Dietary Niacin intake may reduce all cause and cardiac mortality in chronic kidney disease: Study

A recent study published in the
journal Frontiers in Nutrition found that dietary intake of niacin is
associated with a reduction in all-cause and cardiac mortality in chronic
kidney disease patients.

Chronic kidney disease (CKD) is a
global health concern with increased morbidity and mortality. Reducing the
disease burden and the risk of the disease is essential to increase the quality
of life of individuals. Nutrition plays a vital role in promoting the health of
the affected individuals. Niacin (vitamin B3) is a precursor for the synthesis
of nicotinamide adenine dinucleotide phosphate (NADP) and nicotinamide adenine
dinucleotide (NAD). These are necessary for mitigating oxidative stress,
inflammation, and endothelial dysfunction. Niacin works by attenuating systemic
inflammation and lowering the risk of cardiovascular events by inhibiting the
production of pro-inflammatory cytokines.

Also Read: Recommendations for screening, treatment, and management of lupus nephritis: New ACR guideline summary

By obtaining data from the
2003–2018 National Health and Nutrition Examination Survey (NHANES) the
researchers conducted a cohort study. The study included about 6,110 patients
with CKD who are 18 years or older. The hazard ratios for all-cause mortality
and cardiovascular disease (CVD) mortality were estimated using Weighted Cox
proportional hazards models and restricted cubic splines (RCS). Based on the
variety and the quantity of food consumed, Niacin intake was estimated using
the 24-hour dietary recall method. National Death Index (NDI) mortality data
(as of 31 December 2018) was used to determine All-cause and cardiac mortality
rates.

Findings:

  • The median niacin intake was 20.89 mg/day, with
    an interquartile range of 15.67–27.99 mg/day.
  • Over a median follow-up of 87 months, there were
    1,984 all-cause deaths, including 714 CVD deaths attributed to cardiovascular
    deaths.
  • Compared with low niacin intake, dietary intake
    of 22 mg or more was associated with a multivariate-adjusted hazard ratio of
    0.71 (95% CI, 0.57–0.88) for all-cause mortality and 0.75 (95% CI, 0.57, 0.98)
    for CVD mortality.
Also Read: Atrasentan Enhances Insulin Sensitivity in Type 2 Diabetes Patients with Chronic Kidney Disease: Study Reveals

The present study is the first
large-scale prospective cohort study to explore the association between dietary
niacin intake and all-cause and cardiovascular mortality in patients with CKD. The
study concluded that higher dietary niacin intake was associated with lower all-cause
mortality and cardiovascular mortality in CKD. Researchers suggested further studies
that explore the dose-response relationship between dietary nicotinate intake
and reduced all-cause and CVD mortality in CKD.

Further reading: Dietary niacin
intake and mortality among chronic kidney disease patients. Front. Nutr. Doi:10.3389/fnut.2024.1435297.

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Early Time Restricted eating more effective than midday Time Restricted for reducing weight and insulin resistance in PCOS patients: Study

Researchers have established that early time-restricted eating (e-TRE) is better than mid-day time-restricted eating (m-TRE) for weight management and for improving insulin sensitivity in women with polycystic ovary syndrome (PCOS). PCOS is the most common endocrine and metabolic disorder affecting women of reproductive age worldwide and is implicated with an increased risk for metabolic syndrome, cardiovascular diseases, and type 2 diabetes. A recent study was conducted by Maryam A. and colleagues which was published in the Iranian Biomedical Journal.

With more and more interest in this specific type of intermittent fasting-the time-restricted eating-in improving weight loss, regulation of glucose, and lipids metabolism, there remain uncertainties as to whether or not such restriction should come early in the day and termed e-TRE (e-TRE) or come middle of the day and labeled as m-TRE (m-TRE). This clinical study, therefore, attempts a head to head comparison of e-TRE vs. m-TRE on selected metabolic parameters on women patients with PCOS.

A total of 50 overweight or obese women, aged 18-40 years, and diagnosed with PCOS using the modified Rotterdam criteria, were enrolled in this randomized clinical trial. The participants were randomly assigned to either the e-TRE group (8:00–18:00, n=25) or the m-TRE group (11:00–21:00, n=25). Both interventions lasted for 6 weeks.

Anthropometric measurements and metabolic markers assessed were body weight, waist circumference (WC), body mass index (BMI), fasting blood sugar (FBS), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Independent and paired t-tests (and non-parametric equivalents) were applied to examine the differences.

Results

Anthropometric Parameters Improved Significantly

  • Both e-TRE and m-TRE groups presented significant reductions in body weight, WC, and BMI after 6 weeks (p = 0.0001).

Enhanced Glycemic Control

  • The FBS and HOMA-IR levels significantly decreased in both groups (p = 0.0001). However, e-TRE showed more significant reduction in the fasting insulin levels (p = 0.0001), which was not significant in the m-TRE group (p = 0.05).

Changes in Lipid Profile

  • e-TRE significantly improved TC and LDL levels (p = 0.0001), while the m-TRE group did not exhibit significant changes (p = 0.05). Changes in TG and HDL were not statistically significant in either group (p = 0.05).

Intergroup Comparisons

  • When comparing e-TRE and m-TRE, significant differences were found in weight, BMI, FBS, TC, LDL, fasting insulin, and HOMA-IR (p = 0.05), favoring e-TRE as the superior intervention.

Early TRE was significantly better than mid-day TRE to reduce body weight and insulin resistance in women with PCOS. These results highlight the potential of e-TRE as an easy and non-pharmacological intervention for improving metabolic disorders associated with PCOS. However, its efficacy on lipid profile and overall metabolic health has to be validated further with more randomized control trials.

Reference:

Aminian M, Hajshafiha M, Heidari M, Daneghian S. Effect of Two Types of Time-Restricted Eating on Glycemic, Lipid Indices and Weight of Women with Polycystic Ovary Syndrome. Iran Biomed J. 2024 Dec 1;28(7):2. PMID: 39645592.

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Endometriosis and Fibroids Linked to Long-Term Premature Mortality Risk, finds research

Researchers have established that endometriosis and uterine fibroids significantly raise long-term risks of premature mortality, or death before the age of 70. These associations are not limited to reproductive ages; they include highly increased risks of death from cancers of the female genital system, diseases of the respiratory system outside cancer, and nervous system disorders. A recent study was conducted by Wang YX. and colleagues which was published in the BMJ journal.

It was an observational cohort study of the Nurses’ Health Study II in the United States from 1989 to 2019. The data were collected for the analysis of premature death effects of such conditions. The prospective cohort study included 110,091 women, aged 25-42 years in 1989, who did not have a history of hysterectomy before diagnosis of endometriosis or fibroids, cardiovascular diseases, or cancer. Over the 27.2 years of follow-up, data were collected from biennial questionnaires and analyzed using Cox proportional hazards models to estimate hazard ratios for total and cause-specific premature mortality.

Key Findings

Premature Death Incidence:

  • Women with laparoscopically confirmed endometriosis had a crude incidence of 2.01 per 1000 person-years compared to 1.40 per 1000 person-years for those without endometriosis.

Hazard Ratios for Premature Mortality:

  • Endometriosis was associated with a 19% higher risk of premature death in age-adjusted models (HR: 1.19; 95% CI, 1.09-1.30), which increased to 31% after adjusting for behavioral factors (HR: 1.31; 95% CI, 1.20-1.44).

  • There was no association between overall preterm mortality and uterine fibroids (HR: 1.03; 95% CI, 0.95-1.11) but a risk of 2.32 times of dying from gynecological cancers was found (HR: 2.32; 95% CI, 1.59-3.40).

Cause-Specific Mortality

  • There was a significant increased risk of death from the following diseases in endometriosis:

  • Malignant neoplasm of organs of the gynecological system: HR 2.76 (95% CI, 1.79-4.26).

  • Diseases of the nervous system: HR 2.50 (95% CI, 1.40-4.44).

  • Non-malignant respiratory diseases: HR 1.95 (95% CI, 1.11-3.41).

  • Senility and ill-defined diseases: HR 1.80 (95% CI, 1.19-2.73).

Combined Conditions:

  • Women with both endometriosis and fibroids had an increased risk of all-cause premature mortality, with differences in cardiovascular and respiratory disease mortality.

This study points out that women with previous endometriosis and uterine fibroids have greater risks of premature mortality by gynecological cancers and non-cancer causes. Such a finding emphasizes the importance of viewing gynecological conditions under a holistic approach to improve long-term health outcomes.

Reference:

Wang, Y.-X., Farland, L. V., Gaskins, A. J., Wang, S., Terry, K. L., Rexrode, K. M., Rich-Edwards, J. W., Tamimi, R., Chavarro, J. E., & Missmer, S. A. (2024). Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study. BMJ (Clinical Research Ed.), 387, e078797. https://doi.org/10.1136/bmj-2023-078797

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Bovhyaluronidase azoximer may reduce exercise intolerance in patients with long-term pulmonary sequelae of COVID-19: Study

Petrovax announced today the positive results from “Long-CoV-III-21,” a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of bovhyaluronidase azoximer in adult patients with pulmonary sequelae of COVID-19. Bovhyaluronidase azoximer, marketed under the brand name Longidaza, is a polymer-conjugated hyaluronidase with an extended half-life. The study drug and placebo were administered for 71 days, with an observation period extending to Day 180.

Longidaza demonstrated a statistically significant 62% reduction in the proportion of patients with exertional desaturation (OR = 0.35, p = 0.0051) and a 27% reduction in the proportion of patients exhibiting exertional dyspnea (OR = 0.62, p = 0.043) by Day 71 compared to placebo. Marked improvements were also observed in resting dyspnea and distance walked during the six-minute walk test. The drug’s effects on exercise tolerance indicators were sustained for more than 100 days after the last dose.

Longidaza did not affect pulmonary function in the overall population. However, subgroup analysis revealed that the drug was associated with a significantly greater change from baseline in predicted Forced Vital Capacity (FVC) in patients with cardiovascular comorbidities (difference = 3.31%, p = 0.042) and in those infected with earlier variants of SARS-CoV-2 (difference = 4.17%, p = 0.021) compared to placebo.

“Long-CoV-III-21 is among the first randomized, double-blind trials to show a significant effect of a novel therapy in patients with post-COVID pulmonary sequelae. The sustained effects of Longidaza offer hope for patients struggling with dyspnea, fatigue, and reduced physical capacity to improve their quality of life,” said Sergey Avdeev, MD, Chair of the Pulmonology Department at Sechenov University and principal investigator of the trial. “Although the drug did not show a significant effect on pulmonary function recovery in the entire study population, results in subgroups strongly suggest that research into hyaluronidase-based medications should continue—not only for post-COVID pulmonary sequelae but also for other fibrotic conditions.”

Study findings were presented at the Asian Pacific Society of Respirology congress in Hong Kong.

In parallel with long COVID research, Petrovax has been developing an inhaled form of Longidaza for the treatment of interstitial lung diseases. The safety of this new delivery route was demonstrated in a recent Phase 1 study. A Phase 2 trial of inhaled Longidaza in patients with idiopathic pulmonary fibrosis is planned for 2025.

About Long-CoV-III-21

Long-CoV-III-21 is a prospective, randomized, double-blind, placebo-controlled clinical trial designed to test the efficacy and safety of Longidaza (3000U) intramuscular injections in patients with pulmonary sequelae of COVID-19 (NCT06383819). Three hundred ninety-two patients were randomized 1:1 to receive either Longidaza or placebo every 5 days for 71 days. The follow-up period lasted up to Day 180. The study enrolled patients with a history of COVID-19 infection 1 to 12 months prior to screening, restrictive lung disease, fibrotic-like radiological abnormalities in the lungs, and decreased SpO2 at rest or after exertion. The study was conducted at 37 clinical sites.

The primary endpoint was the change from baseline in predicted Forced Vital Capacity.

The main secondary endpoints included the proportions of patients with exertional desaturation and dyspnea after the six-minute walk test, the distance walked in the six-minute walk test, and dyspnea at rest.

About Long COVID and Pulmonary Sequelae of COVID-19

Long COVID affects a significant portion of COVID-19 patients, with studies estimating its prevalence at approximately 10-20% of those infected. Long COVID impacts several organ systems, leading to a variety of symptoms, including persistent fatigue, breathlessness, and exercise intolerance, which can last for months or even years beyond the initial infection. A subset of patients with long COVID develop pulmonary sequelae, characterized by fibrotic-like changes in the lungs (assessed by CT), respiratory symptoms, and restrictive-type pulmonary function impairment. Currently, these patients are treated with antifibrotics, steroids, immunosuppressant medications and n-acetyl cysteine. However, all of these approaches lack high-quality evidence specific to post-COVID pulmonary sequelae.

“It may seem that we are past COVID-19, but a recent CDC survey shows that 7% of U.S. adults have had long COVID-about 17 million people. Developing effective therapies to help patients recover is crucial,” says Sergey Avdeev.

About Hyaluronic Acid and Longidaza

Recent research shows that hyaluronic acid is not only a structural component of the extracellular matrix but also a key regulator of fibrotic tissue remodeling and chronic inflammation-key mechanisms of post-COVID pulmonary sequelae. Longidaza (bovhyaluroniodaze azoximer) is a polymer-conjugated hyaluronidase with over 20 years of clinical use, a well-established safety profile, and a prolonged half-life. It has been used clinically as an anti-inflammatory and anti-adhesion therapy. Preclinical studies have demonstrated Longidaza’s potential to reduce fibrosis, while a pilot study involving 160 post-COVID-19 patients showed statistically significant improvements in pulmonary function, respiratory symptoms, and exercise tolerance.

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Ethyl lactate ameliorates liver injury and alcohol-associated liver disease, reveals research

A research team led by Prof. LI Yu from the Shanghai Institute of Nutrition and Health (SINH) of the Chinese Academy of Sciences (CAS) and collaborators have discovered that ethyl lactate, a key nonethanol ingredient found in distilled liquors, ameliorates alcoholic hepatic steatosis (fatty liver), inflammation, and acute-on-chronic liver injury in alcohol-associated liver disease (ALD). The study was published online in Advanced Science.

Increasing global alcohol exposure has aggravated the global prevalence of ALD. Aberrant upregulation of hepatic lipogenesis induced by excessive alcohol consumption is a critical driver of the progression of ALD, and the severity of ALD is highly dependent on the level of alcohol intake. Distilled spirits, with higher ethanol content than wine and beer, may increase the potential for more ethanol ingestion. Currently, there are no effective therapeutic approaches to limiting lipogenesis in ALD patients.

Alcoholic beverages are complex mixtures of water, ethanol, and nonethanol ingredients. Due to their various raw materials, fermentation processes, and aging processes, distilled spirits produce abundant nonethanol ingredients such as esters, acids, higher alcohols, and aldehydes. These nonethanol ingredients determine the quality, type, taste, and flavor of various alcoholic beverages. However, whether nonethanol ingredients in alcoholic beverages regulate the pathogenesis of ALD has largely remained unclear.

In this study, researchers first identified 40 chemical compounds in five widely consumed distilled spirits, i.e., whisky, brandy, baijiu, rum, and vodka, using gas chromatography with flame ionization detection (GC-FID) and high-performance liquid chromatography with ultraviolet detection (HPLC-UV). Thirteen chemical compounds were identified as the main nonethanol ingredients of distilled spirits, based on their concentrations.

To investigate the roles of these nonethanol ingredients in regulating the pathogenesis of ALD, the researchers performed in vivo screening by using a mouse model of chronic-plus-binge ethanol feeding (also known as the Gao-Binge Model). They found that ethyl lactate, alone among these thirteen compounds, ameliorates hepatic steatosis, inflammation, and acute-on-chronic liver injury in a dose-dependent manner.

Mechanistically, researchers found that ethyl lactate ameliorates hepatic steatosis and acute-on-chronic liver injury in ALD by inducing fibroblast growth factor 21 (FGF21), which inhibits alcohol-induced aberrant activation of mTORC1 (the mechanistic Target of Rapamycin Complex 1, a protein complex that serves as a cellular regulator of growth, metabolism, and protein synthesis), and hepatic lipogenesis.

Interestingly, ethyl lactate is widely present not only in alcoholic beverages but also in other fermented foods such as vinegar, bread, and sausages. It is also a recognized food flavoring agent.

This study advances the understanding of the foodborne small molecule ethyl lactate in regulating the progression of ALD, and may provide a new strategy for the prevention and treatment of ALD as well as obesity-related metabolic disorders.

Reference:

Yang Jiang, Shuang Wei, Shiming Shen, Yuxiao Liu, Weitong Su, Dong Ding, Zengpeng Zheng, Haokai Yu, Tingting Zhang, Qiuli Yang, Jiuxiang Zhao, Yi Shen, Xia Fang, Liangcai Lin, Dongguang Xiao, Aoyuan Cui, Qin Wan, Yadong Zhang, Yu Li, Cuiying Zhang, Ethyl Lactate Ameliorates Hepatic Steatosis and Acute-on-Chronic Liver Injury in Alcohol-Associated Liver Disease by Inducing Fibroblast Growth Factor 21, Advanced Science, https://doi.org/10.1002/advs.202409516

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Lower Adverse Effects and Pain: Study Supports Fire Needle and Cupping in Herpes Zoster Treatment

China: A recent study published in the Archives of Dermatological Research highlights the enhanced effectiveness of combining fire needle therapy and cupping with standard drug treatments, such as famciclovir and gabapentin, in managing acute herpes zoster (AHZ). This integrative approach has shown superior pain relief, quicker symptom resolution, and fewer adverse reactions, as well as a reduced incidence of postherpetic neuralgia (PHN) compared to drug therapy alone. However, experts emphasize that fire needle and cupping therapy should be viewed as complementary to standard medication, not as standalone treatments.

The study also illuminates the necessity of incorporating a sham-treated control group in future research to eliminate potential placebo effects. Given the invasive nature of fire needling and cupping, understanding the specific contributions of these therapies to treatment outcomes is crucial for validating their efficacy.

Shihua Li, People’s Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yunnan Province, China, and colleagues aimed to evaluate the effectiveness and safety of combining fire needle therapy and cupping (FC) with oral famciclovir and gabapentin in treating acute-phase herpes zoster.

For this purpose, the researchers conducted a randomized controlled trial involving 84 AHZ patients meeting diagnostic criteria. Participants were randomly assigned to three groups on a 1:1 basis. Group A received oral famciclovir and gabapentin (FG), while Group B received a combination of fire needle plus cupping (FC) alongside FG treatment.

The primary outcome was the difference in pain levels, measured by the Visual Analog Scale (VAS). Secondary outcomes included changes in sign-symptom scores, adverse effect incidence, and PHN occurrence.

Based on the study, the researchers reported the following findings:

  • Both groups experienced reduced VAS and symptom-sign scores after one week of treatment compared to baseline.
  • Group B showed a significantly greater reduction in VAS scores than Group A.
  • Symptom-sign score improvements were significantly better in Group B compared to Group A.
  • Adverse reaction rates were higher in Group A (21.95%) than in Group B (4.76%), with a significant difference.
  • The incidence of PHN was significantly lower in Group B (4.76%) compared to Group A (29.27%).

The authors concluded that combining fire needles and cupping with medication offers better pain relief and symptom improvement for AHZ than medication alone. This suggests that fire needles and cupping can serve as an effective complementary therapy, enhancing treatment outcomes and safety.

They emphasized that this approach should supplement standard drug treatments, not replace them. The authors also acknowledged the absence of a sham control group, which may have influenced the results, and recommended future studies include such controls to confirm these findings.

Reference:

Zhang, Y., Jing, M., Wang, L. et al. Combining fire needle plus cupping with famciclovir and gabapentin in the treatment of acute herpes zoster: a revised intervention approach. Arch Dermatol Res 317, 112 (2025). https://doi.org/10.1007/s00403-024-03628-3

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FDA Issues Urgent Safety Warning on Ocaliva, Highlights Risk of Serious Liver Injury in Primary Biliary Cholangitis Patients

USA: The U.S. Food and Drug Administration (FDA) has issued an important update to its Drug Safety Communication regarding Ocaliva (obeticholic acid), a medication approved for the treatment of primary biliary cholangitis (PBC). The new communication highlights the increased risk of serious liver injury among PBC patients without advanced cirrhosis who are taking Ocaliva.

This update builds upon a previous safety communication from May 26, 2021, which restricted the use of Ocaliva in PBC patients with advanced cirrhosis due to the risk of severe liver-related complications. However, following an in-depth review of postmarket clinical trial data, the FDA has now identified serious liver injuries in patients without cirrhosis as well. Some of these cases have progressed to liver transplantation, emphasizing the severity of this risk.

Ocaliva, approved in May 2016, is a prescription medication that has been shown to improve a liver test called alkaline phosphatase (ALP) in PBC patients who did not respond to the standard treatment, ursodeoxycholic acid (UDCA). Although initial trials showed promising results, a recent postmarket clinical trial revealed a higher incidence of liver-related complications in patients receiving Ocaliva compared to those receiving a placebo. Specifically, risks of liver transplant and death were higher in the treatment group. Among these findings, 7 out of 81 patients receiving Ocaliva needed a liver transplant, compared to just 1 in the placebo group. Additionally, four patients in the Ocaliva group died, compared to just one in the placebo group.

Between May 26, 2021, and September 18, 2024, the FDA identified 20 cases of serious liver complications in patients treated with Ocaliva. These included liver transplants, evaluations for liver transplantation, and liver-related deaths. Notably, three of these cases involved patients for whom Ocaliva should have been discontinued based on the progression of liver disease, underscoring the importance of regular liver monitoring.

The FDA urges healthcare providers to monitor liver tests frequently in patients taking Ocaliva to detect signs of worsening liver function early. Additionally, healthcare providers should discontinue Ocaliva at the first evidence of liver disease progression or if the medication is no longer effective. Patients are advised to contact their healthcare provider immediately if they experience symptoms such as a swollen belly, yellowing of the skin or eyes, bloody or black stools, mental confusion, or other signs of liver injury.

The FDA also encourages patients, caregivers, and healthcare providers to report side effects related to Ocaliva or other medications to the FDA MedWatch program. These reports are vital for ongoing monitoring and ensuring public health and drug safety.

This recent communication reflects the FDA’s commitment to continuously evaluate and communicate risks associated with widely used treatments. Ongoing vigilance is essential to ensure the safety of patients with chronic conditions like PBC.

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Healthy prenatal diet may reduce abnormal patterns of infant growth: JAMA

A new study published in the Journal of American Medical Association showed that a nutritious diet during pregnancy lowers the chance of either a sluggish or fast-growing baby. The strategies to avoid obesity may benefit from an understanding of the relationships between a baby’s growth and the quality of the nutrition consumed during pregnancy. Monique Hedderson and team carried out this study to assess the relationships between the size of the newborn and the growth of the baby from birth to 24 months of age and the prenatal dietary quality.

The data from birthing parent-child dyads in 8 cohorts that took part in the Environmental Influences on Child Health Outcomes program from 2007 to 2021 were utilized in this cohort analysis. The period of data analysis was March 2021 to August 2024. In terms of infant growth from birth to ages 6, 12, and 24 months, the results were classified as slow growth, within reference range, or rapid. Infant birth weight was classified as small for gestational age (SGA), reference range, or large for gestational age (LGA).

A total of 2854 birthing parent-child dyads were involved in the research. 225 Asian or Pacific Islander newborns (7.9%), 640 Black infants (22.4%), 1022 Hispanic infants (35.8%), 664 White infants (23.3%), and 224 infants (7.8%) of other races or several races were among the racially and ethnically varied members of the cohort.

The reduced risks of LGA, rapid growth through birth to age 6 months and age 24 months, and delayed growth from birth to age 6 months, 12 months, and 24 months were linked to a high HEI score (>80), which is a sign of a better diet. There was no correlation between SGA and high HEI.

The above chances of LGA and rapid infant growth from birth to age 12 months and lower odds of rapid growth to age 6 months were linked to a low EDIP score, which is suggestive of a less inflammatory diet. However, there was no correlation with SGA when compared to an EDIP score of 63.6 or above.

Overall, this research discovered that eating a healthier diet during pregnancy in accordance with current USDA guidelines was linked to having an infant with a lower risk of LGA and a higher chance of having a healthier growth trajectory during the first 2 years of life.

Source:

Hedderson, M. M., Schuh, H. B., Knapp, E. A., Bekelman, T. A., Catellier, D. J., Westlake, M., Lyall, K., Schmidt, R. J., Dunlop, A. L., Comstock, S. S., Chatzi, L., Sauder, K. A., Dabelea, D., Switkowski, K. M., Lin, P.-I. D., Avalos, L. A., Zhu, Y., Ferrara, A., … Smith, L. M. (2024). Prenatal Diet and Infant Growth From Birth to Age 24 Months. In JAMA Network Open (Vol. 7, Issue 11, p. e2445771). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.45771

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Whitening Toothpaste May Worsen Dental Erosion, While Fluoride and Nano-HAP Offer Protection: Study Finds

Turkey: A new in vitro study has shed light on how various types of toothpaste impact enamel and dentine, with implications for the prevention and management of erosive toothwear. Researchers investigated whitening, fluoride-containing, and fluoride-free toothpastes, revealing key differences in their effects on dental surfaces.

The study, published in BMC Oral Health, revealed that whitening toothpastes can exacerbate dental erosion by increasing the surface roughness of enamel and dentine. In contrast, the protective efficacy of fluoride-free toothpastes was found to vary significantly depending on their active ingredients, with some formulations offering minimal protection against erosive damage.

The global rise in erosion lesions has driven researchers to explore effective toothpaste formulations capable of protecting tooth surfaces from acid attacks. Despite extensive efforts, there is no clear consensus on which toothpaste ingredients offer the best defense against erosive toothwear. This ongoing uncertainty underscores the need for further studies in this area. To address this gap, researchers from Turkey, Betül Kübra Kurucu Karadeniz & Emel Karaman, set out to assess the preventive effects of toothpastes with various active ingredients on enamel and dentine erosion.

For this purpose, the researchers used ninety recently extracted bovine incisors, separating the crowns and roots and grinding them flat to prepare enamel and dentine surfaces. The specimens were then divided into six groups: Curaprox Enzycal Zero Fluoride (fluoride-free), Colgate Total 12 (1450 ppm NaF), Splat Biocalcium (fluoride-free and Nano-HAP), Colgate ProRelief (1450 ppm NaF and arginine), Sensodyne Repair and Protection (1450 ppm NaF and novamin), and Opalescence Whitening (1100 ppm NaF).

Each specimen was exposed to a demineralizing solution for 2 minutes and artificial saliva for 60 minutes, repeated four times daily over five days. Brushing was performed with a charged toothbrush at the start and end of the erosive cycles. Initial and final surface roughness was measured on the fifth day using a 3D profilometer, with comparisons made using the Wilcoxon test to identify changes in roughness levels following treatment.

The following were the key findings of the study:

  • Opalescence Whitening and Curaprox Enzycal Zero Fluoride significantly increased surface roughness in both enamel and dentine compared to baseline.
  • These groups exhibited rougher surfaces than all other groups, except for Colgate ProRelief.
  • Sensodyne Repair and Protection resulted in the smoothest enamel surfaces.
  • Colgate Total 12 led to the smoothest dentine surfaces.
  • Enamel samples in the Opalescence Whitening group showed a significantly greater increase in surface roughness compared to dentine samples.

Within the limitations of this in vitro study, the authors concluded that whitening toothpastes increased both enamel and dentine surface roughness, with enamel roughness being significantly greater than dentine roughness in response to whitening toothpastes. Toothpastes containing fluoride, fluoride combined with novamine, and fluoride combined with arginine were effective in dental erosion prevention. The protective effects of fluoride-free toothpastes varied depending on their specific active ingredients.

“Additionally, toothpastes containing Nano-HAP demonstrated potential in preventing erosive tooth wear (ETW) even without fluoride, though fluoride remains the most effective and reliable option. Nano-HAP toothpastes may serve as an alternative for patients who cannot or choose not to use fluoride” the researchers wrote.

Reference:

Karadeniz, B.K.K., Karaman, E. Effects of different toothpastes against erosive tooth wear of enamel and dentine in vitro. BMC Oral Health 24, 1471 (2024). https://doi.org/10.1186/s12903-024-05260-z

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Rare case of Paralabral Cysts with Associated Infraspinatus and Teres Minor Denervation: A Report

The case report by Zachary Jodoin et al provides an educational and intriguing insight into the anatomical innervation of the shoulder musculature with correlation to unique paralabral pathophysiology. This case provides students and residents with a real-life example of clinical pathology with applied anatomy, while also giving providers and patients realistic expectations on the recovery process.

The shoulder is one of the most intricate articulation complexes in the human body. Any insult to its equilibrium can cause joint instability, pain, and dysfunction. The complex bony projections of the scapula, lengthy nature of the nerves, and extensive mobility of the joint places nerves at risk for impingement; this can, especially, be seen when examining the axillary and suprascapular nerves. Another rare cause of nerve impingement is a paralabral cyst secondary to labral tearing. If a paralabral cyst expands into the limited space occupied by the nerves, this can result in neuropraxia, muscle wasting, and loss of function. This phenomenon presents an interesting anatomic and clinical correlation.

Case Report: A 41-year-old male with no past medical history presented with left shoulder pain for 3 months. Physical examination showed a great range of motion but diffusely decreased strength. Magnetic resonance imaging of the left shoulder demonstrated posterosuperior labral tearing with an associated paralabral cyst extending into the spinoglenoid notch. An additional anteroinferior labral tear with an associated paralabral cyst was also found. Extensive infraspinatus and teres minor muscle atrophy suggesting active denervation was present. The patient failed conservative management and underwent arthroscopic labral repair with posterosuperior and anteroinferior paralabral cysts excision. The patient had an unremarkable recovery and by 1 year had full motion and 5/5 strength in all planes.

The authors concluded that – “While paralabral cysts are well documented, there have been limited reports of cysts causing neural impingement of the axillary or the distal suprascapular nerve, let alone both occurring within the same individual. This case provides an interesting clinical scenario which very clearly depicts the neural innervation of the shoulder and pathologies that can impact function. This cystic impingement is a very interesting and rare finding that provides tremendous insight into both shoulder pathology and anatomy. This case is also useful to predict patient recovery after long-term nerve impingement and muscle denervation. This patient presented with significant loss of strength, motion, and shoulder dysfunction, but after surgical intervention, he regained complete motion and strength. This information can be used to help educate and guide patients in practice.”

Further reading:

Paralabral Cysts with Associated Infraspinatus and Teres Minor

Denervation: A Case Report

Zachary Jodoin et al

Journal of Orthopaedic Case Reports 2024 November:14(11): Page 40-44

https://doi.org/10.13107/jocr.2024.v14.i11.4908

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