Colchicine prophylaxis in urate-lowering therapy may reduce risk of cardiovascular events: Study

A new study published in the journal of The Lancet Rheumatology showed that individuals with gout who started urate-lowering treatment had a decreased risk of cardiovascular events when compared to patients who were not taking preventive colchicine.

Gout flares may occur when urate-lowering medication is started. There is a temporarily elevated risk of cardiovascular events linked to flare-ups of gout. Therefore, Edoardo Cipolletta and his team set out to assess the risk of cardiovascular events in gout patients starting urate-lowering treatment with flare prophylaxis using colchicine versus no prophylaxis.

Using information from the Clinical Practice Research Datalink Aurum, an English primary-care database connected to hospitalization and death records, this study was conducted a retrospective new-user cohort analysis. They contrasted individuals who were taken colchicine for flare prophylaxis with those who were not treated with any kind of gout flare prophylactic. The exposure of interest was colchicine prophylaxis (defined as a prescription for ≥21 days) given concurrently with urate-lowering treatment. The main outcome, independent of any prior cardiovascular events, was a composite of fatal and non-fatal myocardial infarction or stroke within 180 days following the start of urate-lowering treatment.

To equalize factors across study groups, propensity score overlap weighting was employed. In addition to intention-to-treat and per-protocol analyses (the latter with an inverse likelihood of censoring weighting), they employed Cox regression. The hazard ratio and risk difference with 95% CIs were used to quantify the link. Prioritizing the study issue involves members of the UK Gout Society.

A total of 99,800 gout patients who were starting urate-lowering treatment were included in the trial out of the 111,460 patients who qualified. With a mean age of 62·8 years, there were 25 511 female patients out of 99 800, 74 289 male patients, and 84 928 White patients. A total of 16,028 patients were administered colchicine prophylaxis, whereas 4063 individuals had prior cardiovascular events. The risk of cardiovascular events was considerably lower in patients who received colchicine prophylaxis than in those who did not.

According to the intention-to-treat analysis, the weighted rates of cardiovascular events were 28.8 per 1000 person-years for patients who received colchicine prophylaxis and 35·3 per 1000 person-years for those who did not. The results for secondary outcomes, stratified analyses, and analytical techniques were comparable. Overall, when gout patients started using urate-lowering medication, those who were provided colchicine prophylaxis had a decreased risk of cardiovascular events than those who did not.

Reference:

Cipolletta, E., Nakafero, G., McCormick, N., Yokose, C., Avery, A. J., Mamas, M. A., Choi, H. K., Tata, L. J., & Abhishek, A. (2024). Cardiovascular events in patients with gout initiating urate-lowering therapy with or without colchicine for flare prophylaxis: a retrospective new-user cohort study using linked primary care, hospitalisation, and mortality data. In The Lancet Rheumatology. Elsevier BV. https://doi.org/10.1016/s2665-9913(24)00248-0

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Pregnancy Hypertension Linked to Increased Risk of Neurological Disorders, finds study

Researchers have established that gestational hypertension, preeclampsia, and eclampsia are associated with a new onset of neurological disorders that occur months to years after delivery. A recent study was conducted by Therese and colleagues which was published in the journal JAMA Neurology.

This cohort of a register-based study performed on first-time mothers from 2005 to 2018 in Sweden found records of 648,385 singleton pregnancies. The study population was from the Swedish Medical Birth Register with follow-up data being sourced from the National Patient Register. Women were followed beginning 42 days post delivery until the first neurological event, death, emigration, or the end of the study period in 2019.

Of the 659,188 primiparous women, there were exclusions of women with chronic hypertension (n=4,271) and pre-existing neurological disorders (n=6,532). Thus, a final cohort of 648,385 women was identified who had a mean age of 28.5 years at the time of their first pregnancy. The main exposures of interest were gestational hypertension, preeclampsia, and eclampsia. The main outcome was a composite of neurological disorders, including migraine, headache, epilepsy, sleep disorders, and mental fatigue. Risk was assessed with Cox regression analysis, expressed as adjusted hazard ratios and 95% confidence intervals.

Key Findings

Prevalence of Conditions

  • Gestational hypertension affected 11,133 women.

  • Preeclampsia affected 26,797 women.

  • Eclampsia was diagnosed in 625 women.

Neurological Risk Increased:

  • Women with gestational hypertension had a 27% increased risk of new-onset neurological disorders (aHR, 1.27; 95% CI, 1.12–1.45).

  • Preeclampsia was associated with an increased risk of 32% (aHR, 1.32; 95% CI, 1.22–1.42).

  • Eclampsia carried the greatest risk with a 70% increase (aHR, 1.70; 95% CI, 1.16–2.50).

Specific Neurological Outcomes:

  • Women with eclampsia had a more than fivefold increased risk for epilepsy (aHR, 5.31; 95% CI, 2.85–9.89).

The current findings indicate significant associations between hypertensive pregnancy disorders and new-onset neurological conditions. Routine postpartum visits should include neurological evaluations, particularly for women who experienced gestational hypertension, preeclampsia, or eclampsia. Early detection and management of conditions like epilepsy or mental fatigue could mitigate long-term complications and enhance quality of life. Healthcare providers should prioritize postpartum follow-up for these women, paying special attention to neurological symptoms to ensure timely intervention and improved maternal health outcomes.

Reference:

Friis T, Bergman L, Hesselman S, et al. Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders. JAMA Neurol. Published online December 23, 2024. doi:10.1001/jamaneurol.2024.4426

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Periodontal Disease may predict Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes, finds study

Periodontal Disease may predict Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes, finds a study published in the Clinical and Experimental Research.

This study aimed to assess the association between periodontal disease and metabolic syndrome (MetS) among women at prior high risk for gestational diabetes with the hypothesis that women with MetS show more signs of periodontal disease than women without MetS. A total of 112 women from an original study cohort of 348 women at high risk of gestational diabetes were examined 4–6 years postpartum. Diagnosis of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. Insulin resistance was approximated by the homeostatic model assessment for insulin resistance. Full‐mouth examinations and panoramic radiographs provided the total dental index, number of teeth, and decayed, missing, and filled teeth index. Clinical examination assessed bleeding on probing, probing depth, visible plaque index, signs of infection, and clinical attachment levels. The periodontal inflammatory burden index (PIBI) was also calculated. Information on oral health habits, symptoms, and individual opinions on oral health was collected through questionnaires. Results: Five years after delivery, 21% of the women had MetS, and they had more gingivitis compared to those without MetS (bleeding on probing: 52% and 44%, p = 0.011). Women with MetS tended to have more periodontitis than those without (39% and 25%, p = 0.13). A high PIBI correlated with insulin resistance (partial correlation of PIBI and homeostatic model assessment for insulin resistance: 0.25 p < 0.05). Periodontal disease was associated with insulin resistance and MetS in women at prior high risk of developing gestational diabetes.

Reference:

Poulsen H, Meurman JH, Kautiainen H, Huvinen E, Koivusalo S, Eriksson JG. Periodontal Disease and Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes. Clin Exp Dent Res. 2024 Dec;10(6):e70053. doi: 10.1002/cre2.70053. PMID: 39665824; PMCID: PMC11636310.

Keywords:

Periodontal, Disease, predict, Metabolic Syndrome, Women, Prior High Risk, Gestational Diabetes, study, Poulsen H, Meurman JH, Kautiainen H, Huvinen E, Koivusalo S, Eriksson JG , gestational diabetes, metabolic syndrome, periodontal disease

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Updated Guidelines on Amniocentesis and Chorionic Villus Sampling: Key Recommendations for Safe Prenatal Diagnosis

UK: The Royal College of Obstetricians and Gynaecologists (RCOG) has updated its Green-top Guideline No. 8 on amniocentesis and chorionic villus sampling (CVS), offering evidence-based recommendations for prenatal diagnosis. This fifth edition, updated from the previous version published in June 2010, guides the appropriate use of these procedures for pregnant women at risk of genetic disorders or other pregnancy complications.

The guidelines were published online in BJOG: An International Journal of Obstetrics & Gynaecology.

Amniocentesis and CVS are commonly offered to pregnant women for prenatal testing, especially when there is an increased likelihood of genetic conditions such as Down syndrome or when fetal anomalies are detected through screening. CVS is typically performed between 11 and 13 weeks of gestation, although it may be carried out as late as 14+6 weeks if necessary. For those considering CVS during this time, individualized counseling is recommended to weigh the benefits and risks of CVS versus amniocentesis. The latter is usually performed after 15 weeks of gestation to obtain amniotic fluid for analysis.

One of the key points highlighted in the guideline is the importance of informing patients about the risks of miscarriage associated with both procedures. When performed by appropriately trained operators, the risk of miscarriage following amniocentesis or CVS is generally below 0.5%, a reassuring statistic for most women. However, in cases of multiple pregnancies, such as twins, the miscarriage risk is around 1%, so this should be discussed with patients.

The guidelines stress that amniocentesis should not be performed before 15 weeks of gestation, while CVS should not be conducted before 10 weeks. The ideal time for CVS is between 11 and 13 weeks to minimize technical difficulties and ensure better sample collection. The guidelines also include a note on blood-borne viruses, advising that viral load and antigen test results should be reviewed before conducting invasive tests, and discussing the risk of viral transmission.

These updated guidelines ensure that both amniocentesis and CVS are performed safely and effectively, with clear patient counseling about their options. This evidence-based approach supports clinicians and pregnant women in making informed decisions about prenatal genetic testing.

The authors suggest that future research should focus on examining the rates of procedure-related pregnancy loss in multiple pregnancies, particularly considering chorionicity. Additionally, they recommend investigating the risk of mother-to-child transmission following invasive procedures during acute infections, such as Hepatitis C, to better understand the potential complications in these scenarios.

Reference:

Navaratnam, K., & Alfirevic, Z. (2021). Amniocentesis and chorionic villus sampling. BJOG: An International Journal of Obstetrics & Gynaecology, 129(1), e1-e15. https://doi.org/10.1111/1471-0528.16821

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MP HC orders increase in MBBS seats in private colleges for EWS reservation

Noting that there is no provision for EWS seats in the private medical colleges, a Division bench of the Madhya Pradesh High Court on Monday asked the State Government to increase the seats in the private medical colleges to provide reservation to the candidates belonging to Economically Weaker Section (EWS) category.

Further, the Division bench of the HC comprising Chief Justice Suresh Kumar Kait and Justice Vivek Jain also took cognisance of the fact that there is no provision for EWS seats in the private medical colleges under the rules framed in the State. The bench opined that this violated the 103rd amendment providing a separate quota for EWS candidates.

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Therapeutic-dose anticoagulation linked to lower mortality in COVID-19

For patients hospitalized for COVID-19, administration of therapeutic-dose versus prophylactic-dose anticoagulation with heparins is associated with lower 28-day mortality, according to a review published online Dec. 24 in the Annals of Internal Medicine.

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2020 to 2023 saw increase in buprenorphine dispensing for teens

Buprenorphine dispensing increased among adolescents and decreased among young adults between 2020 and 2023, according to a research letter published online Dec. 23 in the Journal of the American Medical Association.

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COVID-19 infection not linked to changes in MS symptom severity

COVID-19 infection is not associated with immediate changes in multiple sclerosis (MS) symptom severity or disability, according to a study published online Dec. 23 in Neurology.

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Could AI plus lasers help catch very early breast cancers?

Very early-stage breast cancers are notoriously tough to spot via mammograms, but new technology might make detection easier.

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Neurological outcomes worsen with gestational HTN, preeclampsia, eclampsia

Gestational hypertension, preeclampsia, and eclampsia are associated with an increased risk for neurological outcomes in the months or years after giving birth, according to a study published online Dec. 23 in JAMA Neurology.

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