Moderate-to-Severe Retinopathy of Prematurity Linked to Autism Risk, reveals study

Researchers have identified that moderate to severe retinopathy of prematurity (ROP) is strongly related to the increased risk of autism spectrum disorder (ASD) in children born extremely premature. A recent study was conducted by Pia L. and colleagues which was published in the journal Acta Paediatrica.

Extremely preterm infants, those born at less than 28 weeks of gestation, are more susceptible to a variety of complications, including neurodevelopmental disorders. ROP, a retinal disorder that affects premature infants, has been examined for its association with long-term developmental impairments. The study included children without perinatal brain injuries or genetic disorders, in an attempt to control the association between ROP and autism spectrum disorder.

The study analyzed data from children born extremely premature (<28 weeks) in the Region Västra Götaland between 2013 and 2017. Of 266 children evaluated for neurodevelopmental outcomes, 143 were included after excluding cases with documented brain injuries or genetic disorders. These children were categorized based on the severity of their ROP: no or mild ROP (stage <1) and moderate-to-severe ROP (stage ≥2). Neurodevelopmental diagnoses diagnosed included ASD, attention deficit hyperactivity disorder (ADHD), and intellectual disability. Statistical adjustments for this analysis were made for gestational age and sex.

Key Findings Overall Neurodevelopmental Outcomes:

  • 18% of 143 children had an autism spectrum disorder diagnosis

  • ADHD was diagnosed in 15%, and intellectual disability in 7%

ROP Severity and Risk of Autism:

  • For patients with no or mild ROP (stage <1), 10% met the criteria for an autism spectrum disorder diagnosis.

  • On the contrary, 27% of those with moderate-to-severe ROP (stage ≥2) were diagnosed with ASD (p = 0.008).

High Risk of ASD:

  • The risk of ASD diagnosis was threefold increased in cases of moderate-to-severe ROP even after adjustment for gestational age and sex (p = 0.011).

It is established that moderate-to-severe retinopathy of prematurity was significantly associated with higher risks of later autism spectrum disorder in extremely preterm children without documented brain injuries or genetic disorders. Integrated approaches to care should thus not only emphasize ophthalmologic health but also neurodevelopmental health, and indeed, both approaches must target improving outcomes for such a vulnerable group.

Reference:

Lundgren P, Olsson HBK, Pivodic A, Jacobson L, Vallin L, Smith LE, Sävman K, Hellström A. Increased risk of autism in extremely preterm children with a history of retinopathy of prematurity. Acta Paediatr. 2024 Dec 19. doi: 10.1111/apa.17539. Epub ahead of print. PMID: 39698790.

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Depemokimab reduces exacerbations in patients with severe asthma with eosinophilic phenotype, reveals study

A recent novel study published in
the New England Journal of Medicine found that Depemokimab can reduce asthma
exacerbations in patients with the eosinophilic phenotype.

Improperly controlled asthma results
in episodic severe exacerbations despite treatment with medium- or high-dose
inhaled glucocorticoids along with additional controller medications. Increased
levels of high levels of unregulated type 2 inflammation are seen in individuals
with asthma exacerbations. Uncontrolled eosinophilic inflammation is a
recognized risk factor for severe disease exacerbations, airway remodeling, and
decline in lung function among asthmatic patients, with blood reports showing
abnormal eosinophilic counts. Depemokimab is an ultra-long-acting biological
therapy that was shown to be effective in mild to moderate asthma, leading
to dose-dependent suppression of the blood eosinophil count. Hence, researchers
designed replicate trials of phase 3A SWIFT-1 and SWIFT-2 to investigate
the efficacy and safety of Depemokimab as an adjunctive treatment to standard
care for patients who had severe asthma with an eosinophilic phenotype and a
history of exacerbations despite the receipt of medium- or high-dose inhaled
glucocorticoids.

Also Read: Metoprolol Safer Beta Blocker for Asthma Patients, Surprising Findings from FDA’s large database

The trial included patients with
severe asthma with an eosinophilic phenotype characterized by a high eosinophil
count. The eosinophilic count was considered high when there were ≥300 cells
per microliter in the previous 12 months or ≥150 cells per microliter at
screening and a history of exacerbations despite receiving medium- or high-dose
inhaled glucocorticoids. Patients were randomly divided in a 2:1 ratio to
receive either Depemokimab (at a dose of 100 mg subcutaneously) or placebo at
weeks 0 and 26, along with standard care. The annualized rate of exacerbations
at 52 weeks was the primary endpoint, while the secondary endpoints included
the change from baseline in the score on the St. George’s Respiratory
Questionnaire (SGRQ), the forced expiratory volume in 1 second, and asthma
symptom reports at 52 weeks.

Findings:

  • Among the two trials, 762 were included in the final
    trial, with 502 assigned to receive Depemokimab and 260 assigned to receive a placebo.
  • The annualized rate of exacerbations was 0.46
    with Depemokimab, 1.11 with placebo in SWIFT-1, 0.56 with Depemokimab, and 1.08
    with placebo in SWIFT-2.
  • The SGRQ score showed no significant
    between-group differences in the change from baseline in either trial. Hence, no
    statistical inference was drawn on subsequent secondary endpoints.
  • The adverse events were similar in both groups
    in both trials.
Also Read:Combination therapy with Montelukast Sodium effective for managing Cough Variant Asthma in children, finds study

Thus, the researchers concluded
that Depemokimab reduced the annualized rate of exacerbations among patients
with severe asthma with an eosinophilic phenotype as it targeted interleukin-5
or its receptor and improved patient outcomes. Hence, clinicians can consider using
Depemokimab for tailored asthma management in those struggling with
conventional therapies.

Further reading: Twice-Yearly Depemokimab in Severe Asthma with an Eosinophilic Phenotype. DOI: 10.1056/NEJMoa2406673

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Norepinephrine has positive effect on hemorrhage, pain, and hospitalization in MAMIR for Benign Breast Nodules: Study

A recent study published in the
journal BMC Surgery found that norepinephrine has protective effects on
intraoperative hemorrhage and postoperative pain and also helps to reduce
hospitalization in individuals undergoing resection of benign breast nodules.

Breast tumors are common among
women and range from benign to malignant. Benign tumors are non-invasive but
affect function and aesthetics, needing surgical removal. Mammotome-assisted
minimally invasive resection (MAMIR) is increasingly used for managing benign
nodules of the breast. However, the procedure involves many technicalities and
is challenging. Previous research has shown that norepinephrine may improve the
surgical effect and reduce intraoperative hemorrhage and pain caused by
surgery. Hence, Chinese researchers conducted a study to assess the efficacy of
norepinephrine application in MAMIR concerning intraoperative hemorrhage,
postoperative pain, and postoperative hospitalization.

Also Read: Cryoablation Safe for Breast Cancer Patients who are poor surgical candidates: Study

This retrospective cohort study
included 306 patients with breast nodules admitted at the Xishan People’s
Hospital of Wuxi City between June 2021 and July 2023. Patient’s data,
including age, comorbidities like hypertension and diabetes, and
characteristics of the breast nodule (number, unilateral or bilateral nature,
inner quadrant volume, and total volume), were carefully recorded. Operation
time, intraoperative hemorrhage, postoperative hospitalization, and Visual
analog scale (VAS) score, including postoperative 6-hour pain score, were also
documented. Patients were categorized into non-NPP (norepinephrine) and NPP
groups based on the application of norepinephrine. Univariate and multivariate
analyses were performed to estimate the odds ratio (OR) and the 95% confidence
intervals (CIs) for outcomes.

Findings:

  • A total of 155 individuals who accepted MAMIR
    were included in the study.
  • Intraoperative bleeding, postoperative pain, and
    the duration of hospitalization were less in the NPP group (p < 0.05).
  • According to the Univariable analysis,
    norepinephrine usage reduced intraoperative hemorrhage during the surgery, alleviated
    postoperative pain, and shortened hospital stay.
  • Multivariate analysis revealed that
    norepinephrine usage was an independent factor during MAMIR as it was associated
    with reduced intraoperative hemorrhage and postoperative pain after adjusting
    for other factors.
Also Read:AI Powered Blood Test Detects Earliest Stage of Breast Cancer: Study Finds

Thus, the study concluded that adding
norepinephrine to assist local infiltration during preoperative local
anesthesia improved the operational details. It resulted in reduced
intraoperative hemorrhage, postoperative pain, and postoperative
hospitalization. The researchers added that the addition of norepinephrine was
safe, effective, and an independent positive predictive factor for reducing
pain and hemorrhage in MAMI for benign breast nodule surgery.

Further reading: Sun, Y., Xu, Z.,
Hu, J. et al. The efficacy of norepinephrine application in
Mammotome-assisted minimally invasive resection for benign breast neoplasm: A
retrospective study. BMC Surg 24, 393 (2024). Doi: https://doi.org/10.1186/s12893-024-02701-y

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Study reveals how alcohol use disorder impairs cognitive flexibility

Alcohol use disorder (AUD) affects about 400 million people worldwide and is a leading cause of serious illnesses such as cancer, cardiovascular disease, liver disease and stroke. Beyond these physical impacts, AUD profoundly disrupts brain functions critical for learning, memory and adaptability-key elements of cognitive flexibility.

Now, researchers at the Texas A&M University College of Medicine have shed new light on how chronic alcohol use alters brain signaling pathways, specifically focusing on how it impairs cognitive flexibility. Their findings, recently published in Science Advances, demonstrate the significant role of cholinergic interneurons (CINs) in this process.

Zhenbo Huang, PhD, an associate research scientist in the laboratory of Jun Wang, MD, PhD, and colleagues have demonstrated that alcohol disrupts the brain’s ability to adapt by altering the burst-pause firing patterns of CINs-specialized neurons that release acetylcholine, a key neurotransmitter.CINs are critical gatekeepers in the brain’s striatum, influencing reward-driven learning and motivation by modulating dopamine signaling.

“Dopamine neurons drive the brain’s reward system, while CINs act as the gatekeepers, filtering stimuli that activate these neurons,” said Wang, an associate professor at the Texas A&M College of Medicine.

Using advanced tools such as optogenetics, which uses light to control cells, the researchers uncovered that stimulating CINs in animal models of chronic alcohol exposure produced an altered firing pattern compared to models without chronic alcohol exposure. Normally, CINs fire in a “burst-pause” pattern: a quick burst of activity followed by a pause, which is essential for learning new behaviors and adapting to change. However, in alcohol-exposed models, this firing pattern was significantly disrupted, with shorter and weaker pauses, impairing critical learning process such as reversal leaning.

“Reversal learning is a cornerstone of cognitive flexibility,” Wang explained. “It allows individuals to unlearn behaviors when rules or circumstances change-a process heavily reliant on acetylcholine signaling.”

By combining optogenetics-which uses light to control CIN activity-and fiber photometry-which involves genetically engineered biosensors to detect real-time release of acetylcholine while subjects perform tasks-the team discovered distinct roles for different CIN firing phases. The “burst” phase, which increases acetylcholine release from CINs, aids extinction learning-where old behaviors are unlearned. The “pause” phase, on the other hand, which causes a dip in acetylcholine release from the CINs, is crucial for reversal learning, where new behaviors replace outdated ones.

This groundbreaking research reveals how alcohol undermines these mechanisms, offering new insights into the broader effects of AUD. Importantly, the findings suggest potential therapeutic targets for addressing cognitive impairments associated with AUD.

“The burst and pause dynamics of CINs are critical for behavioral adaptability,” Wang said. “This study highlights their unique roles and lays the groundwork for exploring how similar mechanisms might influence conditions beyond addiction, including aging and neurodegenerative diseases.”

The Wang team continues to explore how CIN dynamics impact brain health, aiming to translate their discoveries into innovative treatments for a variety of brain disorders.

Reference:

Zhenbo Huang et al. ,Dynamic responses of striatal cholinergic interneurons control behavioral flexibility.Sci. Adv.10,eadn2446(2024).DOI:10.1126/sciadv.adn2446

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Transfusing more blood reduces risk of death at six months in heart-attack patients with anemia, finds study

Giving more blood to anemic patients after a heart attack may save lives, according to a Rutgers Health-led study.

The study, published in NEJM Evidence, affirms research conducted in 2023 that suggested mortality rate or recurrent heart attacks were more frequent in anemic patients who received less blood.

Jeffrey L. Carson, provost and Distinguished Professor of medicine at Rutgers Robert Wood Johnson Medical School, led both studies. The 2023 trial – referred to as MINT (myocardium infarction and transfusion) – looked at transfusions in anemic patients following a heart attack.

After that 2023 trial, Carson planned a study on blood transfusions that combined data from similar trials to generate more precise estimates of treatment effects.

In cooperation with researchers in France and the United States, Carson acquired data from the four clinical trials evaluating blood transfusion in 4,311 patients with heart attacks. These trials included patients who had a heart attack and low blood count. Half the patients received less blood transfusions and the other half received more blood transfusions. The trials compared the frequency of death at 30 days or recurrent heart attacks and death at six months.

The results of this analysis, published recently in NEJM Evidence, didn’t definitively establish that giving less blood transfusions increased a patients’ risk of death or heart attack at 30 days, but did suggest that using less transfusions was associated with an increased risk of death at six months.

In the original clinical trial, a large percentage of patients had suffered a previous heart attack, heart failure, diabetes or kidney disease. The average age of participants was 72, with 45% women.

The researchers compared the frequency of the main outcome of death or recurrent heart attack at 30 days after enrollment into the trial. Although not statistically significant, the study found the frequency of mortality or recurrent heart attack was 2.4% lower when a liberal approach was used.

“The results of this analysis show that giving more blood to anemic patients with heart attacks can save lives at six months,” Carson said.

Both studies were funded through by the National Heart, Lung and Blood Institute, which is a part of the National Institutes of Health.

For nearly two decades, Carson has studied the implications of red blood cell transfusion strategies toward providing optimal treatment for patients. His work helped establish transfusion guidelines in 2012 used by physicians to inform patient care, updates to which were announced last year in the Journal of the American Medical Association emphasizing an individualized approach in adults and children that account for the patients underlying medical problems, patient preferences and symptoms.

Reference:

Jeffrey L. Carson, Dean A. Fergusson, Helaine Noveck, Ranjeeta Mallick, Tabassome Simon, Restrictive versus Liberal Transfusion in Myocardial Infarction — A Patient-Level Meta-Analysis, NEJM Evidence, DOI: 10.1056/EVIDoa2400223

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First dual chamber leadless pacemaker implanted in a child, report researchers

UC Davis Director of Pediatric Electrophysiology Dan Cortez has set another world record: He is the first to implant a dual chamber leadless pacemaker in a child. His case report was published this week in the journal PACE: Pacing and Clinical Electrophysiology.

A 13-year-old patient was referred to the UC Davis pediatric electrophysiology clinic for presyncope, a feeling of lightheadedness or dizziness without actually fainting, after being monitored for years for congenital complete heart block.

Pacemakers are typically placed in children with congenital complete heart block, a rare condition that can lead to sudden death and affects 1 in about 15,000 to 22,000 children. Congenital complete heart block may occur due to repaired congenital heart disease or genetic predisposition. It can also be acquired from exposure to certain maternal antibodies.

After serial electrocardiograms and Holter monitors showed progressively lower average heart rates, Cortez talked with the patient and their family about pacemaker options.

Dual chamber leadless pacemakers help regulate the heart’s rhythm by stimulating the heart’s upper (atrial) and lower (ventricular) chambers. Because the patient wanted to remain active in sports without restrictions, leadless pacing was presented as an option, and the family agreed.

The AVEIR dual chamber leadless pacemaker was implanted via the patient’s right internal jugular vein (instead of the femoral vein) so the patient could move easily and return to sports sooner. The minimally invasive procedure took place in the UC Davis Electrophysiology Lab.

The patient had no complications during or after the procedure. Three months later, the patient was able to resume exercise and play sports.

The AVEIR device is different from traditional pacemakers in part because it has no leads or cords and is absorbed by the heart. It is also 10 times smaller than a traditional pacemaker. This pacemaker has been implanted in adults across the country since it received FDA approval in 2023.

“Everyone, kids included, can now have the benefits of pacemakers without leads and without the complications that come with leads long term,” Cortez said. “No matter what kind of pacing a kid needs-atrial or ventricular, or both-they can now safely receive leadless pacing and, after the short recovery period, have no restrictions to their activity level.”

In 2023, Cortez was the first physician in the world to implant a retrievable leadless pacemaker in a child. Five years prior to that, Cortez was the first physician in the world to implant a Micra single-chamber leadless pacemaker through the internal jugular vein in a child.

Reference:

Daniel Cortez, Dual Chamber Aveir Retrievable Leadless Pacemaker Implant via the Right Internal Jugular Vein in a 13-year-old With Congenital Complete Heart Block, Pacing and Clinical Electrophysiology, https://doi.org/10.1111/pace.15129.

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High cardiorespiratory fitness linked to lower risk of dementia, reveals research

High cardiorespiratory fitness is associated with better cognitive performance and lower risk of dementia long term, including in people with a genetic predisposition to dementia, show the findings of a study published online in the British Journal of Sports Medicine.

Cardiorespiratory fitness (CRF) is the capacity of the circulatory and respiratory systems to supply oxygen to muscles and declines increasingly with age as skeletal muscle is lost. CRF declines by around 3% to 6% per decade when people are in their 20s and 30s, but this accelerates to more than 20% per decade by the time people reach their 70s. Low CRF is a strong predictor of cardiovascular events such as strokes and heart attacks and mortality from all causes.

Most previous studies investigating the impact of CRF on cognitive function and dementia risk included a small number of participants. For this study, the authors looked at a much larger group by accessing data on 61,214 dementia-free people aged 39-70 years who enrolled in the UK Biobank study between 2009 and 2010 and were followed for up to 12 years.

At enrolment, a 6-minute submaximal exercise test on a stationary bike was completed to estimate CRF, cognitive function was estimated using neuropsychological tests, and genetic predisposition for dementia was estimated using the polygenic risk score for Alzheimer’s disease. During the follow-up period of up to 12 years, 553 people (0.9%) received a diagnosis of dementia.

Participants were divided into three equal-sized groups standardised by age and sex according to their CRF scores for the analysis which showed that people with high CRF had higher cognitive function and a lower risk of dementia.

Compared with people with low CRF, the incidence rate ratio (IRR) of all dementia was 0.6 for people with high CRF, and onset of dementia was delayed by 1.48 years. A high CRF also reduced all dementia risk by 35% among people with a moderate/high polygenic risk score.

This is an observational study, and as such, can’t establish cause and effect, and the researchers acknowledge various imitations to their findings.

Most importantly the number of dementia cases may have been underestimated because UK Biobank participants are generally healthier than the general population, plus individuals with certain health conditions were excluded from the exercise test making the population investigated ‘healthier’ still. The reliance on registries to identify dementia cases might have led to a further underestimation. Also, the submaximal exercise test used is considered less accurate than maximal exercise testing which requires participants to exercise to exhaustion, and any association between CRF change and dementia risk could not be examined due to the lack of repeat CRF measurements.

The authors conclude, “Our study shows that higher CRF is associated with better cognitive function and decreased dementia risk. Moreover, high CRF may buffer the impact of genetic risk of all dementia by 35%.”

They add that their findings suggest that, “Enhancing CRF could be a strategy for the prevention of dementia, even among people with a high genetic predisposition for Alzheimer’s disease.”

Further research on the relationship between CRF and brain health, especially in older adults, and on the mechanisms by which CRF modifies the relationship between genetic risk and dementia is needed, they say.

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Study Explores Impact of Urogenital Symptoms on Female Sexual Health in perimenopausal phase

Sexual well-being plays a crucial role in the overall health of menopausal women. As women age and go through menopause, they often experience reduced sexual activity, lower arousal and desire, and increased vaginal dryness and painful intercourse. Recent study aimed to explore the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire, arousal, and satisfaction. The researchers conducted a cross-sectional study with 326 patients from three tertiary care hospitals in the United Arab Emirates.

The study assessed the frequency and severity of urogenital symptoms, emotional and physical functioning, and treatment burden using validated questionnaires. Partial least squares-structural equation modeling was used to examine the mediating roles of emotional and physical functioning, as well as the perceived treatment burden, on sexual functioning.

The results showed that urogenital symptom burden and perceived treatment burden did not have a direct effect on sexual functioning. However, the relationships were mediated through emotional and physical functioning. Specifically, urogenital symptom burden significantly predicted poorer emotional and physical functioning, which in turn negatively impacted sexual functioning. Similarly, perceived treatment burden predicted poorer emotional and physical functioning, which then led to lower sexual desire, arousal, and satisfaction.

Conclusion and Implications

The findings emphasize the importance of addressing emotional well-being in managing urogenital symptoms and the emotional factors associated with the use of vaginal treatments. The study provides valuable insights into the complex interconnections between urogenital symptoms, treatment burden, emotional and physical functioning, and various aspects of sexual health among peri- and postmenopausal women. Recognizing the magnitude of these impacts can help healthcare providers deliver more targeted interventions that address the specific needs of each patient.

Key Points

1. The study explored the relationship between urogenital symptom frequency and severity, perception of vaginal treatment burden, and female sexual desire, arousal, and satisfaction.

2. The researchers conducted a cross-sectional study with 326 patients from three tertiary care hospitals in the United Arab Emirates.

3. The study assessed the frequency and severity of urogenital symptoms, emotional and physical functioning, and treatment burden using validated questionnaires. Partial least squares-structural equation modeling was used to examine the mediating roles of emotional and physical functioning, as well as the perceived treatment burden, on sexual functioning.

4. The results showed that urogenital symptom burden and perceived treatment burden did not have a direct effect on sexual functioning. However, the relationships were mediated through emotional and physical functioning. Specifically, urogenital symptom burden and perceived treatment burden significantly predicted poorer emotional and physical functioning, which in turn negatively impacted sexual functioning.

5. The findings emphasize the importance of addressing emotional well-being in managing urogenital symptoms and the emotional factors associated with the use of vaginal treatments.

6. The study provides valuable insights into the complex interconnections between urogenital symptoms, treatment burden, emotional and physical functioning, and various aspects of sexual health among peri- and postmenopausal women. Recognizing the magnitude of these impacts can help healthcare providers deliver more targeted interventions that address the specific needs of each patient.

Reference –

Mohammed M Hassanein et al. (2024). The Impact Of Perceived Vaginal And Urinary Symptoms And Treatment Burden In Predicting Sexual Functioning Among Perimenopausal And Postmenopausal Women.. *International Journal Of Gynaecology And Obstetrics: The Official Organ Of The International Federation Of Gynaecology And Obstetrics*. https://doi.org/10.1002/ijgo.15736

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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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