Routine Thoracentesis in Acute Heart Failure: No Significant Clinical Benefit, Study Reports

Denmark: A recent randomized controlled trial evaluated the impact of routine thoracentesis in patients with acute heart failure and pleural effusion. Thoracentesis, a procedure to drain excess fluid from the pleural space, has been considered a potential adjunct to standard medical therapy in these patients. However, the study findings suggest that upfront thoracentesis does not significantly improve clinical outcomes compared to standard medical treatment alone. 

“For patients with acute heart failure and pleural effusion, routine upfront thoracentesis offered no advantage over standard medical therapy alone in improving clinical outcomes at 90 days,” the researchers reported in Circulation.

Pleural effusion is common in acute heart failure, with large effusions seen in about 20% of cases. Thoracentesis can provide immediate symptom relief but carries risks, and no randomized trials have assessed its benefits in heart-failure-related pleural effusion. With the increasing use of thoracentesis, there is a need for evidence. In the TAP-IT trial, Signe Glargaard, Department of Cardiology, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Denmark, and colleagues examined the impact of adding therapeutic thoracentesis to standard medical therapy in patients with acute heart failure and significant pleural effusion.

For this purpose, the researchers conducted a multicenter, unblinded, randomized controlled trial between August 31, 2021, and March 22, 2024, involving patients with acute heart failure, left ventricular ejection fraction ≤45%, and notable pleural effusion. Those with very large effusions (over two-thirds of the hemithorax) were excluded. Participants were randomly assigned to either upfront ultrasound-guided pleural pigtail catheter thoracentesis with standard medical therapy or standard therapy alone.

The primary outcome was days alive out of the hospital over 90 days, while key secondary outcomes included length of hospital stay and 90-day all-cause mortality, analyzed using the intention-to-treat approach.

The study revealed the following findings:

  • The trial included 135 patients with a median age of 81 years, 33% of whom were female.
  • The median left ventricular ejection fraction was 25%.
  • Patients were randomized into two groups: 68 received thoracentesis, while 67 received standard medical therapy.
  • The thoracentesis group had a median of 84 days alive out of the hospital over 90 days, compared to 82 days in the control group.
  • Mortality rates were identical at 13% in both groups, with no significant difference in survival probability.
  • The median hospital stay was similar: 5 days in both groups.
  • Major complications occurred in only 1% of thoracentesis procedures.

This trial, the first randomized study on thoracentesis for pleural effusion in heart failure, found that adding routine thoracentesis to standard medical therapy did not improve survival or reduce hospital stays over 90 days. The procedure was safe, with a low complication rate of 1%.

“While variability in outcomes may have affected statistical power, these findings provide a foundation for future research to further explore the role of thoracentesis in managing acute heart failure with pleural effusion,” the authors concluded.

Reference: https://doi.org/10.1161/CIRCULATIONAHA.124.073521

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De-escalation Strategy: Ticagrelor to Clopidogrel in AMI Patients improves outcomes in patients with low BMI: JAMA

Researchers have found in a new research that switching from ticagrelor to clopidogrel in acute myocardial infarction (AMI) patients showed improved clinical outcomes in individuals with a lower body mass index (BMI). However, this benefit was not observed in patients with a higher BMI.

The potential benefits of P2Y12 inhibitor deescalation for acute myocardial infarction after percutaneous coronary intervention may be influenced by body mass index (BMI). A study was done to investigate the association of BMI on deescalation outcomes after 12 months in patients with acute myocardial infarction after percutaneous coronary intervention who were initially treated with aspirin plus ticagrelor for 1 month, and to assess whether BMI-based switching from aspirin plus ticagrelor (active control strategy) to aspirin plus clopidogrel (deescalation strategy) is associated with individualized benefits.

This study is a post hoc analysis, based on BMI, of data from the TALOS-AMI (Ticagrelor vs Clopidogrel in Stabilized Patients with Acute Myocardial Infarction) randomized clinical trial. Data were collected from February 14, 2014, to December 31, 2018, with follow-up to January 21, 2021. Analyses were conducted from December 1, 2021, to August 21, 2024. Among 2697 trial participants from 32 centers in South Korea, 2686 participants whose BMI data were available were included. All patients received aspirin plus ticagrelor for 1 month after percutaneous coronary intervention. Stabilized patients were then randomized to either the active control or deescalation strategy for an additional 11 months.

The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, and Bleeding Academic Research Consortium bleeding type 2, 3, or 5 at 12 months after percutaneous coronary intervention. The trial compared the active control and deescalation strategies according to BMIs, including an interaction test. Results Of the 2686 patients included (mean [SD] age, 60.0 [11.4] years; 2234 [83.2%] male), 2344 (1161 in the deescalation group and 1183 in the active control group) had a BMI less than 28, and 342 (184 in the deescalation group and 158 in the active control group) had a BMI of 28 or greater. The deescalation strategy was associated with significantly reduced composite outcomes compared with the active control strategy in the group with a BMI less than 28 (53 [4.6%] vs 98 [8.3%]; adjusted hazard ratio, 0.54; 95% CI, 0.39-0.76; P < .001), primarily due to fewer bleeding complications.

The group had no association with a BMI of 28 or greater. In this post hoc analysis of the TALOS-AMI randomized clinical trial, in stabilized patients with acute myocardial infarction, an unguided deescalation strategy of switching from ticagrelor to clopidogrel after 1 month was associated with better clinical outcomes in those with lower BMIs.

Reference:

Bu S, Kim CJ, Lim S, et al. BMI and Deescalation From Ticagrelor to Clopidogrel in Patients With Acute Myocardial Infarction: A Post Hoc Analysis of the TALOS-AMI Trial. JAMA Netw Open. 2025;8(2):e2461916. doi:10.1001/jamanetworkopen.2024.61916

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Weight-Adjusted Waist Index Identified as Strong Predictor of AMD Risk, reveals research

Researchers have established in a new study that the weight-adjusted waist index is a much better predictor of age-related macular degeneration (AMD) risk than conventional measures of obesity like body mass index (BMI) and waist circumference (WC). In a study from Fujian, China, researchers found that there was a non-linear positive association between the index and prevalence of AMD. Results indicate that those with a greater weight-adjusted waist index have significantly higher odds of developing AMD, highlighting the need for early intervention and screening. The study was conducted by Wu Y. and colleagues published in the Frontiers in Medicine journal.

The research utilized NHANES data from 2005 to 2008, with 20,497 participants. After excluding participants under 40 years old, those with missing information on WC, weight, or other variables of interest, the analysis was finally performed on 5,132 participants. The cohort was close to evenly split by gender, with 50.16% female and 49.84% male. Retinal photography was done in all participants, and AMD was diagnosed according to standard fundus examination criteria.

Weight-Adjusted Waist Index Calculation and Tertile Categorization

Weight-adjusted waist index was calculated by dividing WC by the square root of weight in kilograms. Participants were categorized into three tertiles:

• Tertile 1: 8.59 – 10.85

• Tertile 2: 10.85 – 11.52

• Tertile 3: 11.52 – 15.70

• Participants in the top tertile had 1.9 times increased risk for AMD versus those in the lowest tertile (Odds Ratio [OR] = 2.90, 95% Confidence Interval [CI]: 2.18-3.86; p <.0001).

• Increased weight-adjusted waist index was also associated with raised BMI, WC, weight, diabetes, and hypertension.

• The analysis found a critical threshold effect at an index value of 12.11. Below this threshold, the risk of AMD increased significantly (OR = 1.50, 95% CI: 1.04-2.16; p =.0300).

• Beyond this threshold, however, the risk did not increase (OR = 0.75, 95% CI: 0.39-1.45; p =.3943).

• Furthermore, with every unit rise in the index, the risk of developing AMD rose by 76%.

To determine the predictive value of the weight-adjusted waist index, the researchers conducted receiver operating characteristic (ROC) curve analysis and compared its performance with BMI, WC, and weight. The area under the curve (AUC) values were as follows:

• Weight-adjusted waist index: 0.625

• Weight: 0.560

• BMI: 0.530

• Waist circumference: 0.508

The study authors concluded that the weight-adjusted waist index is a better predictor of AMD risk than BMI, weight, and waist circumference. Those with higher index values are more likely to develop AMD, with a notable threshold effect at 12.11. These results underscore the importance of employing more accurate obesity measures for AMD risk prediction and support the call for early detection and intervention strategies in high-risk groups.

Reference:

Wu Y, Liu Y, Jiao Z, et al. Association between the weight-adjusted waist index and age-related macular degeneration in US adults aged≥40 years: The NHANES 2005–2008. Frontiers in Medicine. 2025;12. doi:10.3389/fmed.2025.1552978

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Long-term practice of Transcendental Meditation may reduce both stress and aging: Study

A collaborative study conducted by researchers at Maharishi International University (MIU), the University of Siegen, and the Uniformed Services University of the Health Sciences reveals that individuals practicing Transcendental Meditation® (TM®) technologies long-term show favorable biological markers of aging and stress. The research compared gene expression, cognitive function (via EEG), and hair glucocorticoids (cortisol and cortisone) in 12-year and 40-year TM groups and non-meditator controls.

“This study provides evidence that long-term practice of TM technologies has a broad range of health benefits at the molecular level,” said Supaya Wenuganen of MIU, one of the lead authors. “The gene expression differences, cognitive function indicators, and lower cortisol levels after long-term TM practice relate to each other in ways suggesting reduction of both stress and aging.”

The article, Possible Anti-Aging and Anti-Stress Effects of Long-Term Transcendental Meditation Practice: Differences in Gene Expression, EEG Correlates of Cognitive Function, and Hair Steroids, appears in a special issue of Biomolecules entitled: “Molecular Advances in Mechanism and Regulation of Lifespan and Aging.”

Altered Gene Expression Indicates Reduced Inflammation, Lower Stress, and Slower Biological Aging

In the study, researchers found that expression of genes associated with inflammation and aging, such as the SOCS3 gene, was lower in TM practitioners (Figure 1). SOCS3 is linked to both chronic stress and energy metabolism, and the results in meditators may indicate lower “allostatic load”-the body’s cumulative burden from chronic stress.

Co-author Kenneth Walton, a senior researcher at MIU, explained “The lower expression of age-related genes and lower hair cortisol in the TM groups extend the findings of short-term studies indicating these practices lead to healthy aging and more resilient adaptation to stress.”

EEG Analysis Shows Slower Age-Related Decline in Cognitive Function

Cognitive function, known to decline with age, was another key area of the study. Using EEG recordings, researchers measured latency of N2 and P3 evoked potential responses—a marker of cognitive processing speed-and observed that older TM practitioners had processing speeds close to those of younger participants (Figure 2). Additionally, TM practitioners scored higher on the Brain Integration Scale (BIS), a comprehensive measure of cognitive performance that includes reaction time, brainwave coherence, and attention.

“The findings around cognitive function are particularly exciting,” added co-author Frederick Travis. “Both younger and older TM practitioners showed higher scores on the BIS compared to non-meditators. The older meditators performed on par with young controls. This reinforces the findings on evoked potential responses, further suggesting a protective effect against cognitive decline with age.”

Lower Ratio of Cortisol to Cortisone in Hair May Indicate Increased Resilience

Hair cortisol concentration (Hair F) and concentration of its inactive precursor, cortisone (Hair E), were measured in all participants. The results showed that the ratio of active to inactive forms was consistently lower in TM practitioners compared to non-meditators, providing further evidence of reduced stress levels (Figure 3). This result aligns with previous findings indicating that regular practice of TM helps maintain a state of lower stress.

“Cortisol plays a critical role in the body’s response to stress, and chronically high cortisol levels are associated with a host of age-related health issues in addition to cognitive decline” Walton explained. “The reduced cortisol-to-cortisone ratio in meditators suggests they have more adaptive reserve, more resilience, contributing to overall health and longevity.”

Building on Previous Research in the Field of Meditation and Aging

The study builds upon prior research from MIU and elsewhere indicating health benefits of Transcendental Meditation technologies, including reduced cardiovascular risk, and improved mental health. By examining a range of biological, cognitive, and stress-related markers, this study offers a look at how meditation might holistically influence health long-term.

Future Directions

This research adds to a growing body of evidence supporting meditation as a tool for health and wellness. Future studies will focus on the biological pathways involved in the observed changes, such as the role of energy metabolism and inflammation pathways in mediating the anti-aging effects.

Reference:

Wenuganen, S.; Walton, K.G.; Travis, F.T.; Stalder, T.; Wallace, R.K.; Srivastava, M.; Fagan, J. Possible Anti-Aging and Anti-Stress Effects of Long-Term Transcendental Meditation Practice: Differences in Gene Expression, EEG Correlates of Cognitive Function, and Hair Steroids. Biomolecules 2025, 15, 317. https://doi.org/10.3390/biom15030317

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JAMA: Oral mizoribine with glucocorticoids safe and effective for treatment initiation in lupus nephritis

A new study published in the Journal of American Medical Association showed that when taken with glucocorticoids for induction treatment of active lupus nephritis, oral mizoribine was well tolerated and noninferior to intravenous cyclophosphamide.

Intravenous cyclophosphamide is commonly used to treat lupus nephritis, however it has significant side effects. An option to induction treatment for lupus nephritis might be oral mizoribine. There are not many extensive, long-term clinical trials with mizoribine, though. Thus, to evaluate the safety and effectiveness of oral mizoribine against IV cyclophosphamide as induction treatment for Chinese patients with lupus nephritis, Zheyi Dong and colleagues carried out this investigation.

The patients with class III, III+V, IV, IV+V, or V lupus nephritis between the ages of 18 and 70 were recruited from 40 Chinese facilities for this clinical study. A 24-hour urine protein level of 1.0 g or more and a systemic lupus erythematosus disease activity index of 8 or higher were prerequisites for inclusion. The trial concluded on March 14, 2019, with the first patient being enrolled on November 29, 2014. 52 weeks was the follow-up period.

Analysis of the data took place between September 4, 2019, and January 21, 2020. For 52 weeks, oral glucocorticoids were administered together with oral mizoribine (50 mg, three times a day) or cyclophosphamide (6 intravenous doses at 0.5-1.0 g/m2 body surface area, with a maximum dosage of 1.0 g/d).

A total of 250 patients in all were randomized, and 243 of them received treatment (120 patients [49.4%] received cyclophosphamide, and 123 patients [50.6%] received mizoribine). The relative risk ratio (mizoribine vs. cyclophosphamide) was 0.861, and the overall remission rate at 52 weeks was 66.1% (76 of 115 patients) for the mizoribine group and 76.8% (86 of 112 patients) for the cyclophosphamide group.

Mizoribine was not inferior to cyclophosphamide, as shown by the 2-sided 95% CI’s lower limit being higher than the noninferiority margin of 0.726. Kidney function and other immunological parameter changes were mostly comparable among the groups.

Upper respiratory tract infections were the most common adverse event in both groups, with the frequency of any treatment-related treatment-emergent adverse events being 80.5% in the mizoribine group and 78.7% in the cyclophosphamide group. Overall, this study found that induction treatment with oral mizoribine in conjunction with glucocorticoids seems to be both safe and effective for Chinese patients with lupus nephritis.

Reference:

Dong, Z., Luo, P., Sun, S., Ni, Z., He, Y., Huang, X., Liu, Z., Wu, Z., Zhang, X., Liao, Y., Zhao, J., Lin, H., Zhang, X., Fu, R., Ding, G., Xu, Y., Wang, L., Xiao, Y., Shi, S., … Chen, X. (2025). Mizoribine or cyclophosphamide for lupus nephritis: A randomized clinical trial. JAMA Network Open, 8(3), e250648. https://doi.org/10.1001/jamanetworkopen.2025.0648

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Excessive Water Intake Identified as Rare Trigger for Asthma Exacerbation: Case Report

China: A recent case report has highlighted an unusual trigger for asthma exacerbation—excessive water consumption. While asthma is commonly worsened by allergens, air pollution, smoking, and viral infections, fluid overload as a contributing factor remains largely unreported. This rare case emphasizes the need for clinicians to consider fluid balance in asthma management.

The case, published in Clinical Medicine Insights: Case Reports, involved a 72-year-old man in China who had been managing bronchial asthma for two years with inhaled and oral medications. Upon hospitalization for worsening chest tightness, wheezing, and shortness of breath, he was treated with standard asthma therapies, including nebulized bronchodilators, corticosteroids, and oxygen therapy. Initially, his symptoms showed mild improvement, but his condition unexpectedly worsened despite ongoing treatment.

“Upon further investigation, we discovered that the patient had been consuming large amounts of water—approximately 3.5 liters daily, in addition to intravenous fluids—due to persistent dry mouth from oxygen therapy. However, his fluid output was significantly lower, resulting in a serious positive fluid balance. The excessive fluid retention was suspected to contribute to pulmonary congestion, further aggravating his asthma symptoms,” Huachen Jiao, Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China, and colleagues described in their case report.

As his condition deteriorated, his medical team introduced diuretics, including intravenous furosemide and bumetanide, to reduce fluid overload. Simultaneously, his fluid intake was strictly regulated, and careful monitoring of his daily intake and output was initiated. Over the following days, his asthma attacks became less frequent and severe, and his breathing difficulties gradually improved. The patient’s condition stabilized, and he was eventually discharged with well-controlled symptoms.

This case suggests that excessive fluid intake may exacerbate asthma symptoms by increasing blood volume and promoting pulmonary edema, leading to breathing difficulties. The findings emphasize the importance of fluid balance in asthma management, particularly in hospitalized patients receiving oxygen therapy. While rare, this report highlights the need for clinicians to be vigilant about excessive fluid consumption as a potential risk factor for asthma exacerbation.

“Given the limited data available on this phenomenon, further studies are necessary to establish the exact mechanisms by which excessive water intake influences asthma and to develop guidelines for fluid management in patients with respiratory conditions. Recognizing and addressing fluid overload may help improve asthma outcomes and reduce prolonged hospital stays for affected individuals,” the authors concluded.

Reference:

Lv, S., Jiao, H., Qu, Y., Zhang, M., Wang, R., Li, Y., Jiang, F., & Xin, L. (2024). A Case Report of Asthma Exacerbation Induced by Excessive Drinking Water. Clinical Medicine Insights: Case Reports. https://doi.org/10.1177/11795476241253107

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Long-Term Ibuprofen Use Linked to Increased Risk of Male Infertility, Study Finds

Taiwan: A nationwide retrospective cohort study has highlighted a potential link between ibuprofen use and male infertility, raising important public health considerations. The findings, published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, suggest that prolonged exposure to this widely used nonsteroidal anti-inflammatory drug (NSAID) may have implications for reproductive health, particularly in men of reproductive age.

“Ibuprofen use for more than 60 days was linked to a notably higher incidence of male infertility compared to acetaminophen,” the researchers wrote. 

Ibuprofen is commonly used to relieve pain, inflammation, and fever. While it is generally regarded as safe for short-term use, concerns have been raised regarding its potential impact on hormonal balance and reproductive function. Earlier research suggests that nonsteroidal anti-inflammatory drugs, including ibuprofen, may influence the male reproductive system in different ways. Considering this, Dah-Ching Ding, Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien, Taiwan, and colleagues sought to assess the effect of ibuprofen on male infertility in Taiwan.

For this purpose, the researchers conducted a nationwide retrospective cohort study utilizing the Taiwan National Health Insurance Database from January 1, 2000, to December 31, 2021. They focused on males aged 20–59 years who had used either ibuprofen or acetaminophen between 2000 and 2020. The primary outcome assessed was the incidence of male infertility. The researchers employed Cox regression analysis to estimate cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs). The Kaplan–Meier method was used to depict cumulative incidence curves. The study included 11,194 participants in both the ibuprofen and acetaminophen groups.

The study led to the following findings:

  • After propensity score matching, both groups were comparable in terms of age, medication year, and disease prevalence.
  • Using ibuprofen for more than 60 days per year was associated with a higher hazard ratio (HR: 2.01) for male infertility compared to acetaminophen use for the same duration.
  • The cumulative incidence analysis indicated a significant association between ibuprofen use for more than 60 days per year and an increased risk of male infertility compared to acetaminophen.

The researchers note that given the widespread use of ibuprofen, these findings have significant public health implications. If future prospective studies confirm this association, it could influence medical recommendations and encourage more cautious use of the drug, especially among men trying to conceive. Healthcare providers may need to discuss potential reproductive risks with patients who use ibuprofen frequently, particularly for chronic pain management.

“The link between ibuprofen use and male infertility could have important public health consequences. If future studies confirm these findings, they may influence medical guidance and shape conversations about medication use, especially for those of reproductive age,” the researchers concluded.

Reference:

Huang, W., Wang, J., & Ding, D. (2025). Ibuprofen use and male infertility: Insights from a nationwide retrospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 307, 128-133. https://doi.org/10.1016/j.ejogrb.2025.02.001

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Calcipotriol Boosts Effectiveness of Daylight Photodynamic Therapy for Actinic Keratoses: Study Finds

Italy: A recent case-control study published in Dermatology Reports has demonstrated that pre-treating actinic keratoses (AKs) with calcipotriol (CAL) ointment before daylight photodynamic therapy (DL-PDT) significantly improves treatment outcomes. Actinic keratoses commonly appearing on sun-exposed skin are precursors to squamous cell carcinomas (SCCs), making effective management crucial for skin cancer prevention.

The study involved 20 immunocompetent male patients with grade I-II AKs on the face and/or scalp. Participants were randomly divided into two groups: the case group received 0.005% calcipotriol ointment for 14 days before undergoing DL-PDT, while the control group applied a standard moisturizing cream. Both groups then underwent three sessions of DL-PDT to assess treatment efficacy.

To measure the effectiveness of this approach, Benedetta Sonego, Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy, and colleagues used the Actinic Keratosis Area Severity Index (AKASI) scoring system, evaluating actinic damage at baseline, three months, and six months post-treatment. Results revealed a notable reduction in AKASI scores among patients who received calcipotriol pre-treatment, suggesting that CAL enhances the therapeutic impact of DL-PDT.

The combination therapy was well tolerated, with minimal discomfort reported among participants. This underscores the potential of calcipotriol as a safe and effective adjunct to DL-PDT for managing AKs.

The study led to the following findings:

  • Significant AKASI Score Reduction: Patients pre-treated with calcipotriol (CAL) showed a greater reduction in AKASI scores compared to the control group, indicating enhanced treatment efficacy.
  • Improved DL-PDT Effectiveness: CAL pre-treatment boosted the therapeutic impact of daylight photodynamic therapy (DL-PDT) for actinic keratoses.
  • Well-Tolerated Treatment: The combination therapy was safe and effective, with minimal patient discomfort.

These findings highlight the clinical benefits of incorporating calcipotriol into AK treatment regimens, potentially improving lesion clearance and reducing the risk of progression to SCCs. Further research could help establish this approach as a standard practice, offering a more effective solution for individuals at risk of actinic damage and non-melanoma skin cancers.

“The findings indicate that integrating calcipotriol into the treatment regimen enhances AK clearance and may reduce the risk of progression to squamous cell carcinoma, offering a promising approach for improved skin cancer prevention,” the authors concluded.

Reference:

Sonego, B., Zelin, E., Bonin, S., Pozzebon, T., Bazzacco, G., Corio, A., Agozzino, M., Caro Caposiena, D. R., Zalaudek, I., & di Meo, N. (2024). Calcipotriol as a daylight photodynamic therapy enhancer: a case-control study. Dermatology Reports, 17(1). https://doi.org/10.4081/dr.2024.10077

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BioUnion™ Glass Ionomer promising for Dentin Remineralization and treating root surface and secondary caries: Study

Researchers have found in a new study that glass ionomer containing BioUnion™ fillers demonstrated effective dentin remineralization and enhanced dentin surface strength through sustained ion release during pH cycling. These properties suggest that this material could be a promising option for clinical use in treating root surface caries and secondary caries.

A novel glass ionomer cement (GIC) containing BioUnion™ fillers, was developed to enhance anti-demineralization and remineralization by releasing Zn²⁺, F⁻, and Ca²⁺ ions. This study evaluated its effectiveness in preventing root dentin demineralization during pH cycling. Bovine root dentin specimens were divided into three groups: Control (without GIC), Conventional GIC (GIC; Fuji IX, GC Corporation, Tokyo), and GIC with BioUnion™ fillers (GIC-Bio; Caredyne Restore, GC Corporation). A 4-week pH-cycling protocol was applied, involving daily exposure to a demineralizing solution (pH 4.5) for 4 hours and a simulated body fluid (pH 7.4) for 20 hours. Demineralization was assessed using swept-source optical coherence tomography (SS-OCT) and transverse microradiography (TMR). The characteristics of the dentin surface after the pH cycling were evaluated using the Vickers micro-hardness test and Fourier-transform infrared spectroscopy (FTIR). Data were analyzed using one-way ANOVA for FTIR and two-way ANOVA for TMR and micro-hardness. Results: TMR analysis revealed significantly lower mineral loss and lesion depth in the GIC-Bio group throughout the experimental period (p < 0.001), while SS-OCT images indicated intact surfaces near the margins for both GIC-Bio and conventional GIC, while the control group displayed a pronounced demineralized zone. Progressive increase on surface hardness and mineral content was observed in the GIC-Bio group as confirmed by micro-hardness testing and FTIR analysis, respectively. GIC containing BioUnion™ fillers achieved maximal reduction in lesion depth and promoted remineralization of root dentin among the tested groups. GIC containing BioUnion™ fillers represent a potentially viable material for the caries management due to its ability to enhance dentin remineralization and surface mechanical properties through sustained ion release during pH cycling.

Reference:

Kyaw Htet, Noriko Hiraishi, Kittisak Sanon, Panchanit Ubolsaard, Khin Pyae Sone, Yasushi Shimada. Effect of Zinc-Releasing Glass Ionomer Cement on Preventing Dentin Demineralization, Journal of Dentistry, 2025, 105718, ISSN 0300-5712,

https://doi.org/10.1016/j.jdent.2025.105718. (https://www.sciencedirect.com/science/article/pii/S0300571225001630)

Keywords:

BioUnion™ , Glass, Ionomer, promising, Dentin, Remineralization, treating, root, surface, secondary, caries, Study, Journal of Dentistry

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Study finds, biannual azithromycin administration reduces mortality in children

A new study published in recent issue of The Journal of Antimicrobial Chemotherapy revealed a large biennial distribution of azithromycin dramatically lowers mortality of children aged 1 to 5 in high-mortality regions.

In high-mortality areas, especially sub-Saharan Africa, biannual mass drug administration of azithromycin (MDA-azithromycin) has been suggested as a means of lowering infant mortality. Since MDA programs seem to be one of the most equitable intervention platforms in low-resource contexts, delivery through MDA presents the chance to influence the most underprivileged and marginalized groups. Thus, Meenalotchini Prakash Gurunthalingam and colleagues carried out this investigation to assess the effectiveness of MDA-azithromycin across a range of protocols and conditions.

Through September 2024, following a thorough search of PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov for randomized controlled studies (RCTs) that compared biennial MDA-azithromycin to placebo in children ages 1 to 59 months. Mortality in children under one year and those aged 12 to 59 months were the main results. Antibiotic resistance and adverse effects were secondary results.

Review Manager 5.4’s random-effects model was used to analyze the data, and I2 was used to measure heterogeneity. The Cochrane RoB2 tool evaluated risk of bias, while trial sequential analysis (TSA) evaluated cumulative evidence reliability.

There were nearly 691 to 235 children from 5 RCTs. TSA indicated inconclusive data on azithromycin’s non-significant mortality decrease in children under one year of age. MDA-azithromycin dramatically decreased mortality in children aged 12 to 59 months, with TSA confirming adequate evidence.

Although adverse effects were uncommon, there was little information on antibiotic resistance, which called for more observation. One trial had a significant risk of bias, and the quality of the evidence varied from moderate to extremely low.

Overall, as per WHO guidelines, biannual MDA-azithromycin considerably lowers mortality in children aged 12 to 59 months, hence promoting its usage in high-mortality settings.

Reference:

Gurunthalingam, M. P., Singh, M. P., & Gaikwad, N. R. (2025). Biannual azithromycin mass drug administration for reduction of childhood mortality: a systematic review and meta-analysis. The Journal of Antimicrobial Chemotherapy. https://doi.org/10.1093/jac/dkaf092

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