higher doses, these findings are reassuring for people who are pregnant or planning to have children that taking a higher dose of folic acid early in pregnancy may still positively impact the brain health of their child,” Meador said. “Additional studies are needed to determine the best dose of folic acid to maximize benefits and minimize risks to neurodevelopment as well as other outcomes, which could vary for different groups of women.”

A limitation of the study was that it did not look at other factors that may affect folic acid intake and absorption, such as other vitamins taken and genetics.

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PM Modi’s Post-Budget Webinar: Expert Panel Discuss Expansion of Medical Education in India, here are key takeaways

New Delhi: From faculty shortage, and reforms in MBBS Curriculum to ways of improving doctor population ratio in India- several key aspects of medical education sector were discussed by a Health Ministry panel at the recently held Post Budget Webinar.

The webinar, which was held today from 9:00 AM to 6:30 PM included a session held by the Health Ministry on “Expansion of Medical Education”.

Chaired by the Director of AIIMS Delhi, Dr. M Srinivas, the session included discussions by Dr B N Gangadhar, Chairman of the National Medical Commission (NMC), Dr Abhijath Seth, the President of the National Board of Examinations, Dr. Rajib Bahl, DG ICMR and Secretary DHR, Dr G D Puri from AIIMS Jodhpur, Prof Suneela Garg, Sanjeev Singh among others.

Here are the key takeaways from the discussions held by the Health Ministry Panel:

(1) Faculty Shortage:

Addressing the issue of faculty shortage across medical colleges, the President of the National Board of Examinations in Medical Sciences (NBEMS), Dr. Abhijath Seth talked about the possibility of creating a national pool of faculty. Terming it as a “novel concept”, he added that this could be one of the “innovative tools to address the shortage of faculties”.

Pointing out that this faculty database gets used at the University level, Dr. Seth further mentioned that various institutes across the world address their own shortage of faculties by hiring aging or honorary faculties on a contractual basis

However, Dr. Seth added that while this may be a good midterm to long term solution, it may not be very effective as a short-term results. He mentioned that while for PG education, focus is required on basic medical sciences, humanization of medical practices, preclinical exposure and clinical research skill development, postgraduate training needs intense focus on structured clinical training and competency-based skill training.

Mentioning that the biggest challenge would be to bring uniformity in the medical training across the country, particularly for medical educators, he further added that it is required to integrate public and private sector. Opining that the passion for teaching should be used, Dr. Seth suggested increasing the age limit for the teachers, incentivizing and giving recognition to the teachers for their noble contributions to teaching and training.

He also added that the national pool of faculty should also include healthcare professionals who would like to contribute pro bono. Dr. Seth also said to identify the legendary role models and mentors across the country. Further, he advocated for the continuous promotion of innovation and research.

“If we start from working on it today, we should be able to build this concept in due time with collective efforts for the national interests. The national database of teachers, the biggest advantage is it will not only provide physical training, but now we will have another facet of training which is skill and virtual training as well as digital education. We can utilize the national database far more effectively for these other two facets of training which … virtual training as well as the digital education,” he added while speaking about the effective solutions to address real-time faculty shortage.

(2) MBBS Curriculum: 

During the meeting, Dr. Rajiv Bahl, DG ICMR & Secretary DHR spoke about the areas where the medical curriculum is lacking and he also suggested possible reforms.

Pointing out where the medical curriculum is lacking, Dr Bahl said that instead of creating competent physicians, the focus in the curriculum is on the transmission of knowledge. Another issue that Dr. Bahl pointed out is that the focus of a medical graduate continues to be on individual therapeutic care or inpatient care, instead of preventive and promotive care. He mentioned that while this is only part of one subject, it needs to come in the medical practice of all physicians. Similarly, he pointed out that outpatient care and primary healthcare are given less importance, including the importance given to Public Health epidemiology. As per Dr. Bahl, the curriculum needs more focus on morality, ethics, empathy, social awareness, communication, and other soft skills that a doctor needs.

Speaking about the issue of research, Dr Bahl opined that there is very little focus in this area, adding that the focus should be on finding ways to make the physicians understand innovations, change in evidence, understanding it, and using the evidence throughout their careers. 

While suggesting reforms in the MBBS curriculum, Dr. Bahl suggested raising digital technology for the transmission of knowledge to medical students. “To any graduate, any person, any student, it seems such a waste to spend the time the faculty has with the students on simply transmitting knowledge through lectures. Therefore, one suggestion that I have is using precious faculty-student interaction in classrooms, labs,and  clinics for problem-solving and checking understanding of fundamental concepts of students,” he added.

Apart from this, he also suggested utilizing telelearning in a better manner to improve quality of medical education. Pointing out how an exceptional faculty at AIIMS, New Delhi is teaching only fifty-sixty students, he added that telelearning could be used for them to teach fifty thousand or even hundred thousand students.

Another reform that Dr. Bahl suggested in the medical curriculum is providing clinical exposure to the medical students from the first week itself to make preclinical basic sciences relevant to patient care. Otherwise, Dr. Bahl opined that the students get cutoff from understanding why subjects like anatomy, physiology, biochemistry, etc are useful and he also suggested focusing on basic research skills in the students.

(3) E-Learning Platforms to Standardize Medical Education: 

Dr. G D Puri from AIIMS Jodhpur spoke about developing and deploying e-learning platforms to standardize medical education across the country. He added that it requires a strategic approach and addresses technological and infrastructural challenges while leveraging existing initiatives. Mentioning that the key objectives are to ensure accessibility, quality, consistency and alignment with national educational standards, he added, that already the need for standardized curriculum across the country has been stressed.

He added that a standardized curriculum requires to be developed with the collaboration between the National Medical Commission (NMC), National Board of Examinations (NBE), and NHA, as well as prominent medical institutes like AIIMS Delhi, PGI, other AIIMS and other Medical Universities across the country. 

“They need to collaborate to create content that meets national standards,” he added further mentioning that by leveraging the existing government initiatives such as a national digital library, national medical college network etc. a centralized repository of e-content of medical education could be created and further it could be integrated with the National Digital Health Mission to access the health data which can be a supportive tool for evidence-based learning instead of knowledge-based learning.

Dr Puri talked about developing comprehensive interactive modules based on CBME goals set by NMC. He added that not only video and audio lectures, which have highlighted the knowledge, should be used to transmit the knowledge. He suggested that virtual simulations like Virtual reality, and augmented reality should be used to announce the understanding of the complex surgical and medical procedures and incorporate real-world case studies and clinical scenario-based learning rather than just knowledge. According to him, the students will get hands-on experience from these even if they lack physical clinical exposure.

(4) Ways to achieve the ideal doctor-population ratio:

While speaking about the ways to achieve the ideal doctor-population ratio, the Chairman of NMC, Dr. B N Gangadhar said that increasing human resources is necessary to cope with the new types of disease patterns. He also said that the focus should be on outpatient care and continuity of management.

Dr. Gangadhar said that there are around three million doctor shortages across the world. He added that the limit should not be drawn at one doctor per thousand population as he highlighted that in developed countries, there are almost three doctors per thousand. He also emphasised on complete utilization of clinical resources.

(5) Integrating DNB Teachers as Faculties in Medical Colleges: 

Indicating a measure to increase the faculty pool in medical colleges, Dr Gangadhar added that in the hospitals that were running DNB education, those teachers can also have been made eligible to become teachers in medical colleges.

“So several such reforms have been made to expand these numbers of teachers that could be available and also we have said that those who have done diploma and have been working as senior residents in medical colleges for a long time could also be converted and elevated into or redesignated into medical teachers,” Dr. Gangadhar said, further adding that NMC has been trying to produce more doctors and more specialists.

(6) Faculty Development Programme: 

Dr. MV Srivastava talked about the faculty development programme, which has been in place for a couple of decades. She said that a lot of the INIs have tried to implement this programme, however, it has not been made mandatory and she also pointed out that the faculty development programme is not properly structured.

She recommended making the faculty development programme compulsory for all medical faculties at all career stages. She opined that it is not just at the beginning when one enters the medical education sector as an assistant professor and is on a probation period. As per Dr. Srivastava, this program should be factored into all career stages, including the senior-most level. She also highlighted the need for training in Pedagogical assessment methods.

(7) Digital Accreditation Programme: 

Another panel member Sanjeev Singh talked about a digital accreditation programme to standardise the process. He mentioned how the NMC conducts a lot of physical inspections and added that the movement of online system of assessments is a welcome change.

In this regard, he opined that a digital accreditation portal would be very good, where a desktop review of all the documents which have been sent would be assessed. He also suggested conducting AI driven audits to track these compliances with minimal human interference.

(8) District Residency Programme:

Mentioning that the District Residency Programme (DRP) should be utilised properly, the Principal Secretary of Health and Family Welfare, UP PSMH pointed out that the DRP has two components. While one of the components was three months compulsory PG training in the public health facilities, the other one was that the same PG colleges could apply twenty five percent core seats with the same infrastructure.

He opined that all the PG colleges both in government and private should try to take this advantage and increase PG seats by twenty-five percent.

The second issue that he pointed out is that DNB seats are not used properly. He mentioned that many of the hospitals have the opportunity to take more DNB seats and opined that the DNB seats should be increased by a hundred percent.

(9) Seat increase cap in existing medical colleges:

Referring to NMC’s cap of one hundred fifty MBBS seats, the Principal Secretary of Health and Family Welfare added that when the issue of increasing seventy-five thousand seats in the next five years is being regarded, it needs to be considered that the old medical Colleges already have hundred fifty to two hundred seats.

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Breast-conserving surgery improves sexual well-being compared to breast reconstruction: Study

For women with breast cancer, breast-conserving therapy (BCT) is associated with improved sexual well-being, compared to mastectomy followed by breast reconstruction, reports a study in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

“In our study, patients undergoing BCT scored consistently higher on a measure of sexual well-being, compared to total mastectomy and breast reconstruction,” comments Jonas A. Nelson, MD, MPH, of Memorial Sloan Kettering Cancer Center, New York. “The findings highlight the need for increased attention to sexuality when discussing breast cancer treatment options.”

Sexual well-being after breast cancer surgery

Many women with breast cancer have sexual health concerns. In previous studies, up to 85% of breast cancer patients report sexual dysfunction but few receive any medical guidance for sexual dysfunction.

For many patients, BCT – sometimes called “lumpectomy” – offers an effective alternative to mastectomy. For those who undergo mastectomy, breast reconstruction has established benefits in terms of quality of life and self-esteem.

Few studies of breast cancer treatment have focused on sexual well-being, especially in comparing the outcomes of BCT versus postmastectomy breast reconstruction (PMBR). Using validated BREAST-Q questionnaire, Dr. Nelson and colleagues analyzed sexual well-being scores for 15,857 patients who underwent breast cancer surgery between 2010 and 2022.

About 54% of patients underwent BCT and 46% had PBMR. Scores on a sexual well-being subscale – addressing sexual attractiveness, sexual confidence, and comfort level during sex – were compared between groups, including long-term follow-up when available.

Better recovery after BCT; few patients receive sexual medicine consultation

Before surgery, the two groups had similar average scores for sexual well-being: 62 in the BCT group and 59 in the PBMR group (on a 0-to-100 scale). By six months, sexual well-being score in the BCT group had improved to 66, and remained around that level at up to five years.

At all times, women undergoing PBMR had lower sexual well-being scores, compared to BCT. Average score at six months was 49, improving to 53 with longer follow-up. Sexual well-being score was even lower – average 41 – for patients who had not yet completed breast reconstruction by the end of the study period.

Overall, scores averaged 7.6 points higher in the BCT group. Sexual well-being was significantly correlated with scores in other BREAST-Q domains, including physical well-being of the chest, satisfaction with breasts, and psychosocial well-being.

Despite the impact on sexual well-being, only 3.5% of the BCT group and 5.4% of the PBMR group received sexual medicine consultation, which was available from a dedicated service at the authors’ cancer center. After adjustment for other factors, PBMR patients were about half as likely to receive sexual medicine consultation.

The study adds to previous evidence that women undergoing BCT for breast cancer recover sexual well-being more quickly, compared to PMBR. “For breast cancer patients who are eligible for either BCT or mastectomy, BCT may be the superior choice for patients who wish to maintain their sexual well-being,” the researchers write.

The authors also emphasize the need to consider and discuss the impact of breast cancer surgery on sexual well-being. Dr. Nelson concludes: “Although many patients have low sexual health, most do not receive sexual medicine consultation, suggesting an opportunity for providers to improve breast cancer patients’ sexual health.”

Reference:

 Stern, Carrie S. MD1; Kim, Minji BS1; Smith Montes, Elizabeth MS1; Boe, Lillian A. PhD2; Zhang, Kevin BA1; Vingan, Perri BS1; Carter, Jeanne PhD3; Mehrara, Babak J. MD1; Tadros, Audree B. MD, MPH4; Allen, Robert J. Jr. MD1; Nelson, Jonas A. MD, MPH1. Breast-Conserving Therapy Preserves Sexual Well-Being More than Postmastectomy Breast Reconstruction: Trends, Factors, and Interventions. Plastic and Reconstructive Surgery 155(3):p 407-420, March 2025. | DOI: 10.1097/PRS.0000000000011657

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CO₂ Laser Excision: A Promising Minimally Invasive Treatment for Large Xanthelasma Palpebrarum, Study Finds

China: A recent study published in the British Journal of Ophthalmology highlights the effectiveness of carbon dioxide (CO₂) laser excision as an advanced treatment option for large xanthelasma palpebrarum, offering a precise and minimally invasive approach. The study revealed that CO₂ laser excision is highly effective in treating xanthelasma palpebrarum, achieving clearance rates exceeding 99% for mild to moderate lesions and 95% for severe cases.

“Recurrence occurred in 6.8% of patients, with higher rates observed in lesions larger than 2 mm. Minor complications included scarring (4.4%), hyperpigmentation (8.1%), and hypopigmentation (8.5%), reinforcing its potential as a reliable treatment option,” the researchers reported.

Xanthelasma palpebrarum is a common lipid disorder characterized by yellowish plaques on the eyelids. While generally benign, these lesions can be cosmetically distressing and may indicate underlying lipid abnormalities. Traditional treatment methods include surgical excision, chemical peeling, cryotherapy, and electrosurgery, each with its own limitations, such as scarring, pigmentation changes, and recurrence.

Against the above background, Dingqiao Wang, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China, and colleagues aimed to assess the long-term effectiveness and safety of CO₂ laser excision as an innovative approach for treating large xanthelasma palpebrarum.

For this purpose, the researchers included 295 patients diagnosed with xanthelasma palpebrarum, categorizing them into 246 with grade I, 16 with grade II, 22 with grade III, and 11 with grade IV lesions. All patients underwent CO₂ laser excision and were monitored for 12 months. Treatment efficacy was determined based on clearance and recurrence rates, assessed through digital photography, while complications were documented.

Key Findings:

  • The study included 66 male and 229 female participants, with an average age of 41.7±11.6 years.
  • Clearance rates were over 99% for grades I-III and approximately 95% for grade IV lesions.
  • The overall recurrence rate was 6.8%, with significantly higher recurrence in lesions over 2 mm in height than those under 2 mm.
  • Complications during the 12-month follow-up included scarring (4.4%), hyperpigmentation (8.1%), and hypopigmentation (8.5%), with no severe adverse events reported.

The researchers highlight CO₂ laser excision as a precise, minimally invasive, and effective treatment for large xanthelasma palpebrarum lesions, marking a significant advancement in therapeutic approaches. Their findings demonstrate high efficacy, particularly for extensive lesions, with clearance rates exceeding 95%, a low recurrence rate of 6.8%, and minimal complications such as scarring, hyperpigmentation, and hypopigmentation.

“By employing laser technology for precise excision, this method presents notable advantages over conventional treatments. However, we acknowledge limitations, including the study’s single-centre, retrospective design and follow-up duration, necessitating future multicentre trials to validate these findings and refine treatment protocols,” the researchers concluded.

Reference:

Wang D, Mao Z, Li Z, Gao W, Qu Y, Li X, Jiang Y, Lin X. Carbon dioxide laser excision as a novel treatment for large xanthelasma palpebrarum: long-term efficacy and safety. Br J Ophthalmol. 2025 Feb 24;109(3):427-432. doi: 10.1136/bjo-2024-325581. PMID: 39237290.

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Onychomycosis prevalence significantly higher in psoriasis patients: Study

A new study showed that psoriasis patients were 1.68 times more likely to acquire onychomycosis than people without psoriasis. The major findings of this study were published in the journal of Mycoses.

It has been observed that the prevalence of onychomycosis which is a common nail condition marked by thicker, discolored, and brittle nails, varies among psoriasis patients in comparison to the general population. About 2% to 3% of people worldwide suffer with psoriasis that affects up to 79% of individuals with nail involvement.

Accurate diagnosis is made more difficult by the frequent overlap in the clinical characteristics of nail psoriasis and onychomycosis. To provide evidence-based insights for clinical management, Mengying Liu and team conducted a systematic review and meta-analysis to determine if the prevalence of onychomycosis varies between those with psoriasis and those without.

Using the Population, Comparator, Intervention, and Outcome (PICO) framework, the research question and keywords were created. Using the keywords “onychomycosis,” “psoriasis,” and so forth, entries in either English or Chinese were retrieved as of October 26, 2024, from Embase, PubMed, the Cochrane Library, CBM, CNKI, and Web of Science. Additionally, STATA was used for the meta-analysis.

A total of 967 documents were found, and the final analysis included 13 studies with 10,967 non-psoriasis people and 2751 psoriasis patients. According to the meta-analysis, the prevalence of onychomycosis was 1.68 times higher in psoriasis patients than in non-psoriasis patients (95% CI: 1.21-2.33).

The probability of onychomycosis among clinically unrecognized patients was 1.78 times greater (95% CI: 1.33-2.38) for those with psoriasis than for those without the condition, according to subgroup analysis. Most of the included studies have moderate to low levels of bias.

According to the findings of this review and meta-analysis, it is critical to rule out nail lesions associated with onychomycosis before making a psoriasis diagnosis. This is especially important before starting immunosuppressive medications like methotrexate, steroids, or biologics, as they may make fungal infections worse. These results highlight how crucial it is to have a proper diagnosis, particularly before immunosuppressive treatment, in order to stop fungal infections from getting worse. Overall, psoriasis patients are far more likely to have onychomycosis than non-psoriasis people.

Source:

Liu, M., Kang, Y., & Zhang, R. (2025). The prevalence of onchomycosis in psoriasis patients: A systematic review and meta‐analysis. Mycoses, 68(2). https://doi.org/10.1111/myc.70035

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Diagnostic and predictive role of maternal circulating PlGF levels promising in reduced fetal movements, reveals study

Women presenting with reduced fetal movements (RFM) have an
increased risk of adverse pregnancy outcomes and stillbirth. A study assessing
the outcome of low-risk pregnancies complicated by isolated RFM at term, found
that RFM were independently associated with mild adverse neonatal outcome and
higher rates of cesarean de livery due to fetal distress and intrauterine fetal
death at admission, compared to the group without RFM occurring prior to
gestational week 37. The mechanisms for the association between maternal
perception of RFM and stillbirth are not fully understood, but it is hypothesized
that placental dysfunction could be a common pathology. In support of this
hypothesis, a register-based retrospective cohort study of perinatal deaths
found an association between RFM and placental insufficiency, defined as
significant placental lesion(s) on pathological examination in cases with
stillbirth.

Placenta-associated biomarkers, such as placental growth
factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) are present in
the maternal circulation during pregnancy. Imbalances in these biomarkers, with
low “proangiogenic” PlGF concentrations and high“antiangiogenetic” sFlt-1
concentrations in maternal circulation, are associated with placenta-related
pregnancy complications such as pre eclampsia and fetal growth restriction.
Placentas from pregnancies with RFM presenting at gestational age (GA) > 36
weeks resulting in adverse delivery outcome have shown increased villous
release of sFlt-1 compared to pregnancies without adverse delivery outcome.

Prospective cohort study conducted in a single tertiary
maternity unit from September 2016 to March 2020. PlGF and sFlt-1 were measured
in maternal serum (n = 122) from prospectively included women presenting with
RFM (gestational age ≥ 37+0). All neonatal and delivery outcomes were
externally reviewed, blinded for biomarker results, and judged whether the
adverse outcomes were most likely associated with placental dysfunction
(“likely placental cause”) or not. Predefined gestational age specific
reference levels for PlGF, sFlt-1 and sFlt-1/PlGF ratio were used and multiple
of the median (MoM) were calculated.

The pregnancies were assigned into three groups: the
“complicated” (likely placental cause, n = 4), the “intermediate”
(non-placental/undetermined cause, n = 9) and the “uncomplicated” (no adverse
outcome, n = 109). Mean PlGF concentration differed significantly between the
three groups (80, 144, and 213 pg/ml, p = 0.004). There was a higher proportion
of PlGF levels < 10th centiles in the “complicated” compared to the
“intermediate” and “uncomplicated” groups (50 % vs. 22 % and 11 %, p = 0.045).
The median MoM of PlGF differed significantly between the three groups (0.43,
0.83 and 1.12, p = 0.006).

In conclusion, predelivery maternal placenta-associated
biomarkers from a real-world population of pregnant women at and beyond term
presenting with RFM show a lower proangiogenic profile (lower PlGF) in
pregnancies with an adverse outcome of likely placental cause. Placenta
associated biomarkers can potentially help to more precisely target RFM
pregnancies at risk of adverse delivery outcome of a likely placental cause.
Authors consider this study to be an important contribution to the concept that
RFM is a marker of placental insufficiency.

Source: S. Bowe et al; European Journal of Obstetrics &
Gynecology and Reproductive Biology 307 (2025) 34–42

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