Precalcitonin guided Protocol Safely Reduces Antibiotic Use in Sepsis Patients, reveals study

Researchers found that a procalcitonin (PCT)-guided protocol significantly reduces the duration of antibiotic therapy in critically ill patients with sepsis as published in JAMA. This study was conducted by Paul Dark and colleagues.

Sepsis is a medical condition in which life is endangered by a flood of immune reactions to infection and usually requires emergency antibiotics. Therefore, early and timely antibiotic intervention is essential; however, the duration of treatment is still not well defined. Biomarkers such as PCT and CRP have been evaluated for the possible use of guiding antibiotic discontinuation decisions. This trial provides additional support for PCT-use recommendations, establishing their clinical effectiveness and safety.

Methods

The Antibiotic Treatment in Hospitalised Patients With Suspected Sepsis (ADAPT-Sepsis) trial enrolled 2,760 suspected-sepsis adult patients in 41 hospitals across the United Kingdom from January 2018 to June 2024. It randomised ICU patients who had received intravenous antibiotics within 24 hours of admission into 3 groups: daily PCT-guided protocol (918 patients), daily CRP-guided protocol (924 patients), or standard care (918 patients). Primary endpoints included total antibiotic usage for 28 days and 28-day all-cause mortality. Secondary outcomes also include the duration of antibiotics first until the sepsis episode. Both allocation and biomarker readings were blinded to clinical teams and patients.

Key Findings

Reduction in the duration of antibiotics:

  • PCT-guided protocol reduced total antibiotic duration to 9.8 days compared with that of the standard care arm at 13.2 days (adjusted mean difference, 3.4 days; 95% CI, 4.3-2.5).

  • The CRP protocol was not statistically significantly shorter than standard care (mean difference: 0.09 days; 95% CI, -0.60 to 0.79).

  • For early initial sepsis, PCT reduced antibiotic usage during this period by 1.13 days (95% CI, 0.58 to 1.68), while CRP indicated a 0.71-day decrement (95% CI, 0.16 to 1.26).

Safety Endpoints:

  • Across all causes, mortality at 28 days was statistically equal for PCT-guided care versus standard care (20.9% vs. 19.4%; absolute difference: 1.57 percentage points; 95% CI, -2.18 to 5.32).

  • Mortality outcomes with CRP-guided care were inconclusive (21.1% vs. 19.4%; absolute difference: 1.69 percentage points; 95% CI, -2.07 to 5.45).

This trial shows that protocols based on procalcitonin safely reduce antibiotic use in critically ill patients with sepsis and induce 10% reduction in duration. These observations provide decisive grounds for the incorporation of procalcitonin into sepsis management.

Reference:

Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA. Published online December 09, 2024. doi:10.1001/jama.2024.26458

Powered by WPeMatico

Anemia in heart failure with preserved ejection fraction associated with RV dysfunction, reveals research

A new study published in the Frontiers in Cardiovascular Medicine journal showed that right ventricular (RV) dysfunction is linked to anemia in heart failure with a preserved ejection fraction (HFpEF), despite traditional risk factors like diabetes, hypertension, and smoking having no effect on this association.

The critical significance of right ventricle in predicting prognosis and functional status in a variety of illnesses is becoming more well acknowledged.  In the therapy of heart failure (HF), it is critical to identify comorbidities that may impact the clinical course and responsiveness to treatment. In actuality, more than half of hospitalizations for individuals with HF are not caused by a heart problem, and a sizable portion of these hospitalizations are unrelated to HF.

Anemia is linked to left ventricular systolic dysfunction and is a frequent consequence in heart failure patients. Its impact on right ventricular function hasn’t been assessed, though. Therefore, Jia Wang and colleagues investigated the potential etiology of RVD in this HF classification and looked at how anemia affected RV contractile efficiency and RV-pulmonary artery coupling in patients with HFpEF.

To assess the relationship between anemia and RV dysfunction in patients with Heart Failure with Preserved Ejection Fraction (HFpEF) and whether this relationship is influenced by traditional risk factors like smoking and hypertension, this study retrospectively examined the electronic medical records of 1,014 HFpEF patients.

In comparison to non-anemic patients, the study found that anemic patients were older and had tricuspid regurgitation (TR) and a considerably higher New York Heart Association functional class. Hemoglobin (Hb) levels were favorably correlated with the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio and weakly negatively correlated with NT-pro-BNP. According to multivariate linear regression analysis, the TAPSE/PASP ratio was independently correlated with the degree of anemia, atrial fibrillation, and TR. 

Overall, the patients with HFpEF worsened by anemia experience a considerable reduction in RV function and there is a strong negative correlation between the severity of anemia and RV function, regardless of age or sex. Moreover, anemia is not linked to traditional cardiovascular risk factors such as diabetes, hypertension, and smoking as a stand-alone risk factor for RV function.

Source:

Wang, J., Jiang, J., Li, X., Tan, X., Zhou, Y., Luo, Z., Wang, X., Zhao, X., Liu, Y., Wang, M., & Zhang, C. (2024). Right ventricular function and anemia in heart failure with preserved ejection fraction. In Frontiers in Cardiovascular Medicine (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fcvm.2024.1424576

Powered by WPeMatico

High Baseline Serum Uric Acid Linked to Increased Cardiovascular and Renal Risks in Type 2 Diabetes: Study

Brazil: A recent study conducted as part of the Rio de Janeiro Type 2 Diabetes Cohort has emphasized the significant role that baseline serum uric acid (sUA) levels and their subsequent changes play in predicting key health outcomes in individuals with type 2 diabetes (T2D).

The prospective cohort study, published in the Journal of Diabetes and its Complications, found that elevated baseline sUA levels were associated with a higher risk of cardiovascular events, renal complications, and peripheral neuropathy in patients with type 2 diabetes.

“Baseline sUA levels were linked to major adverse cardiovascular events (HR: 2.4), renal failure, and microalbuminuria, with women showing a stronger cardiovascular risk association (HR: 2.6) compared to men (HR: 1.2). Additionally, changes in sUA levels were specifically connected to an increased risk of renal failure (HR: 2.4),” the researchers reported.

Serum uric acid, a substance typically associated with gout and kidney disease, has been emerging as an important biomarker for complications in diabetes. Claudia R.L. Cardoso, Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal do Rio de Janeiro, Brazil, and colleagues aimed to examine the relationships between baseline and changes in serum uric acid (sUA) levels and the risks of cardiovascular and microvascular outcomes, as well as mortality, in a type 2 diabetes cohort.

For this purpose, the researchers measured baseline serum uric acid (sUA) in 685 individuals, with 463 having a second sUA measurement during follow-up. The sUA was analyzed as a continuous variable and categorized into sex-specific tertile subgroups, along with low/high levels (>4.5 mg/dl for women; >5.5 mg/dl for men). Cox analyses were used to examine the risks associated with baseline sUA and its changes for all outcomes.

The study led to the following findings:

  • The median follow-up was 10.7 years, with 173 major cardiovascular events (MACEs), 268 all-cause deaths, 127 cases of microalbuminuria, 104 instances of renal failure, 160 cases of retinopathy, and 178 occurrences of peripheral neuropathy.
  • Baseline serum uric acid was a predictor for all outcomes except for all-cause mortality and retinopathy.
  • In tertile and high/low sUA analyses, hazard ratios (HRs) ranged from 1.6 (for microalbuminuria development) to 2.4 (for MACEs and cardiovascular mortality).
  • An interaction with sex was observed for MACEs, with an increased risk in women (HR: 2.6), but not in men (HR: 1.2).
  • Changes in sUA were linked to an increased risk of renal failure (HR: 2.4).

“In a prospective cohort, elevated baseline serum uric acid levels were associated with an increased risk of cardiovascular, renal, and peripheral neuropathy. However, changes in sUA were only linked to the risk of renal failure,” the researchers concluded.

Reference:

Cardoso, C. R., Da Silva Pereira, L., Leite, N. C., & Salles, G. F. (2024). Prognostic importance of baseline and changes in serum uric acid for macro/microvascular and mortality outcomes in individuals with type 2 diabetes: The Rio de Janeiro type 2 diabetes cohort. Journal of Diabetes and its Complications, 39(1), 108921. https://doi.org/10.1016/j.jdiacomp.2024.108921

Powered by WPeMatico

Chronic Coffee Consumption Found Safe for Heart Health in Hypertensive Patients Over Long Term: Study Reveals

Italy: Regular coffee consumption does not increase the risk of cardiovascular disease or overall mortality among individuals with mild-to-moderate hypertension, according to recent findings from the PAMELA study. This observation holds regardless of gender and whether patients are undergoing treatment for hypertension.

The findings were published online in Nutrition, Metabolism & Cardiovascular Diseases on October 23, 2024. 

Evidence indicates that regular coffee consumption in normotensive individuals does not negatively impact cardiovascular health or total mortality. However, whether this holds true for high-risk cardiovascular patients, such as those with elevated blood pressure, remains a topic of ongoing debate. Therefore, Fosca Quarti-Trevano, Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy, and colleagues explored the association between daily coffee intake and the risks of cardiovascular events and total mortality in hypertensive patients.

For this purpose, the researchers analyzed data from 943 hypertensive patients enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, categorizing them as coffee consumers or non-consumers based on self-reported information. Cardiovascular and total mortality outcomes were assessed at the 25-year follow-up, considering variables such as office blood pressure (BP) and 24-hour ambulatory BP.

The study revealed the following findings:

  • Analysis of unadjusted data showed no significant difference in hazard ratios for cardiovascular and total mortality between coffee consumers and non-consumers when considering office blood pressure (0.85 versus 0.83, PNS) or 24-hour ambulatory blood pressure (1.08 versus 0.80, PNS).
  • Adjusted analysis for confounding factors such as age, sex, BP, lipid profile, plasma glucose, cholesterol levels, renal function, and previous cardiovascular events also showed no significant differences.
  • The results remained consistent whether participants were analyzed based on the presence or absence of antihypertensive treatment.

The researchers conclude that chronic coffee consumption has neutral effects on cardiovascular and total mortality in normotensive individuals. While limited data exist on the impact of coffee consumption on fatal cardiovascular events among hypertensive patients with elevated cardiovascular risk, the study found no difference in cardiovascular mortality between coffee consumers and non-consumers over a 25-year follow-up. This remained true even after adjusting for potential confounders.

“These findings provide robust evidence from a large population sample with long-term follow-up, supporting the neutral effects of coffee consumption in hypertensive patients with increased cardiovascular risk profiles, the researchers concluded.

Reference:

Quarti-Trevano, F., Facchetti, R., Cuspidi, C., Mancia, G., & Grassi, G. (2024). Habitual coffee consumption and risk of cardiovascular and all-cause mortality in the PAMELA hypertensive population. Nutrition, Metabolism and Cardiovascular Diseases, 103776. https://doi.org/10.1016/j.numecd.2024.10.014

Powered by WPeMatico

Screw-rod system safe,minimally invasive technique for posterior pelvic fracture, suggests study

Screw-rod system safe,minimally invasive technique for posterior pelvic fracture, suggests study published in the BMC Surgery.

Pelvic fractures are often associated with life-threatening damage and mechanical instability. Surgical therapy is a prior choice. To minimize surgical invasion and risk, bilateral screws combined with curved rod were applied to stabilize posterior pelvic ring. This study was aim to explore the clinical effect of this procedure. From January 2018 to January 2022, 27 patients with posterior pelvic fracture were included retrospectively. There were 12 males and 15 females with an average age of 56.3 ± 14.2 years. The prognosis of pelvis was evaluated by Matta and Majeed scores. Relevant clinical evaluation indications include the time of fracture healing, limb function and complications. Results: The average follow-up time was 14.2 ± 5.4 month. Matta scoring standard: excellent in 18 cases, good in 7 cases, the good rate was 92.6%. The average healing time was 8.4 months. The standard of Majeed score in 6 months after operation: excellent in 14 cases, good in 10 cases, the good rate was 88.8%. At the last follow-up, the functional recovery of the affected limb was satisfactory. No deep infection occurred after operation. The neurological symptoms of patients with caudal sacral nerve injury were recovered 6 months after operation. The results indicated that screw-rod system is a safe technique. Minimally invasive technology reduced frequency of fluoroscopy. It provides a simple and safety method for posterior pelvic fracture.

Reference:

Huang, J., Cheng, J., Shi, B. et al. Modified screw-rod fixation for management of posterior pelvic ring fractures: a retrospective study. BMC Surg 24, 364 (2024). https://doi.org/10.1186/s12893-024-02654-2

Keywords:

Screw-rod, system safe,minimally, invasive, technique, posterior, pelvic, fracture,Huang, J., Cheng, J., Shi, B., Pelvic fracture, Screw-rod system, Unstable pelvic ring

Powered by WPeMatico

Recommendations by ASA may help reduce delirium in older patients having surgery

Delirium and cognitive decline are common complications of anesthesia and surgery in older adults. Evidence-based recommendations on strategies to reduce the risk of postoperative neurocognitive disorders are presented in a new practice advisory in the Online First edition of Anesthesiology, the peer-reviewed journal of the American Society of Anesthesiologists (ASA).

“Cognitive and functional changes after surgery are a serious problem in older patients, sometimes leading to loss of independence,” said lead author Frederick Sieber, M.D., of Johns Hopkins Hospital, Baltimore. “We provide new recommendations on proposed steps to reduce these risks, based on an updated review of the current evidence.”

Many older adults develop delirium after surgery, with symptoms such as confusion, lethargy, or agitation. Although most patients recover, delirium has been associated with persistent neurocognitive impairment.

Following a structured process, an ASA advisory task force reviewed the research evidence on measures to minimize cognitive and other complications of anesthesia common in patients aged 65 years or older scheduled for inpatient surgery. Based on their findings, the multidisciplinary expert panel developed the following recommendations:

  • Expand Preoperative Evaluation: Consider expanded preoperative evaluation in older adults scheduled for inpatient procedures to reduce the risk of postoperative delirium. If patients are identified with cognitive impairment and/or frailty, changes in patient care can be initiated. These changes include, but are not limited to, involvement of a multidisciplinary care team and geriatrician or geriatric nurse visits, and patient and family education on postoperative delirium risk.
  • Choose Type of Anesthesia with an Anesthesiologist: Choosing either neuraxial or general anesthesia for older adults when either is clinically appropriate, based on shared decision-making. The evidence suggests no superiority with either technique in reducing postoperative delirium. Either total intravenous or inhaled anesthesia is acceptable for general anesthesia in the older population.
  • Consider Dexmedetomidine to Reduce Risk: Among older patients scheduled for inpatient procedures, it is reasonable to consider dexmedetomidine to lower the risk of postoperative delirium while also considering its effects on bradycardia (slowed heart rate) and/or hypotension (low blood pressure).
  • Minimize use of Other Medications: Consider the risks and benefits of medications with potential central nervous system effects in older adults, as these drugs may increase the risk of postoperative delirium.

The report emphasizes that limitations remain in the available evidence reviewed and further details the critical issues identified by the task force that remain in the key areas considered, that require further research.

“It is critically important for anesthesiologists to be aware of the risks of postoperative delirium and other neurocognitive disorders in older adults,” Dr. Sieber said. “We hope our practice advisory will promote an evidence-based approach to efforts to assess and reduce those risks, which guide next steps in research to improve cognitive outcomes and prevent functional decline for this vulnerable and growing population.”

Reference:

Frederick Sieber et al, 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery, Anesthesiology (2024). DOI: 10.1097/ALN.0000000000005172

Powered by WPeMatico

Updated practice guideline on treatment of borderline personality disorder released by American Psychiatric Association

The American Psychiatric Association(APA) today published an updated Practice Guideline for Treatment of Patients with Borderline Personality Disorder. The guideline provides recommendations on evidence-based assessment, treatment planning, and psychosocial interventions and pharmacotherapy treatments.

Borderline personality disorder is classified among the personality disorders and affects 1.4%-2.7% of the U.S. population. It involves a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. It typically begins in adolescence or early adulthood and can persist for many years. However, despite previous understandings of the disorder, it can remit, and symptoms can be reduced and managed.

Despite the lifetime burden and psychosocial impairment associated with borderline personality disorder, evidence-based treatments are often not available, and misperceptions persist. This guideline is intended to improve the quality of care for people with borderline personality disorder by providing clinicians with knowledge and understanding of evidence-based assessment and treatment.

The practice guideline includes eight clinical recommendations or suggestions, depending on the level of scientific evidence.*

Assessment and Determination of Treatment Plan

1. APA recommends (1C) that the initial assessment of a patient with possible borderline personality disorder include the reason the individual is presenting for evaluation; the patient’s goals and preferences for treatment; a review of psychiatric symptoms, including core features of personality disorders and common co-occurring disorders; a psychiatric treatment history; an assessment of physical health; an assessment of psychosocial and cultural factors; a mental status examination; and an assessment of risk of suicide, self-injury, and aggressive behaviors, as outlined in APA’s Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd Edition.

2. APA suggests (2C) that the initial psychiatric evaluation of a patient with possible borderline personality disorder include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment.

3. APA recommends (1C) that a patient with borderline personality disorder have a documented, comprehensive, and person-centered treatment plan.

4. APA recommends (1C) that a patient with borderline personality disorder be engaged in a collaborative discussion about their diagnosis and treatment, which includes psychoeducation related to the disorder.

Psychosocial Interventions

5. APA recommends (1B) that a patient with borderline personality disorder be treated with a structured approach to psychotherapy that has support in the literature and targets the core features of the disorder.

Pharmacotherapy

6. APA recommends (1C) that a patient with borderline personality disorder have a review of co-occurring disorders, prior psychotherapies, other nonpharmacological treatments, past medication trials, and current medications before initiating any new medication.

7. APA suggests (2C) that any psychotropic medication treatment of borderline personality disorder be time-limited, aimed at addressing a specific measurable target symptom, and adjunctive to psychotherapy.

8. APA recommends (1C) that a patient with borderline personality disorder receive a review and reconciliation of their medications at least every 6 months to assess the effectiveness of treatment and identify medications that warrant tapering or discontinuation.

The guideline was developed by the APA Practice Guideline Writing Group, chaired by George A. Keepers, M.D., using a clearly defined and transparent process consistent with the recommendations of the Institute of Medicine (2011) and the Council of Medical Specialty Societies. A detailed description of the process is included in the guideline.

“Several key findings emerged from the thorough and critical review of the literature conducted to develop this Guideline,” Keepers said. “First, several structured psychotherapies were found to be effective for treatment of borderline personality disorder. No therapy emerged as a ‘gold standard.’ Second, no evidence was found for any pharmacotherapy’s effectiveness in treating the core symptoms of the disorder. This finding led to the recommendations designed to limit polypharmacy and prolonged treatment with medications. We anticipate that many more patients will be able access psychotherapeutic treatment and that clinicians will avoid the risks of ineffective pharmacologic treatment as a result of this guideline.”

Borderline Personality Disorder Guideline Resources

The full Practice Guideline for the Treatment of Borderline Personality Disorder, Executive Summary and Appendices are available free online and as a printed copy for purchase from APA Publishing. APA is also developing related resources to facilitate understanding of the guidelines and their implementation, including training slides, clinician guide, patient/family guide, webinar and case vignettes. All of these materials will be available to practitioners and the public.

*A recommendation (denoted by the numeral 1 after the guideline statement) indicates confidence that the benefits of the intervention clearly outweigh the harms. A suggestion (denoted by the numeral 2 after the guideline statement) indicates greater uncertainty. Although the benefits of the statement are still viewed as outweighing the harms, the balance of benefits and harms is more difficult to judge, or either the benefits or the harms may be less clear. With a suggestion, patient values and preferences may be more variable, and this can influence the clinical decision that is ultimately made. Each guideline statement also has an associated rating for the strength of supporting research evidence. Three ratings are used: high, moderate, and low (denoted by the letters A, B, and C, respectively) and reflect the level of confidence that the evidence for a guideline statement reflects a true effect based on consistency of findings across studies, directness of the effect on a specific health outcome, precision of the estimate of effect, and risk of bias in available studies (Agency for Healthcare Research and Quality 2014; Balshem et al. 2011; Guyatt et al. 2006).

Reference:

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, Second Edition, https://doi/book/10.1176/appi.books.9780890428009.

Powered by WPeMatico

Cutting early life exposure to parental smoking may lower MS risk in genetically prone, reveals study

Cutting early life exposure to parental smoking may lower the risk of developing MS (multiple sclerosis) in those who are genetically predisposed to the disease, finds research published online in the Journal of Neurology Neurosurgery & Psychiatry.

The interplay of genes and environmental factors, including smoking, alter key aspects of brain structure in early childhood, likely facilitating development of the disease and suggesting that there may be a window of opportunity to stave this off, conclude the researchers.

MS is an autoimmune disease that is typically diagnosed between the ages of 20 and 40. But it’s not clear if it stems from early inflammatory brain damage or a latent neurodegenerative process overlaid with inflammation, explain the researchers.

Exactly when the disease process begins isn’t known either. But brain volume loss and poorer cognitive performance before clinical signs and symptoms appear suggests that these precede diagnosis.

Studies on migration show that early life environmental factors have a key role, but exactly how these interact isn’t yet known, they add.

To shed more light on how and when the interplay of environmental and genetic risk factors might affect brain volume, and so facilitate future MS development, the researchers used data from the population based Dutch Generation R study.

Participants in this study had good quality data on genotype and/or the known environmental risk factors of Epstein Barr virus infection, vitamin D levels, weight (BMI), parental tobacco exposure, and outdoor activity at the age of 5, plus high quality brain scan images at the ages of 9 and 13.

In all, the researchers drew on imaging data showing brain volume for 5350 participants and brain microstructure for 5649 participants, none of whom had been diagnosed with MS.

Polygenic risk scores, derived from DNA samples, were used to assess genetic risk of developing MS, with the genetic variant rs10191329, used as a marker of future MS severity.

In all, 642 children tested positive for Epstein Barr virus infection and 405 had been exposed to household parental smoking.

The final analysis was based on genetic data from 2817 participants and brain volume and microstructure imaging data from 2970 participants.

This showed an interplay between genetic and environmental risk factors for MS that was associated with certain aspects of brain structure during childhood and the early teens.

Specifically, higher genetic risk for MS was associated with a strong immune response to Epstein-Barr virus infection, and it was also associated with increased susceptibility to the negative effects of household parental smoking on brain development.

Higher MS genetic risk and household parental smoking interacted and were associated with lower total brain volume and grey matter volume, including thalamic volume.

No associations were observed for carriers of the rs10191229 genetic valiant.

This is an observational study, and as such, no firm conclusions about cause and effect can be drawn.

By way of explanations for the findings, the researchers point out that higher Epstein-Barr virus antibodies may be caused by defective immune system control of this virus due to genetic risk for MS, possibly facilitating development of the disease later in life.

And the prevailing theory is that tobacco smoke produces chronic inflammation of the respiratory tract, thereby increasing the inflammatory activity of the immune system, they add.

“Our results importantly add another potential mechanism of tobacco smoke exposure in individuals with higher polygenic MS risk. The increased brain vulnerability to the effects of parental smoking may increase exposure of [central nervous system] antigens to the developing immune system, increasing the risk of a brain specific autoimmune disease,” they suggest.

“How this increased vulnerability influences other MS risk factors may open a window for prevention of MS by limiting childhood exposure to household smoking or other toxic exposures associated with MS (ie, household chemicals), and should be a focus for further studies,” they conclude.

Reference:

de Mol CL, Lamballais S, Muetzel R, et alEnvironmental multiple sclerosis (MS) risk factors, genetic MS risk, and brain development in a general paediatric populationJournal of Neurology, Neurosurgery & Psychiatry Published Online First: 10 December 2024. doi: 10.1136/jnnp-2024-335053

Powered by WPeMatico

Sleep disorders independent predictors of taste dysfunction, suggests study

Sleep disorders are independent predictors of taste dysfunction, suggests study published in the BMC Oral Health.

This study aimed to investigate the association between sleep disorders and the prevalence of taste dysfunction and the mediation effect of oral microbe in adults over 40 years. Cross-sectional data were utilized from the National Health and Nutrition Examination Survey (2011–2014). Regression models were employed, adjusting for demographic variables and covariates. Subgroup analyses were conducted based on age, sex, ethnicity, and education level. Multiplicative interactions were assessed through likelihood ratio tests. Additionally, the impact of sleep disturbance on the alpha diversity of the oral microbiome was examined using the rank-sum test (significance threshold: p < 0.05). Mediation analysis based on oral microbiota was conducted. Results: The analysis included 4869 participants. After adjusting for adjusting for demographic variables and covariates, individuals with sleep disorders exhibited a 36% increased risk of taste dysfunctions compared to those without sleep disorders (OR: 1.36, 95% CI: 1.00-1.84, p = 0.05). Interaction analyses indicated no significant differences between sleep disorders and taste dysfunctions concerning sex, educational level, and age across various models (Crude Model, Model 1, Model 2, and Model 3; p for interaction > 0.05). Furthermore, compared with the non-sleep disorder group, patients with sleep disorders demonstrated decreased numbers of OTUs, Shannon-Wiener indices, and Faith’s phylogenetic diversity indices in the oral microbiota (p < 0.05). However, the mediation analysis failed to reveal an indirect effect of oral microbiome on taste dysfunction (p > 0.05.) Sleep disorders independently correlate with a higher risk of taste dysfunctions, potentially associated with alterations in oral flora.

Reference:

Huang, R., Zheng, Q., Dai, J. et al. Sleep disorders as independent predictors of taste dysfunction risk. BMC Oral Health 24, 1432 (2024). https://doi.org/10.1186/s12903-024-05190-w

Keywords:

Sleep, disorders, independent, predictors, taste, dysfunction, suggests, study, BMC Oral Health, Huang, R., Zheng, Q., Dai, J

Powered by WPeMatico

Low Serum Uromodulin Levels Linked to Diabetic Kidney Disease, finds study

Researchers have discovered a significant association of low serum levels of uromodulin with diabetic kidney disease (DKD), meaning it could be a predictive marker for the disease. A recent study was published in the journal of BMC Nephrology conducted by Shaimaa and colleagues.

This meta-analysis was based on the PRISMA protocol; systematically reviewed data from PubMed, Cochrane Library, Web of Science, and Scopus; and consisted of six studies which met the inclusion criteria by examining the relationship between serum uromodulin levels and DKD. The standardized mean difference (SMD) with a 95% confidence interval (CI) was applied to evaluate the association. Heterogeneity was determined using the I² statistic with a threshold of 50% for significant heterogeneity. Sensitivity and subgroup analyses were performed to explore the sources of heterogeneity, and quality of studies was evaluated using the Newcastle-Ottawa Scale (NOS). Publication bias was assessed by funnel plots and Egger’s test.

In total, 1,774 patients were included in the meta-analysis. Pooled results are presented below:

  • Low Levels of Uromodulin: Serum uromodulin levels were found to be significantly lower in patients with DKD (SMD: -0.31; 95% CI: -0.48 to -0.13; I² = 45%).

  • Sensitivity Analysis: After sensitivity, results were still significant, and the heterogeneity was lost due to adjustment (SMD:-0.38; 95% CI:-0.49 to -0.27; I²=3%).

  • Regional Analysis: The subgroup analyses proved that the uromodulin levels were reduced significantly by uromodulin levels throughout various regions.

  • America: SMD:-0.34(95% CI:-0.51 to -0.17; p<0.0001)

  • Asia: SMD: -0.63(95% CI: -1.15 to -0.11; p=0.02).

  • Europe: SMD:-0.54(95% CI:-1.06 to -0.02;p=0.04)

  • Diabetes Types: Results found to be significant for the following diabetes types.

  • Type 1 diabetes: SMD: -0.34 (95% CI: -0.51 to -0.17; p <0.0001).

  • Type 2 diabetes: SMD: -0.58 (95% CI: -0.95 to -0.22; p=0.002).

This meta-analysis confirmed that low serum uromodulin levels are significantly associated with DKD, and it may have the potential as a predictive biomarker. However, further studies are necessary to refine its diagnostic accuracy and explore its implications in diverse populations and clinical settings.

Reference:

Barr, S. I., Abd El-Azeem, E. M., Bessa, S. S., & Mohamed, T. M. (2024). Association of serum uromodulin with diabetic kidney disease: a systematic review and meta-analysis. BMC Nephrology, 25(1). https://doi.org/10.1186/s12882-024-03854-x

Powered by WPeMatico