Archive for month: September, 2024

Tranexamic acid may help control GI bleeding, and prevent rebleeding in cirrhosis patients suggests a study published in the Hepatology.

Estonia: The follow-up study group of the Gestational Diabetes Study (GDS) has shed light on the impact of maternal weight-related factors on the development of atopic diseases, including asthma, in children born to mothers at risk for gestational diabetes mellitus (GDM).

Recent research found that 0.25% lidocaine is as effective as the commonly used 0.5% concentration in dermatological surgeries, with potential benefits of patient safety and effectiveness. The 0.25% dosage was satisfactory to the patients with an advantage of reduced risk of potential toxicity. The trial results were published in the journal Dermatologic Surgery. 

Lidocaine is a local anesthetic extensively used in dermatologic surgery. It is the staple anesthetic of choice for procedures such as Mohs surgery and standard excisions. Despite its widespread use, there is no formal standard was established for the optimal concentration of lidocaine to be used in these procedures. Most of the surgeons use 0.5% due to the lack of standardized concentration guidelines across clinics. However, recent literature has challenged this norm by suggesting that more dilute concentrations of lidocaine may be equally effective while offering additional benefits, including reduced toxicity risks and conservation of lidocaine supplies—critical during periods of shortage. As research showed that more dilute lidocaine concentrations may achieve similar anesthetic effects while minimizing risks, Yelena et al from Baylor College of Medicine, Houston, Texas conducted a study to evaluate the efficacy of 0.25% lidocaine in comparison to 0.5% lidocaine. They carried out a double-blind, randomized controlled trial to determine if the lower concentration could provide adequate anesthesia during dermatologic surgery, specifically in Mohs surgery and standard excisions, without compromising patient comfort or safety.

The trial involved 100 patients who were randomized to receive either 0.25% or 0.5% lidocaine for percutaneous anesthesia before undergoing cutaneous surgery. Objectivity was maintained by blinding both the patients and the surgeons to the concentration being administered. Postoperatively, patients responded to a survey that assessed their pain levels during the procedure, overall satisfaction with the anesthesia, and their willingness to undergo future dermatologic surgeries under the same conditions.

Findings:

• The trial found no statistically significant differences between the two groups.
• Patients who received 0.25% lidocaine reported similar pain levels, satisfaction rates, and willingness to undergo future procedures as those who received 0.5% lidocaine.
• Additionally, there was no notable difference in the total volume of lidocaine used or the need for rescue doses of additional anesthetic.

Thus, the study concluded that 0.25% lidocaine is a safe and effective option for achieving anesthesia during Mohs surgery and standard excisions in dermatology. Lower concentration of the drug can provide comparable anesthetic efficacy to the standard 0.5% concentration. It also has the added advantage of patient safety by reducing the risk of toxicity. Furthermore, usage of the dilute solution for dermatological procedures could help conserve supplies, a significant consideration during times of lidocaine shortages. These results pave the way for optimized, high-value care in dermatologic surgery, prioritizing both patient safety and resource management.

Further reading: Dokic, Yelena MD; Mireles, Nabor Stephen BSA; Hu, Aileen Y. BS; Joshi, Tejas P. BS; Shimizu, Ikue MD; Ranario, Jennifer Song MD, MBA*. Efficacy of 0.25% Lidocaine Versus 0.5% Lidocaine in Dermatologic Surgery: A Double-Blind, Randomized Controlled Trial. Dermatologic Surgery ():10.1097/DSS.0000000000004319, July 12, 2024. | DOI: 10.1097/DSS.0000000000004319

Changes in people’s voices recoded on a smartphone can signal a serious flare up in symptoms of chronic obstructive pulmonary disease (COPD), according to a pilot study presented at the European Respiratory Society (ERS) Congress in Vienna, Austria.

COPD, which includes emphysema and chronic bronchitis, is a serious and long-term lung condition. According to the World Health Organisation, COPD is the third leading cause of death worldwide.

A flare-up in symptoms, such as difficulty breathing and coughing, is known as an exacerbation. During an exacerbation patients may need extra treatment or hospitalisation, and their risk of dying increases. However, if treatment can be given at a very early stage, these risks are far lower.

The study was presented by Ms Loes van Bemmel, a researcher in the department of respiratory medicine at Maastricht University Medical Centre in the Netherlands. She said: “After an exacerbation, patients report a lower quality of life, their lung function can decline, and patients are at an increased and prolonged risk for cardiovascular events such as heart attack and stroke. It’s vital to detect exacerbations as early as possible so appropriate treatment can be given. Unfortunately, it has proved difficult to detect exacerbations at their onset, since symptoms usually start when patients are at home.

“Patients and their families have told us that there are voice changes before and during exacerbations. We wanted to see if we could record patients’ speech at home and analyse these recordings for early signs of an exacerbation.”

Twenty-eight people with COPD took part in the research. Researchers asked them to record their voices via a smartphone app every day for 12 weeks. They recorded themselves saying “aah” for as long as they could manage with one breath, then either reading a short paragraph of a story or answering a question.

Participants also completed a daily questionnaire to gauge their COPD symptoms. During the study, there were 16 occasions when a patient experienced a flare-up of symptoms.

Researchers analysed the voice recordings and looked for changes that coincided with symptom flare-ups. They found that patients’ voices became higher pitched when an exacerbation was imminent. They also found more ‘jitter’ in patients voices when an exacerbation was beginning. Jitter is when a voice sounds breathy or hoarse.

Ms van Bemmel said: “There were clear differences between patients’ recordings on a normal day and on the first day of an exacerbation. This confirmed our hypothesis that speech changes significantly, even at the very beginning of an exacerbation.

“These are preliminary results, so our findings need to be validated in larger numbers of patients with COPD. If we are able to do this, it would pave the way for early detection and diagnosis of exacerbations in the home environment. This would enable patients to manage these events themselves at home.

“While every disease is different, speech analysis could potentially help in other respiratory diseases as well. We suspect there are speech biomarkers for many respiratory diseases.”

Ms van Bemmel and her colleagues are now planning research to build on their findings. In partnership with researchers at Radboud University Medical Centre in the Netherlands, the team will co-create a mobile app with people living with COPD. The SPEAK app will be used by patients to detect exacerbations via speech signals and give support for treating symptoms in the home. At the same time, the researchers are looking into ways to responsibly collect, store and analyse speech data so that the privacy of the speaker is maintained.

Professor Frits Franssen is Secretary of the ERS assembly on respiratory clinical care and physiology, Head of the Department of Respiratory Medicine at Maastricht University Medical Centre, Netherlands, and was not involved in the research. He says: “COPD is a common and serious condition. When symptoms flare up, it can lead to a long-term deterioration in health and can even be fatal. If we spot these exacerbations early and give treatment, we know that serious complications can often be averted. At the moment, that means the patient or their family deciding something is wrong then seeing a doctor for assessment and tests.

“This research is interesting because it suggests that the early signs of a COPD exacerbation can be picked up via changes in a patient’s voice recorded on a smartphone. This finding needs to be tested in a larger study. If it can be validated, this could lead to a quick and efficient system to alert a patient and their doctor that treatment is needed. Because it works via a smartphone, voice analysis could be used by anyone, at anytime and anywhere. This could ultimately save money, time and patients’ lives.”`

Reference:

Voice changes recorded on a smartphone can indicate a flare up of COPD symptoms, European Respiratory Society, Meeting:European Respiratory Society Congress 2024.

Patients with throat problems were less able to regulate their blood pressure in a new study led by the University of Southampton.

The study published in JAMA Otolaryngology is the first to observe reduced baroreflex sensitivity in patients with throat symptoms.

The baroreflex is a crucial part of the autonomic nervous system which detects changes in blood pressure and adjusts our heart rate and blood vessel tone accordingly to maintain stable blood pressure. It is what stops us from fainting when we stand up.

Researchers from the University of Southampton and University Hospitals of Dorset Foundation Trust believe the findings could be explained by the Vagas nerve (which controls the autonomic nervous system) prioritising protection of the airways over less urgent functions, such as blood pressure regulation.

“Our immediate survival depends on the throat being able to separate air and food passages each time we swallow,” says the lead author of the study Reza Nouraei, Professor of Laryngology and Clinical Informatics at the University of Southampton.

“The throat does this using delicate reflexes, but when these reflexes are disturbed, for example, due to a viral infection like Covid or exposure to reflux affecting nerves in this region, the control of this critical junction becomes compromised, giving rise to symptoms like the feeling of a lump in the throat, throat clearing and coughing.

“To compensate for a faulty throat, the autonomic control system must expend significant amounts of energy to maintain a safe airway. We found that in patients with a faulty throat, the heart, specifically a function called baroreflex, is less well controlled. This is one of the Peters that has been robbed to pay Paul.

“The problem with robbing this Peter is that it likely impacts long-term survival, as patients with reduced baroreflex function are more likely to die of a heart attack or stroke in years to come.”

The researchers compared the heart rates, blood pressure and baroreflex sensitivity of 23 patients admitted to Ear, Nose and Throat (ENT) surgery with aerodigestive (laryngopharyngeal) symptoms and 30 patients admitted to Gastroenterology with digestive (esophagogastric) symptoms at University Hospitals of Dorset NHS Foundation Trust.

Reflux was a common cause of symptoms in both groups – making up the majority of digestive group cases. Other causes like thinning of the vocal cord were present in the aerodigestive group.

The team found patients in the aerodigestive group had a higher resting heart rate, lower resting blood pressure, and lower baroreflex sensitivity, than those in the digestive group.

“Now, and especially since Covid which damages nerves, we are seeing more patients with throat symptoms,” says Professor Nouraei.

“Reduced baroreflex sensitivity impacts survival independent of other cardiovascular risks, so if the association we’ve discovered is confirmed by future studies, the need to make timely and accurate diagnoses and provide early and definitive treatments will become more pressing.”

The study adds to the increasing interest in the Vaus nerve and holistic health. As well as regulating blood pressure through the baroreflex, the Vagus nerve controls our heart rate, digestion, respiration, mood and a host of other bodily functions which affect our health and wellbeing.

Professor Nouraei says: “This study helps us to think about patients more holistically. As a clinician, if you can fix a problem in the throat that is potentially taking away bandwidth from the Vagus, then it frees up the nerve to give to the rest of the body.

“If there is a chance that throat problems can affect functions like the baroreflex, or have a wider impact on overall wellbeing, then they need more consideration.”

The researchers will now look at the long-term impacts of throat conditions on autonomic health and the effects of treatment.

Reference:

Nouraei SAR, Ayres L, Perring SJ. Baroreflex Sensitivity in Patients With Laryngopharyngeal Dysfunction—The Overwhelmed Vagus Hypothesis. JAMA Otolaryngol Head Neck Surg. Published online September 05, 2024. doi:10.1001/jamaoto.2024.2270