GLP-1 receptor agonists show potential in reducing obesity-associated cancers among type 2 diabetes patients: JAMA

USA: The cohort study of more than 1.6 million patients with type 2 diabetes (T2D) with no prior diagnosis of 13 obesity-associated cancers (OACs) showed that glucagon-like peptide receptor agonists (GLP-1RAs) may reduce the risk of specific compared with insulins or metformin.

Patients with T2D treated with GLP-1 receptor agonists versus insulin had a significant risk reduction in 10 of 13 OACs, including colorectal, esophageal, gallbladder, endometrial, liver, kidney, ovarian, and pancreatic cancer as well as meningioma and multiple myeloma, the researchers report in JAMA Network Open. Compared with metformin, no decrease in cancer risk was associated with GLP-1RAs.

Thirteen human malignant neoplasms have been identified as OACs, i.e., excess body fat is associated with an increased risk of cancer development and a worse prognosis in patients with these specific tumors. The glucagon-like peptide receptor agonist class of pharmaceuticals are effective agents for type 2 diabetes treatment and achieving weight loss, however, there is no clarity on the association of GLP-1RAs with the incident risk of 13 OACs. Therefore, Lindsey Wang, Case Western Reserve University School of Medicine, Cleveland, Ohio, and colleagues aimed to compare the incident risk of each of the 13 obesity-associated cancers in patients with T2D who were prescribed GLP-1RAs versus insulins or metformin.

The retrospective cohort study utilized a nationwide multicenter database comprising electronic health records (EHRs) from 113 million US patients. The study cohort comprised 1,651,452 patients diagnosed with T2D with no prior history of OACs and were prescribed GLP-1 receptor agonists, insulins, or metformin between March 2005 and November 2018. Data analysis was performed on April 26, 2024.

The researchers examined incident (first-time) diagnosis of each of the 13 OACs occurring during a 15-year follow-up after the exposure using Cox proportional hazard and Kaplan-Meier survival analyses with censoring applied.

The study led to the following findings:

  • In the study population of 1 651 452 patients with T2D (mean age, 59.8 years; 50.1% male), GLP-1RAs compared with insulin were associated with a significant risk reduction in 10 of 13 OACs, including in gallbladder cancer (HR, 0.35), meningioma (HR, 0.37), hepatocellular carcinoma (HR, 0.47), pancreatic cancer (HR, 0.41), ovarian cancer (HR, 0.52), multiple myeloma (HR, 0.59), colorectal cancer (HR, 0.54), esophageal cancer (HR, 0.60), kidney cancer (HR, 0.76), and endometrial cancer (HR, 0.74).
  • Although not statistically significant, the HR for stomach cancer was less than one among patients who took GLP-1RAs compared with those who took insulin (HR, 0.73).
  • GLP-1RAs were not associated with a reduced risk of postmenopausal breast cancer or thyroid cancer.
  • Of those cancers that showed a decreased risk among patients taking GLP-1RAs compared with those taking insulin, HRs for patients taking GLP-1RAs vs those taking metformin for colorectal and gallbladder cancer were less than 1, but the risk reduction was not statistically significant.
  • Compared with metformin, GLP-1RAs were not associated with a decreased risk of any cancers but were associated with an increased risk of kidney cancer (HR, 1.54).

In the study, GLP-1RAs were associated with lower risks of specific types of OACs compared with metformin or insulins in patients with T2D.

“These findings offer initial evidence suggesting that GLP-1 receptor agonists may have potential benefits in preventing cancer among populations at heightened risk,” the researchers concluded. “They underscore the need for additional preclinical and clinical investigations aimed at preventing specific obesity-associated cancers.”

Reference:

Wang L, Xu R, Kaelber DC, Berger NA. Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes. JAMA Netw Open. 2024;7(7):e2421305. doi:10.1001/jamanetworkopen.2024.21305

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Blood test can help predict risk of obstructive sleep apnea: Study

Measuring the level of homocysteine, an amino acid, in the blood can help predict a person’s risk of developing obstructive sleep apnea, a disorder characterized by recurrent interruptions in breathing due to relaxation of the throat muscles during sleep. This simple blood test can also help clinicians gauge whether a patient with the mild or moderate form of the disorder is likely to develop the severe form, according to a study conducted in Brazil by researchers at the Sleep Institute and the Federal University of São Paulo (UNIFESP), with FAPESP’s support.

An article describing the study is published in European Archives of Oto-Rhino-Laryngology.

“We don’t yet know whether apnea causes the rise in blood levels of homocysteine or the rise in levels of this amino acid causes severe apnea. Our hypothesis is that it’s a two-way correlation,” says Monica Levy Andersen, a professor at UNIFESP and last author of the article. “It would be a good idea for more physicians in all specialties to include a homocysteine test in the blood work prescribed for checkups of people over 40. It’s simple and low-cost for the SUS [Sistema Único de Saúde, Brazil’s public health service]. The results could provide more information on this correlation, at the very least.”

Homocysteine has long been a concern for cardiologists since there is strong evidence that abnormally high levels of the amino acid (hyperhomocysteinemia), i.e. more than 15 micromoles per liter of blood (µmol/l), can cause alterations in blood vessel walls and favor the development of coronary disease, thrombosis, heart attacks and strokes.

“A deficiency of B-complex vitamins, especially B6, B9 and B12, predisposes a person to hyperhomocysteinemia. Eating food that contains these vitamins or taking them as supplements can be a strategy to modulate blood levels of the amino acid,” explains Vanessa Cavalcante-Silva, a postdoctoral researcher at UNIFESP and first author of the article.

Epidemiology of sleep

The Epidemiological Study of Sleep (“Episono”) has been led for more than 15 years by Sergio Tufik, also a professor at UNIFESP, to find out about sleep quality and the influence of sleep disorders on the health of people living in São Paulo city.

Data for 2007, published by the group in another article, showed that 42% snored three times per week or more, and almost 33% had sleep apnea.

Besides complaints from family members about loud snores, apnea impairs concentration and memory. It also accelerates cellular aging and increases the risk of several ailments, such as high blood pressure, diabetes and heart failure (read more at: agencia.fapesp.br/42179).

To investigate the correlation between sleep apnea and blood levels of homocysteine, the team coordinated by Andersen selected a sample of Episono volunteers who had taken a polysomnography test to measure their apnea-hypopnea index (AHI), which indicates the severity of sleep apnea by counting the number of times breathing slows or stops during an average hour of sleep.

“Up to five events per hour is considered normal. Between five and 15 is classed as mild apnea, 15-30 is moderate, and more than 30 is severe,” Cavalcante-Silva says.

The team first measured the AHI of 854 volunteers who took part in the 2007 round of the Episono survey, diagnosing no apnea in 54.4%, mild apnea in 24.4%, moderate apnea in 12.4% and severe apnea in 8.8%. The same subjects were also classified according to blood levels of homocysteine, with up to 10 µmol/l being considered normal, 10-15 µmol/l moderate, and more than 15 µmol/l high.

“When we cross-tabulated the data, we saw that subjects with high levels of homocysteine also had a higher AHI. Those with more than 15 µmol/l had an AHI that was 7.43 higher on average than those with less than 10 µmol/l,” Cavalcante-Silva says. The influence of factors such as weight, biological sex and age was corrected by statistical methods.

In a second stage, the researchers analyzed data for the same volunteers in the 2015 round of the survey, although the sample size fell to 561 as some of them were unable to participate in this round. The proportions were now as follows: no apnea 29.8%, mild 31.2%, moderate 19.4%, severe 19.6%.

“In this stage, the aim was to find out whether homocysteine was a risk factor for the development of apnea, so we excluded participants who had apnea in 2007 and analyzed the data for those who were then sleeping normally. In this subgroup, a rise of 1 µmol/l in the 2007 level of homocysteine represented a rise of 0.98% in the risk of a diagnosis of apnea in 2015,” Cavalcante-Silva says.

“It’s a low risk, but it exists. The fact is that we presented a novel factor which is easy to measure and has clinical and practical applicability,” Andersen notes. “Now it would be interesting to conduct a study with a different format, in which the participants are assessed annually and we could obtain more extensive data.”

Reference:

Cavalcante-Silva, V., Morelhão, P.K., Fernandes, G.L. et al. Homocysteine as a predictor of apnea–hypopnea index in obstructive sleep apnea: a longitudinal epidemiological study (EPISONO). Eur Arch Otorhinolaryngol 281, 3237–3243 (2024). https://doi.org/10.1007/s00405-024-08614-z.

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Gastroesophageal reflux disease may increase risk of atrial fibrillation, suggests study

A recent research unveiled a significant association between gastroesophageal reflux disease (GERD) and an increased risk of developing atrial fibrillation (AF). This observational study published in the recent issue of Frontiers in Cardiovascular Medicine suggests that GERD could be a contributing factor to AF.

Atrial fibrillation affects approximately 2% to 3% of the global population. The individuals with AF are at a higher risk of heart failure and stroke and may experience symptoms such as fatigue, dyspnea, dizziness and heart palpitations. AF imposes significant health and economic burdens on society by contributing to substantial medical expenses and diminished quality of life.

To explore this potential link, Lei Wang and team employed a two-sample Mendelian randomization (MR) approach which assessed the causal impact of one condition on another by using genetic variants as instrumental variables. The study utilized data from two large genome-wide association studies (GWAS). The first GWAS included a total of 6,02,604 participants and examined the genetic variants associated with GERD. The second GWAS, involving over 1,030,836 participants which focused on genetic variations linked to AF.

The analysis utilized 76 single nucleotide polymorphisms (SNPs) as markers to investigate the relationship between genetically predicted GERD and AF incidence. The MR analysis revealed a significant correlation between GERD and AF.

The inverse-variance weighted method was employed to evaluate effect sizes and additional statistical techniques such as MR-Egger, simple mode, weighted mode, MR Pleiotropy Residual Sum, outlier and weighted median were used for sensitivity analysis. This model showed that genetically predicted GERD was associated with a higher incidence of AF, with an odds ratio (OR) of 1.165 (95% CI 1.102–1.231; P = 7.637 × 10−8). Also, the MR-Egger method indicated no evidence of gene pleiotropy by suggesting that the observed association was not prompted by the confounding genetic factors (intercept = 0.003, P = 0.581). The reliability and robustness of these findings were confirmed through various MR methods in the sensitivity analysis.

The findings of this research suggest a potential causal link between GERD and an increased risk of AF. If GERD is indeed a contributing factor to AF, early treatment of GERD might reduce the risk of developing AF. Further research and elaborate clinical trials are required to fully establish this causal significance.

Reference:

Wang, L., & Lu, Y. W. (2024). Gastroesophageal reflux disease may causally associate with the increased atrial fibrillation risk: evidence from two-sample Mendelian randomization analyses. In Frontiers in Cardiovascular Medicine (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fcvm.2024.1393383

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POST-PCI Trial: Surveillance stress testing at 12 months offers no added benefit in high-risk PCI patients, regardless of ACS status

South Korea: In the realm of post-percutaneous coronary intervention (PCI) care, the debate over the necessity of routine stress testing continues to evolve, particularly concerning patients with and without acute coronary syndrome (ACS). A secondary analysis of the POST-PCI randomized clinical trial sheds new light on this crucial aspect of cardiovascular management.

The prespecified analysis of the POST-PCI randomized clinical trial including 1706 patients revealed no incremental benefit from surveillance stress testing at 12 months compared with standard care alone in high-risk patients who had undergone PCI presenting with or without ACS.

“ACS patients had higher rates of major cardiovascular events (MACE) than those without ACS in the first year after PCI,” the researchers reported in JAMA Cardiology. “A follow-up strategy of functional testing at 12 months failed to improve clinical outcomes during long-term follow-up compared with standard care, irrespective of initial ACS status.”

Patients undergoing PCI after ACS represent a common and high-risk cohort within atherosclerosis management. Despite advancements in PCI devices and antithrombotic therapies, concerns persist regarding residual ischemic risk and recurrent cardiovascular events post-PCI. The optimal surveillance strategy for these patients remains contentious, with advocates proposing active surveillance to mitigate future ischemic events. Routine stress testing is frequently employed in clinical practice post-PCI, yet its prognostic significance in high-risk ACS patients remains uncertain.

Given the heightened risk of adverse cardiovascular events and mortality in ACS compared to stable coronary artery disease, the utility of routine stress testing warrants evaluation in this subgroup. Drawing upon data from the POST-PCI trial, which compared routine stress testing with standard care in high-risk PCI patients, Jinho Lee, University of Ulsan College of Medicine, Seoul, South Korea, and colleagues aimed to assess clinical outcomes based on randomized follow-up strategies at 12 months. This analysis specifically examines the impact of routine functional testing in patients initially presenting with ACS versus those without ACS.

The POST-PCI trial was a randomized clinical trial that compared routine functional testing follow-up strategies vs standard care alone 12 months after high-risk PCI. Patients were categorized as presenting with or without ACS. Patient enrollment was from 2017 through 2019, and patients were randomized from 11 sites in South Korea; data analysis was performed in 2022.

Patients categorized as presenting with or without ACS were randomized to either a routine functional testing or standard care alone follow-up strategy 12 months following high-risk PCI.

The primary endpoint assessed was a combination of mortality from any cause, myocardial infarction, or hospitalization due to unstable angina within two years from randomization. Kaplan-Meier curves were used to determine event rates over the study period, and Cox proportional hazard models were employed to calculate hazard ratios (HRs), with interactions also evaluated.

The study led to the following findings:

  • Of 1706 included patients, 350 patients, 20.5% were female, and the mean patient age was 64.7 years. In total, 526 patients presented with ACS.
  • Compared with those without ACS, patients with ACS had a 55% greater risk of the primary outcome (HR, 1.55) due to higher event rates in the first year.
  • The 2-year incidences of the primary outcome were similar between strategies of routine functional testing or standard care alone in patients with ACS (functional testing: 6.6%; standard care: 8.5%; HR, 0.76) and patients without ACS (functional testing: 5.1%; standard care: 4.9%; HR, 1.04).
  • Although a landmark analysis suggested that invasive angiography and repeat revascularization rates were higher after one year in the routine functional testing group, the formal interactions between ACS status and either invasive angiography or repeat revascularization were non-significant.

Among high-risk patients with acute coronary syndrome who underwent PCI, implementing routine surveillance functional testing 12 months post-PCI did not reduce the incidence of the primary composite outcome—including all-cause mortality, myocardial infarction (MI), or hospitalization for unstable angina—compared to those receiving standard care alone over two years.

“These findings were consistent irrespective of ACS status, though the study had insufficient statistical power to allow for firm conclusions,” the researchers concluded.

Reference:

Lee J, Kang D, Kim H, et al. Routine Stress Testing After PCI in Patients With and Without Acute Coronary Syndrome: A Secondary Analysis of the POST-PCI Randomized Clinical Trial. JAMA Cardiol. Published online June 26, 2024. doi:10.1001/jamacardio.2024.1556

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Empagliflozin Use Leads to Rare Case of Emphysematous Cystitis in Non-Diabetic Patient: Case Study

Malta: A recent case study published in Cureus Journal has described a rare medical case in which the use of empagliflozin, a medication typically prescribed for managing type 2 diabetes (T2D), has been linked to the development of emphysematous cystitis in a non-diabetic patient. Emphysematous cystitis (EC) is a severe and uncommon urinary tract infection characterized by gas within the bladder wall and lumen. It is predominantly seen in diabetic patients.

Empagliflozin belongs to a class of medications known as sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which work by increasing glucose excretion through the urine. While typically used to lower blood sugar levels in patients with diabetes, these drugs have also been associated with various side effects, including urinary tract infections.

Emphysematous cystitis poses a complex and potentially life-threatening urinary tract infection characterized by the accumulation of gas within the bladder walls and surrounding tissues. The exact pathophysiology of this condition remains poorly understood, though it is often linked to facultative anaerobic microorganisms. While emphysematous cystitis is most commonly seen in individuals with diabetes, it’s important to note that non-diabetic patients can also be affected, often due to various underlying risk factors, as detailed below.

Notably absent in medical literature are reported cases of emphysematous cystitis associated with empagliflozin use in non-diabetic patients with heart failure and reduced ejection fraction. The unique and unprecedented situation highlights the significance of the case study, which aims to explore this unexplored area and provide valuable insights into the management and understanding of emphysematous cystitis in non-diabetic patients with diverse clinical profiles.

The case concerns an 83-year-old non-diabetic male with end-stage heart failure who presented with symptoms of EC after being administered empagliflozin.

The etiology, diagnostic techniques, potential risk factors, and prospective management strategies were examined. Additionally, the possible influence of the patient’s comorbidities, along with the SGLT2 inhibitor’s mechanism of action, was postulated as the primary cause.

Although the patient does not have diabetes, his current treatment regimen for heart failure and his diagnosis, especially considering frailty and advanced age, create conditions that could potentially lead to the development of emphysematous cystitis, the study stated.

The researchers suggested that a combination of glycosuria due to SGLT2 inhibitors’ use could have set the stage for the mentioned facultative organisms to colonize the bladder.

They explained, “Colonization could lead to anaerobic respiration and fermentation, producing carbon dioxide (CO2) and other gases, which then accumulate in the bladder, culminating in the observed disease manifestation.”

In conclusion, The atypical presentation indicates a potential association between empagliflozin and emphysematous cystitis (EC) in non-diabetic patients with heart failure, a correlation not previously documented in medical literature. This underscores the critical need for careful monitoring and additional research in this field.

Reference:

Busuttil N, Khalaf R, Galea I, et al. (May 27, 2024) A Case Study of Emphysematous Cystitis in a Non-diabetic Patient Following Empagliflozin Use: An Uncommon Presentation. Cureus 16(5): e61150. doi:10.7759/cureus.61150

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What you eat at age 40 could influence your quality of life at 70, unravels study

Chicago: We all want to age with grace, but a new study found that fewer than 1 in 10 people were able to live free of disease and maintain good physical, cognitive and mental health to age 70 and beyond.

The study suggests that sticking to a healthy diet in midlife could increase your chance of achieving healthy aging.

The research, based on data from over 100,000 people spanning 30 years, revealed that people who followed a healthy diet from their 40s onward were 43-84% more likely to be well-functioning physically and mentally at age 70 compared with those who did not.

“People who adhered to healthy dietary patterns in midlife, especially those rich in fruits, vegetables, whole grains and healthy fats, were significantly more likely to achieve healthy aging,” said Anne-Julie Tessier, PhD, postdoctoral fellow at Harvard TH Chan School of Public Health. “This suggests that what you eat in midlife can play a big role in how well you age.”

Tessier will present the findings at NUTRITION 2024, the flagship annual meeting of the American Society for Nutrition held June 29–July 2 in Chicago.

In terms of particular foods, the researchers found that higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy were associated with greater odds of healthy aging, while higher intakes of trans fat, sodium, total meats, red and processed meats were associated with a lower odds of healthy aging.

While many previous studies have shown that a healthy diet can help to ward off chronic diseases, the new research is unique in its focus on healthy aging — defined not just as the absence of disease but the ability to live independently and enjoy a good quality of life as we grow older.

“Traditionally, research and derived dietary guidelines have focused on preventing chronic diseases like heart disease,” said Tessier. “Our study provides evidence for dietary recommendations to consider not only disease prevention but also promoting overall healthy aging as a long-term goal.”

Researchers analyzed data from over 106,000 people going back to 1986. Participants were at least 39 years old and free of chronic diseases at the start of the study and provided information about their diet via questionnaires every four years. As of 2016, nearly half of the study participants had died and only 9.2% survived to age 70 or older while maintaining freedom from chronic diseases and good physical, cognitive and mental health.

The researchers compared rates of healthy aging among people in the highest versus lowest quintiles for adherence to each of eight healthy dietary patterns that have been defined by previous scientific studies. The strongest correlation was seen with the alternative healthy eating index, a pattern that reflects close adherence to the Dietary Guidelines for Americans. Participants in the top quintile for this dietary pattern were 84% more likely to achieve healthy aging than those in the bottom quintile.

Strong correlations were also found for the empirical dietary index for hyperinsulinemia diet (associated with a 78% greater likelihood of healthy aging), planetary health diet (68%), alternative Mediterranean diet (67%), dietary approaches to stop hypertension (DASH) diet (66%), the Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet (59%) and empirical dietary inflammatory pattern (58%). A somewhat more modest association was found for the healthful plant-based diet (43%).

“A finding that stood out was the association between the planetary health diet and healthy aging,” said Tessier. “This diet is based on the EAT Lancet Commission’s report which emphasizes fruits, vegetables, whole grains, plant proteins and healthy fats from sustainable sources. The fact that it emerged as one of the leading dietary patterns associated with healthy aging is particularly interesting because it supports that we can eat a diet that may benefit both our health and the planet.”

The ties between diet and healthy aging remained strong even when the researchers accounted for physical activity and other factors that are known to impact health. Tessier noted that each of the healthy dietary patterns was linked with healthy aging as a whole, as well as with the individual components of healthy aging, including physical health, cognitive functioning and mental health.

Given the study’s focus on dietary patterns in middle age, Tessier said that future research could help to elucidate the potential impacts of switching to a healthier dietary pattern later in life.

References: What you eat at age 40 could influence your quality of life at 70 AMERICAN SOCIETY FOR NUTRITION MEETING NUTRITION 2024

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Exercise, improvement of thyroid function and weight control may improve low backache during pregnancy: Study

Researchers have identified significant associations between physical inactivity, weight gain, hypothyroidism, and lower back pain (LBP) during pregnancy, shedding light on critical factors influencing maternal health. A study was recently published in the Journal of Back and Musculoskeletal Rehabilitation by Shi C. and colleagues in China.

Pregnancy induces profound physiological changes, including hormonal fluctuations and weight gain, which can exacerbate musculoskeletal issues like lower back pain. Physical inactivity during pregnancy is a known risk factor for various complications, and thyroid function abnormalities, such as hypothyroidism, further complicate maternal health.

In this cohort study, researchers enrolled 420 pregnant women with an average age of 26.333 ± 5.820 years. Participants were initially screened with the question: “Do you have any plans for pregnancy in the next month?” Those who responded affirmatively underwent further evaluations. Physical activity levels and pain intensity were assessed using the International Physical Activity Questionnaire Short Form (IPAQ-S) and Visual Analogue Scale, respectively. Serum thyroid-stimulating hormone (TSH) levels were measured using automated chemiluminescence assays and commercial kits. Assessments were conducted at four points: before pregnancy and during the first, second, and third trimesters.

The key findings of the study were as follows:

• Women who reported LBP demonstrated lower engagement in physical activities compared to those without LBP. This association was consistent across all trimesters.

• Pregnant women with LBP experienced significantly higher weight gain during the second and third trimesters compared to their counterparts without LBP (p < 0.05).

• Women with low physical activity levels had notably higher TSH levels throughout pregnancy compared to those with moderate to high physical activity (p < 0.05). There were no significant differences in body mass index (BMI) related to TSH levels.

• Factors such as physical inactivity (before pregnancy: OR 1.11, 95% CI 0.89-1.22; first trimester: OR 1.09, 95% CI 1.02-1.59; second trimester: OR 0.92, 95% CI 0.87-1.31; third trimester: OR 1.12, 95% CI 1.02-1.39), TSH levels (OR 0.85, 95% CI 0.57-1.29), and weight gain (second trimester: OR 0.87, 95% CI 0.92-1.59; third trimester: OR 1.44, 95% CI 1.02-1.98; p < 0.05) were identified as predictors of increased pain intensity during pregnancy.

Researchers observed that physical inactivity, elevated TSH levels, and higher weight gain predicted increased pain intensity throughout pregnancy. These findings underscore the importance of health-oriented interventions aimed at promoting physical activity, maintaining thyroid function, and managing weight gain in pregnant women to alleviate lower back pain and enhance maternal well-being.

Reference:

Shi, Chencui, Zou, Qiangdong, and Wei, Hong. ‘The Association of Back Pain with Physical Inactivity and Hypothyroidism in Pregnant Women’. 1 Jan. 2024 : 1 – 9. https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr240086

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Cognitive behavioral intervention reduces eating disorder symptoms in bulimia nervosa: Study

A recent study published in the Journal of American Medical Association suggests that integrating digital interventions into routine care could help reach more patients and reduce the clinical burden associated with bulimia nervosa (BN).

This 2-group randomized clinical trial analyzed the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BN. The trial conducted in Germany from February 2, 2021 to July 9, 2022 included participants of 18 to 65 years old who fulfilled the diagnostic criteria for BN. The participants enrolled online through self-referral and data analyses were conducted from October 24, 2022 to December 23, 2023.

The intervention consisted of a web-based cognitive behavioral self-help program that included 12 weekly modules and this was compared to a waiting-list control group that only had access to routine care. The primary outcome analyzed was the change in the number of bulimic episodes between baseline and posttreatment. The secondary outcomes included changes in global eating disorder symptoms, clinical impairment, well-being, work capacity, comorbid symptoms, self-esteem and emotion regulation which were complemented by weekly measures and ecological momentary assessment.

The study involved a total of 154 participants with a mean age of 29.6 years, of which 96.8% were female. The results indicated that the participants who were receiving the web-based intervention showed a significantly greater decrease in bulimic episodes when compared to the control group. The intervention group demonstrated a Cohen d of −0.48 for bulimic episodes and a Cohen d of −0.61 for binge-eating episodes. Also, no significant changes were observed in the compensatory behaviors (Cohen d = −0.25; 95% CI, −0.51 to 0.02; P = .21). This intervention was superior in enhancing the global eating disorder symptoms and clinical impairment. Also, there were no significant effects observed on well-being and work capacity.

Further in depth analyses found significant improvements in self-esteem and emotion regulation issues among the intervention group. Also, no significant changes were found in comorbid symptoms which suggested that while the web-based intervention was effective in addressing core eating disorder symptoms and related impairments, it did not impact other co-occurring psychological issues.

The outcomes highlights the effectiveness of a web-based cognitive behavioral self-help intervention in reducing eating disorder symptoms and the disease-related burden in individuals with BN. Overall, these findings illuminate the potential of digital interventions to complement established treatments and provide better access to care for the patients with bulimia nervosa.

Source:

Hartmann, S., Timm, C., Barnow, S., Rubel, J. A., Lalk, C., & Pruessner, L. (2024). Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa. In JAMA Network Open (Vol. 7, Issue 7, p. e2419019). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.19019

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Oxycodone PR or high dose levodopa not effective against parkinsonian central pain, suggests study

A new study published in the journal of Movement Disorders found that neither oxycodone-prolonged release (PR) nor higher doses of levodopa/benserazide offer significant relief for Parkinsonian central pain (PCP).

Patients with Parkinson’s disease (PD) report chronic pain which has a significant negative influence on their quality of life unlike the general population. The patients with Parkinson’s disease experience a wide range of chronic pain. This includes non-specific pain like musculoskeletal, radicular and restless syndrome and specific pain like dystonia and parkinsonian central pain (PCP), also known as ‘central neuropathic pain’. These pains are mostly caused by various underlying neuropathic, nociceptive and nociplastic mechanisms.

The OXYDOPA study evaluated the pain-relieving effects of oxycodone-PR and increased doses of levodopa/benserazide in patients with PCP. The trial was conducted across 15 centers within the French NS-Park network and included a meticulous design to ensure reliable outcomes. This randomized, double-blind, double-dummy, placebo-controlled, multicenter parallel-group trial ensured that any changes in pain were due to the treatment rather than psychological factors.

The study included a total of 66 PD patients who reported significant PCP (measured as ≥30 on the Visual Analogue Scale) were randomly assigned to receive either oxycodone-PR (up to 40 mg/day), levodopa/benserazide (up to 200 mg/day) or a matching placebo. This was administered three times daily and these treatments were added to the existing dopaminergic therapy which is the standard treatment for PD.

The major findings of this study were:

After 10 weeks, the primary endpoint was the change in average pain intensity over the previous week, rated on the VAS. The mean change in pain intensity for the oxycodone-PR group was a decrease of 17 points (±18.5), the levodopa/benserazide group saw a decrease of 8.3 points (±11.1) and the placebo group experienced a decrease of 14.3 points (±18.9). When compared to the placebo, the difference was negligible for both treatments. Oxycodone-PR showed an absolute difference of -1.54 points, while levodopa/benserazide showed a difference of +7.79 points

All-cause adverse events were experienced by a comparable percentage of participants in each group. Oxycodone-PR was associated with the highest rate of trial dropout (39%) when compared to levodopa/benserazide (5%) and placebo (15%). In summary, despite low tolerance of oxycodone-PR, the findings of this study was unable to derive if this was better for PCP patients than a higher dosage of levodopa.

Reference:

Brefel‐Courbon, C., Harroch, E., Marques, A., Devos, D., Thalamas, C., Rousseau, V., Ory‐Magne, F., Fabbri, M., Maltête, D., Rouaud, T., Drapier, S., Tir, M., Thobois, S., Salhi, H., Corvol, J. C., Castelnovo, G., Lagha‐Boukbiza, O., Fluchère, F., Frismand, S., … Rascol, O. (2024). Oxycodone or Higher Dose of Levodopa for the Treatment of Parkinsonian Central Pain: OXYDOPA Trial. In Movement Disorders. Wiley. https://doi.org/10.1002/mds.29878

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Chronic Tonsillitis Linked to Increased Risk of IgA Nephropathy, Study Finds

Researchers have identified a significant association between chronic tonsillitis and the risk of developing IgA nephropathy (IgAN), a kidney disorder, according to findings from a recent large-scale study in Japan. This study, analysing records of over 4 million individuals, focuses on a previously unexplored link, highlighting the potential implications for clinical practice and patient management. The study was published in the American Journal Of Kidney Diseases conducted by Nakayama T. and colleagues.

IgA nephropathy is a condition characterized by the buildup of immunoglobulin A (IgA) deposits in the kidneys, leading to inflammation and potentially progressive kidney damage. While its exact causes remain unclear, various factors such as genetic predisposition, ethnicity, and environmental triggers are thought to contribute. Chronic tonsillitis, a persistent inflammation of the tonsils, has been increasingly implicated in immune-related disorders, particularly in East Asian populations.

Using the JMDC Claims Database, researchers conducted an observational cohort study spanning from January 2005 to May 2022. They analyzed data from 4,311,393 individuals who underwent health check-ups and had complete medical records, excluding those with prior IgAN or missing data on key variables. Of these, 12,842 individuals (0.3%) had a history of chronic tonsillitis.

The study findings were as follows:

• During a median follow-up period of approximately 3 years, researchers documented 2653 cases of IgA nephropathy.

• The incidence rate of IgAN was notably higher among individuals with chronic tonsillitis (4.93 per 10,000 person-years) compared to those without (1.74 per 10,000 person-years).

• Multivariable analysis revealed that individuals with chronic tonsillitis faced a significantly elevated risk of developing IgAN (HR, 2.72; 95% CI, 1.79-4.14).

The study underscores the importance of recognizing chronic tonsillitis as a potential risk factor for IgA nephropathy. It calls for heightened vigilance among healthcare providers, particularly in populations where chronic tonsillitis is prevalent. Further research is needed to elucidate the underlying mechanisms linking tonsillitis to IgAN and to explore potential preventive strategies.

Reference:

Nakayama, T., Kaneko, H., Suzuki, Y., Okada, A., Morita, H., Fujiu, K., Takeda, N., Fukui, A., Yokoo, T., Takeda, N., Yasunaga, H., Nangaku, M., & Hayashi, K. (2024). Chronic tonsillitis and IgA nephropathy: Findings from a nationwide Japanese cohort study. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation. https://doi.org/10.1053/j.ajkd.2024.04.015

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