Archive for month: May, 2024

Preventive treatment for tuberculosis (TB) can stop latent TB infections from developing into deadly TB disease. Despite TB infection being fully treatable, there is no global consensus as to which subgroups of individuals exposed to TB should be prioritized for preventive treatment, nor whether the benefits of this treatment vary based on factors such as age or confirmed infection.

A new study led by a Boston University School of Public Health (BUSPH) researcher provides clarity to this issue, finding that exposed individuals with confirmed TB infection-i.e. a positive skin or blood test-should receive priority treatment in settings with a low prevalence of the disease, regardless of their age.

However, in high-burden settings, all exposed individuals should be considered for preventative treatment, even without a confirmed infection, according to the findings published in The Lancet Respiratory Medicine.

This strategy can help end the tuberculosis epidemic and support global public health efforts to reduce TB mortality by 95 percent by 2035 (from 2015 estimates). In 2022, there were more than 10 million cases of active TB worldwide, resulting in 1.5 million deaths.

“Tuberculosis affects tens of millions of people every year and has long-term lasting effects, even after people recover,” says study lead and corresponding author Dr. Leonardo Martinez, assistant professor of epidemiology at BUSPH. “Finding ways to optimize prevention is really important to tackle the epidemic.”

For the study, Dr. Martinez and colleagues conducted a comprehensive review and analysis to identify new cases of TB among people who were in close contact with individuals diagnosed with the disease, and compared the effectiveness of preventive treatment in these exposed individuals based on age, infection status, and burden of TB in their settings.

Among 439,644 participants, the team found that preventive TB treatment was 49 percent effective among the 2,496 individuals who developed TB, but particularly among individuals with a positive skin or blood test (for which the effectiveness was 80 percent).

Notably, the researchers found that preventive TB treatment was not effective in most individuals who did not show evidence of infection, except for children under 5.

For those who did have a positive skin or blood test, the effectiveness of the treatment was comparable among individuals of all age groups-adults, children ages 5-17, and children under 5-and the treatment was more effective among individuals in high-burden settings than low-burden settings.

The team also estimated the number of individuals needed to receive treatment (NNT) in order to prevent one person from developing TB disease. Regardless of infection status, the NNT was lower in high-burden settings (29 to 43 people) versus low-burden settings (213 to 455 people). Despite the fact that individuals with negative blood or skin tests do not seem to benefit from preventive treatments, the researchers say the overall low NNT may justify prioritizing this treatment to all exposed contacts in areas where testing for TB infection is inaccessible.

“While it is critical to find and treat people who are spreading TB in the community, the threat of global TB will never end until people with latent TB receive treatment,” says study coauthor Dr. C. Robert Horsburgh, professor of global health. “The results of this study show just how effective such treatment can be.” 

Reference:

Leonardo Martinez, James A Seddon, Prof C Robert Horsburgh, Prof Christoph Lange, Prof Anna M Mandalakas, Effectiveness of preventive treatment among different age groups and Mycobacterium tuberculosis infection status: a systematic review and individual-participant data meta-analysis of contact tracing studies, The Lancet Respiratory Medicine, DOI:https://doi.org/10.1016/S2213-2600(24)00083-3.

Recently published research paper investigates the efficacy of using intracuff lignocaine in preventing postextubation cough in pediatric patients undergoing elective surgeries. The study, conducted in India, involved 120 pediatric patients randomized into two groups: one with intracuff air and the other with intracuff 2% lignocaine. The incidence of postextubation cough was significantly lower in the group with intracuff lignocaine compared to the group with intracuff air. The study also found a significant increase in heart rate in patients with intracuff air compared to those with intracuff lignocaine. Furthermore, the study demonstrated that the diffusion of lignocaine through the cuff was sufficient to provide an adequate localized effect on the tracheal mucosa.

Surgery Duration and Cough Occurrence

The research also explored the relationship between the duration of surgery and the occurrence of cough in patients with reduced end-operative cuff pressure. It was found that as the duration of surgery increases, more time is available for the diffusion of lignocaine through the cuff at lower cuff pressure to produce the desired effect on the tracheal mucosa. The study highlighted a few limitations, including the lack of assessment of plasma concentration of lignocaine and the duration of action of intracuff lignocaine on the tracheal mucosa. The findings suggest that intracuff lignocaine significantly reduces postextubation cough in pediatric patients and mitigates adverse haemodynamic responses compared to intracuff air.

Future Considerations

Overall, the research contributes valuable insights into the potential of intracuff lignocaine in preventing postextubation cough and adverse events in pediatric patients undergoing elective surgeries. The study provides important considerations for future research, such as the assessment of plasma levels of lignocaine, the duration of action of intracuff lignocaine, and the exploration of alkalinised lignocaine as a superior option for cuff inflation in pediatric patients.

Key Points

– The research explored the relationship between the duration of surgery and the occurrence of cough in patients with reduced end-operative cuff pressure. It was observed that as the surgery duration increased, more time was available for the diffusion of lignocaine through the cuff at lower cuff pressure to produce the desired effect on the tracheal mucosa. The study did note some limitations, including the lack of assessment of plasma concentration of lignocaine and the duration of action of intracuff lignocaine on the tracheal mucosa.

– Overall, the study highlighted the potential of intracuff lignocaine in reducing postextubation cough and adverse events in pediatric patients undergoing elective surgeries. It also provided important considerations for future research, such as the assessment of plasma levels of lignocaine, the duration of action of intracuff lignocaine, and the exploration of alkalinized lignocaine as a superior option for cuff inflation in pediatric patients.

Reference –

Kavyashree, M. B.; Kundra, Pankaj; Vinayagam, Stalin. Efficacy of endotracheal tube cuff lignocaine in the prevention of postextubation cough in children undergoing elective surgeries – A randomised controlled trial. Indian Journal of Anaesthesia 68(5):p 486-491, May 2024. | DOI: 10.4103/ija.ija_1013_23

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) suggests that the source of sugar is more important than the amount of sugar when it comes to the development of obesity in children.

The study found that the total amount of sugar consumed when very young was not associated with weight at age 10 or 11.

However, children who got a higher proportion of their sugar from unsweetened liquid dairy products (milk and buttermilk) were less likely to go on to live with overweight or obesity.

Similarly, getting more sugar from fruit was associated with less weight gain. However, getting a lot of sugar from sweet snacks such as cakes, confectionery and sweetened milk and yoghurt drinks, such as chocolate milk, was linked to being of higher weight.

“The high consumption of sugary foods is considered a risk factor for childhood overweight and obesity and so children are advised to consume less sugar-rich foods, such as confectionery, cakes and sugar-sweetened drinks, and eat more fruit and unsweetened dairy products, such as milk and yoghurt,” says lead researcher Junyang Zou, of the Department of Epidemiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.

“But while fruit and unsweetened dairy products are considered healthy, they contain high amounts of intrinsic sugars-sugar that occurs naturally in the food, rather than being added. We wanted to know if the source of sugar, added versus intrinsic, as well as the amount, affects the likelihood of developing overweight or obesity.

“While this has been studied before, the results are inconsistent and there is a lack of high quality research on the topic.”

To address this, Ms Zou and colleagues used data from the GEKCO Drenthe study1, an ongoing longitudinal study of a cohort of children born in Drenthe, in the northern Netherlands, between April 2006 and April 2007, to explore the association between total sugar intake in early childhood and the intake of sugar from different sources on weight, weight gain and the development of overweight and obesity.

The answers to a food intake questionnaire filled in by the parents of 891 children (448 males) when the children were 3 years were used to calculate daily total sugar intake and the daily sugar intake from 13 food groups [vegetables; fruits (whole fruit only); cereals; starchy vegetables; nuts; legumes; meat, eggs, vegetarian meat substitutes, and oil, butter, and margarines; milk and milk products; coffee and tea, and coffee and tea-based drinks; sugar-sweetened beverages (including fruit juice, lemonade and sweetened milk and yoghurt drinks); savoury products including homemade and ready meals and soup; sugary snacks such as cakes, confectionery and chocolate; toppings/sauces/sugars].

Height and weight, as measured by trained nurses, were used to calculate BMI Z-scores, the change in this score between 3 and 10/11 years and weight status at 10/11 years (normal weight/overweight/obese, as defined by International Obesity Task Force 2012 criteria).

BMI Z-scores are a widely used measure of weight in childhood and adolescence. They show how a young person’s BMI compares to the average BMI for their age and sex, with higher values representing a higher weight.

All 891 children were included in the BMI-Z score at 10/11y and change in BMI-Z score analyses. 817 of the children (414 males) were included in the weight status analysis (74/891 were living with overweight or obesity at age 3 and were excluded from this analysis).

Average total daily sugar intake was 112g. This made up around a third (32%) of the total daily energy intake of 1,388 calories.

The main sources of sugar were fruit (average daily intake = 13g), dairy products (18.6g), sugar-sweetened beverages (41.7g) and sugary snacks (13.1g).

At 10/11 years of age, 102 children with normal weight at the age of 3 had developed overweight or obesity.

Total sugar intake at 3 years was not related to BMI Z-score, weight gain or weight status 10/11 years.

However, a higher intake of sugar from sugary snacks was related to a higher BMI Z-score at 10/11.

In contrast, a higher daily sugar intake from fruit (whole fruit only) was related to a lower BMI Z-score at 10/11 years and less weight gain. (No significant association was found between fruit juice and weight.)

And a higher sugar intake from unsweetened liquid dairy products (milk and buttermilk) was related to a lower odds of developing overweight/obesity at age 10/11. Children with the highest intake of these products aged 3 had a 67% lower risk of going on to have overweight/obesity, compared to those with the lowest intake.

The study didn’t look at why these foods affected weight differently. However, possible explanations include slower release of sugar from pieces of fruit than from sugary snacks and differences in how the sugars in the different foods (sucrose in cakes and confectionery, fructose in fruit and lactose in dairy) act on the body.

The researchers conclude that when it comes to developing obesity in childhood, the source of sugar seems to be more important than the amount.

Ms Zou adds: “Children should be encouraged to have fruit and milk instead of sweetened milk and yoghurt drinks, sweets, cakes and other foods rich in added sugar.”

Reference:

Source of sugar may be more important than amount when it comes to the development of obesity in children, European Association for the Study of Obesity, Meeting: European Congress on Obesity (ECO2024).

A recent study published in the Journal of Orthopaedic Surgery and Research highlights the role of a potential new indicator for postoperative success in rotator cuff tear repairs. The study analyzes the correlation between preoperative grip strength and postoperative shoulder function following arthroscopic rotator cuff repair (ARCR) where precise predictions can make all the difference in patient outcomes.

Rotator cuff tears (RCTs) are a widespread musculoskeletal issue that often necessitates surgical intervention for repair. ARCR is a common procedure for tendon repair which is frequently used in addressing this condition. The ability to accurately predict postoperative outcomes remains an ongoing challenge for orthopedic surgeons.

The study prospectively enrolled a total of 52 patients with full-thickness repairable RCTs to bridge this gap in knowledge. The baseline parameters like patient characteristics and intraoperative findings were meticulously analyzed along with postoperative shoulder functional outcomes. The Quick Disabilities of the Arm, Shoulder and Hand (QDASH) questionnaire and Constant–Murley scores (CMSs) served as the measures to evaluate shoulder function.

The study discovered a strong association between preoperative grip strength and postoperative shoulder function. The patients who expressed higher grip strength prior to surgery tended to experience more favorable outcomes following ARCR. This finding suggests that a simple preoperative grip strength test could serve as a valuable predictor for postoperative shoulder functional recovery.

The study identified other factors that influenced postoperative outcomes. The number of total suture anchors utilized during surgery inversely correlated with postoperative CMSs by indicating a potential impact of surgical technique on patient recovery. The higher body mass index (BMI) was associated with poorer postoperative QDASH scores during follow-up by highlighting the multifaceted nature of factors that influence surgical outcomes.

These findings suggest that implementing preoperative grip strength assessments as part of the standard evaluation process could provide valuable insights into expected postoperative recovery trajectories. Surgeons can tailor interventions and support strategies accordingly by identifying patients who may face challenges in their rehabilitation journey which could ultimately enhance the overall patient care and satisfaction.

The studies like this serve as important steps toward improving surgical outcomes and patient quality of life. Further research and clinical validation will help in making preoperative grip strength testing as a fundamental tool to offer personalized care and optimized results for individuals who undergo ARCR.

Source:

Liu, Y.-C., Huang, S.-W., Adams, C. R., Lin, C.-Y., Chen, Y.-P., Kuo, Y.-J., & Chuang, T.-Y. (2024). Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair. In Journal of Orthopaedic Surgery and Research (Vol. 19, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13018-024-04750-8