GLP-1RAs Show Promise for Kidney Protection in Type 2 Diabetes, Reveals Research

Italy: A new review published in Minerva Medica has revealed that GLP-1 receptor agonists may help preserve kidney function in people with type 2 diabetes.

Researchers led by Alessandro Perencin from the Department of Medicine (DIMED), Geriatrics Division, University of Padua, Italy, conducted a systematic review to examine whether this class of diabetes medications could provide direct kidney benefits. GLP-1 receptor agonists (GLP-1RAs) are already widely prescribed for blood sugar management and cardiovascular protection, but their potential to safeguard kidney health has not been comprehensively evaluated until now.
To assess this possibility, the team performed an extensive search of medical literature across databases such as PubMed, Embase, Web of Science, and the Cochrane Library. They looked for studies that reported kidney-related outcomes—specifically estimated glomerular filtration rate (eGFR), a key measure of kidney function, and albumin-to-creatinine ratio (ACR), an indicator of protein leakage in the urine—in adults with type 2 diabetes who were treated with GLP-1RAs. Each study was carefully reviewed for quality and risk of bias to ensure reliable conclusions.
Thirteen studies, including both randomized clinical trials and observational analyses, met the inclusion criteria. These investigations suggest that GLP-1RAs may slow the progression of kidney damage, reduce proteinuria, and improve other important markers of renal health in patients with diabetes. Several studies showed significant slowing of eGFR decline and reductions in ACR, pointing to a possible protective effect against diabetic kidney disease.
However, the evidence was not entirely consistent. While some studies demonstrated clear and measurable benefits, others reported only modest improvements or no significant impact on kidney function. Differences in study design, patient populations, and treatment duration may partly explain these mixed results.
Despite these variations, the authors underscore that the overall trend is encouraging. With diabetic kidney disease remaining a major cause of chronic kidney failure worldwide, therapies that can both control blood glucose and support kidney health are urgently needed. GLP-1RAs—already known to lower cardiovascular risk—could offer an added advantage by helping to preserve renal function over time.
The review calls for larger, well-structured clinical trials to confirm these preliminary findings and to clarify how GLP-1RAs exert potential nephroprotective effects. Establishing clear evidence could help physicians decide when and how to incorporate these drugs into treatment plans for people with type 2 diabetes who are at risk of kidney complications.
“The systematic review highlights the emerging role of GLP-1 receptor agonists as more than just blood sugar–lowering agents. While further research is necessary, these medications may one day become a cornerstone not only in managing type 2 diabetes and cardiovascular disease but also in protecting long-term kidney health,” the authors concluded.
Reference:
Perencin A, Ceolin C, Papa MV, Di Marzio B, Zanforlini BM, Devita M, et al. Glucagon-like peptide-1 receptor agonists and its possible nephroprotective role: a systematic review. Minerva Med 2025 Sep 11. DOI: 10.23736/S0026-4806.25.09709-5

Powered by WPeMatico

GLP-1 Receptor Agonists Show Gastrointestinal Safety with Some Risks: Study

USA: Researchers have found in a retrospective study that GLP-1 receptor agonists (RAs) are generally safe for the gastrointestinal (GI) and hepatobiliary systems in patients with type 2 diabetes (T2D).    

The study published in the American Journal of Gastroenterology revealed that the therapy was linked to lower risks of several GI cancers and complications compared with other oral antidiabetic drugs. However, GLP-1 RAs were associated with a higher risk of gastroparesis and intussusception, highlighting the need for careful monitoring in vulnerable patients.
The study, led by Dr. Chengu Niu from the Department of Internal Medicine, Rochester General Hospital, USA, analyzed electronic health records of adults with T2D treated across the United States between 2010 and 2020. Using data from the TriNetX network, researchers conducted a retrospective cohort analysis and included 230,415 patients receiving GLP-1 RAs, matched 1:1 with an equal number of patients on other oral antidiabetic medications such as metformin, empagliflozin, and sitagliptin.
Over a five-year follow-up, the study evaluated various GI and hepatobiliary outcomes, including gastroparesis, bowel obstruction, pancreatitis, cholecystitis, and related GI cancers.
The analysis revealed the following findings:
  • GLP-1 RA use was associated with a higher risk of gastroparesis (HR 1.591).
  • GLP-1 RA use was associated with a higher risk of intussusception (HR 1.383).
  • GLP-1 RA therapy was linked to 15%–26% lower risks of cholangitis, bowel obstruction, ileus, volvulus, chronic pancreatitis, and procedures such as endoscopic retrograde cholangiopancreatography compared to other oral antidiabetic drugs.
  • GLP-1 RA users had lower risks of pancreatic cancer (HR 0.897), gastric cancer (HR 0.838), esophageal cancer (HR 0.741), and colorectal cancer (HR 0.870).
  • There were no significant differences in the risk of biliary cancer or hepatocellular carcinoma between GLP-1 RA users and other oral antidiabetic drug users.
  • Rates of acute pancreatitis, cholecystitis, and cholecystectomy were similar between GLP-1 RA users and the control group.
  • Overall, these findings support the gastrointestinal and hepatobiliary safety of GLP-1 receptor agonists.
The findings suggest that for patients at risk of common GI malignancies or conditions such as cholangitis and bowel obstruction, GLP-1 RAs remain a viable and generally safe option. However, clinicians are advised to exercise caution in patients with preexisting gastroparesis or intussusception, who may benefit from traditional oral antidiabetic therapies instead.
The authors noted several limitations of the study. The results show associations rather than causation, and the five-year follow-up period may not fully capture long-term cancer risks. Socioeconomic factors, access to healthcare, treatment adherence, and medication switching were not assessed and could have influenced outcomes.
“The large real-world analysis supports the gastrointestinal and hepatobiliary safety of GLP-1 receptor agonists in patients with type 2 diabetes, while highlighting the need for vigilance regarding specific complications such as gastroparesis and intussusception. Further long-term studies are needed to confirm these findings and to better assess potential cancer risks associated with GLP-1 RA therapy,” the authors concluded.
Reference:
Niu, Chengu MD1,a; Sun, Kefang MD1; Zhang, Jing MD2; Elkhapery, Ahmed MD1; Zhu, Kaiwen MD1; Malik, Sheza MD1; Xue, Chao MD1; Okolo, Patrick I MD3. Gastrointestinal and Hepatobiliary Safety of Glucagon-like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes. The American Journal of Gastroenterology ():10.14309/ajg.0000000000003760, September 03, 2025. | DOI: 10.14309/ajg.0000000000003760

Powered by WPeMatico

Continuing ACE Inhibitors and ARBs Before Non-Cardiac Surgery Linked to Lower Postoperative Mortality and Functional Decline: Study

Continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers before non-cardiac surgery is linked to a reduced risk of postoperative mortality and functional decline, according to researchers from Science Tokyo. Using a Japanese nationwide registry of 2.6 million patients over 50 years old, the researchers compared outcomes between those who continued antihypertensive therapy and those who did not. Their findings highlight potential benefits of specific classes of antihypertensive drugs depending on type of surgery needed.

Hypertension, or high blood pressure, affects nearly 1.3 billion people globally and is a leading risk factor for serious health issues. When patients with this condition need to undergo surgery, doctors must decide on how to handle their daily blood pressure medication. This is a critical choice, given that the wrong call can lead to severe complications and a decline in the patient’s physical function after the operation.

Unfortunately, this challenge is made even more difficult due to an ongoing debate in the medical community about two main classes of antihypertensive drugs: angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Some doctors hold that continuing these medications can lead to a dangerous drop in blood pressure during surgery. Others have argued that stopping them may instead trigger a dangerous spike in blood pressure, which can damage multiple organs. This lack of consensus creates a clinical dilemma for doctors and puts patients at risk.

In a recent study, a research team led by Associate Professor Shintaro Mandai along with second year MD-PhD student Rena Suzukawa and Professor Shinichi Uchida from the Department of Nephrology at the Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (Science Tokyo), Japan, sought to settle this issue. The study was conducted in collaboration with Professor Kiyohide Fushimi from the Department of Health Policy and Informatics, Science Tokyo. Their paper, which was published in Volume 5, Issue 4 of the European Heart Journal Open on August 11, 2025, explored the association between six classes of antihypertensive drugs and postoperative outcomes in patients undergoing non-cardiac surgeries.

Using a large nationwide registry of patient claims in Japan, the team analyzed data from approximately 2.6 million patients aged 50 years or older. They compared outcomes between patients who continued their antihypertensive therapy before and after surgery and those who did not. They also analyzed the outcomes for different combinations of drugs and whether the type of surgery was a meaningful factor.

Through comprehensive statistical analyses, the researchers revealed that patients who continued taking ACEis or ARBs had a significantly lower risk of mortality and functional decline after non-cardiac surgeries. Interestingly, these benefits were most evident among patients who underwent orthopedic or gastrointestinal surgeries, where they were also associated with a lower risk of sepsis.

These results have important clinical implications as Mandai explains, “By demonstrating the benefits of ACEis and ARBs in an area where randomized controlled trials are difficult to conduct, this study suggests the potential for preventing postoperative complications and maintaining quality of life in older adults.” The general findings contribute to ongoing discussions about perioperative antihypertensive management and suggest that continuing ACE inhibitors and ARBs, rather than withholding them as some clinicians advocate, may be linked to better postoperative outcomes.

Moreover, the study underscores a broader point about the untapped potential of common medications. “Although essential medications such as antihypertensive drugs are often discussed in the context of negative aspects like polypharmacy, this work hints at their added clinical value,” says Mandai. By focusing on these beneficial off-target effects, this research provides a new perspective on inpatient care.

Overall, these efforts by Mandai and his team will hopefully pave the way for practical guidelines for doctors managing patients with hypertension, helping them improve surgical outcomes worldwide.

Reference:

Rena Suzukawa, Shintaro Mandai, Yuta Nakano, Shunsuke Inaba, Hisazumi Matsuki, Yutaro Mori, Fumiaki Ando, Takayasu Mori, Koichiro Susa, Soichiro Iimori, Shotaro Naito, Eisei Sohara, Tatemitsu Rai, Kiyohide Fushimi, Shinichi Uchida, Perioperative antihypertensive medications and effects on functional decline and mortality in non-cardiac surgery, European Heart Journal Open, Volume 5, Issue 4, July 2025, oeaf096, https://doi.org/10.1093/ehjopen/oeaf096

Powered by WPeMatico

Sequential Herbal Irrigation Safe and Biocompatible Alternative in Pediatric Endodontics: Study

A randomized controlled trial published in the Journal of Indian Society of Pedodontics and Preventive Dentistry (July–September 2025 issue) by Shrikant Bhujangrao Kendre, Anuja U. Bhatane, Mahesh Vilasrao Dadpe, Yogesh Jagannath Kale, and Prasanna Trambakrao Dahake has reported that sequential herbal irrigation may offer a safe and effective alternative to conventional irrigants in the endodontic treatment of primary teeth.

The authors point out that while sodium hypochlorite, ethylenediaminetetraacetic acid, and chlorhexidine are commonly used to disinfect root canals, they can pose risks such as cytotoxicity, unpleasant taste, and tissue irritation—factors of particular concern in young children. The study found that a herbal protocol combining Salvadora persica (Miswak), Azadirachta indica (Neem), tea tree oil, and phytic acid achieved antimicrobial efficacy comparable to chemical irrigants, with the added advantages of biocompatibility and safety.

The trial involved 15 children aged 4 to 8 years with bilateral primary molars indicated for pulpectomy, making it one of the first controlled comparisons of sequential herbal and conventional irrigants in pediatric patients. Both treatment groups showed significant microbial reduction, but herbal irrigation demonstrated slightly greater activity against Enterococcus faecalis, a key bacterium implicated in endodontic failure.

Although the difference in efficacy against Prevotella intermedia was not statistically significant, the overall results underscored that the herbal regimen could match or even surpass chemical alternatives in effectiveness. By integrating multiple plant-based agents with known antimicrobial and chelating properties, the sequential protocol leveraged the synergistic action of natural compounds to disinfect root canals while minimizing potential adverse effects.

According to the authors, the findings highlight the promise of herbal irrigants in pediatric dentistry, where tolerance, safety, and biological compatibility are as important as antimicrobial efficacy. The ability to achieve reliable bacterial reduction without exposing children to harsh chemicals makes sequential herbal irrigation a potential game changer in clinical practice. The researchers recommend further trials on larger patient populations to confirm these outcomes and to standardize protocols for herbal use. Still, the study marks an important step in advancing natural, biocompatible strategies in pediatric endodontics.

Reference:

Kendre SB, Bhatane AU, Dadpe MV, Kale YJ, Dahake PT. Comparative evaluation of antibacterial efficacy of sequential herbal irrigation with conventional irrigation in endodontic therapy of primary teeth: A randomized controlled trial. J Indian Soc Pedod Prev Dent. 2025;43(3):410–417. doi:10.4103/jisppd.jisppd_253_25

Powered by WPeMatico

Sarcoidosis Patients at Higher Risk of Psychiatric Symptoms, Meta-Analysis Finds

Belgium: Patients living with sarcoidosis appear to be at a markedly higher risk of developing psychiatric symptoms compared to healthy adults, a new systematic review and meta-analysis published in Frontiers in Medicine has revealed.

The study by Andreas Frans and colleagues from the Department of Medical Psychology and Psychiatry, Antwerp University Hospital, Belgium, highlights the need for routine psychiatric screening in sarcoidosis care to improve patient outcomes. 

Sarcoidosis, a multisystem inflammatory disorder, has long been recognized for its impact on physical health, but its association with psychiatric symptoms and syndromes (PSS) has remained underexplored. To address this gap, the researchers conducted a comprehensive review of existing literature, analyzing 43 studies and 53 case reports that examined psychiatric manifestations in sarcoidosis patients. The meta-analysis included data from 962 patients and assessed the prevalence and risk of psychiatric symptoms compared to healthy controls.
The study revealed the following findings:
  • Fatigue was reported in 54% of sarcoidosis patients.
  • Excessive daytime sleepiness affected approximately 50% of patients.
  • Depression was observed in 25% of patients.
  • Anxiety was reported in 29% of patients.
  • Sleep disturbances and insomnia were present in 27% of cases.
  • Neurocognitive symptoms were reported in 29% of patients.
  • Fatigue and depressive symptoms had the strongest associations with sarcoidosis (OR 20.2 and 4.8, respectively).
  • Overall, sarcoidosis patients have a fivefold higher risk of psychiatric symptoms compared to healthy adults.
The study highlights that psychiatric symptoms in sarcoidosis are multifaceted, ranging from mood and anxiety disorders to cognitive impairments and severe manifestations such as psychosis or catatonia, as noted in individual case reports. The interplay between chronic inflammation, the disease itself, and potential side effects of sarcoidosis treatments may contribute to the development of PSS, emphasizing the complex etiopathogenesis.
Given these findings, the authors advocate for the systematic use of standardized psychiatric assessment tools in routine sarcoidosis management. Early identification and intervention for psychiatric symptoms could help mitigate their impact on quality of life and overall disease outcomes. They also call for future research to focus on larger, multicenter studies, interventional trials, and interdisciplinary care models to better understand and treat psychiatric comorbidities in this population.
“This meta-analysis confirms that sarcoidosis is not only a physical health burden but also significantly affects mental health,” the researchers noted. “Integrating psychiatric evaluation into routine clinical care is crucial for improving patient well-being and treatment outcomes.”
“The study reinforces the need for heightened awareness of psychiatric complications in sarcoidosis. Addressing these challenges through early screening, multidisciplinary care, and targeted interventions can help optimize management and enhance the quality of life for patients living with this complex disease,” they concluded.
Reference:
Frans, A., Van Hoye, G., Van Meerbeeck, X., & Morrens, M. (2025). Psychiatric symptoms and syndromes in sarcoidosis: A systematic review and meta-analysis. Frontiers in Medicine, 12, 1634175. https://doi.org/10.3389/fmed.2025.1634175

Powered by WPeMatico

Adjuvant Radiotherapy or ET Lowers Locoregional Recurrence Rates Risk in Early-Stage Breast Cancer: JAMA

USA: Researchers have found in a new study that adjuvant radiotherapy (RT) or endocrine therapy (ET) significantly reduces the risk of locoregional recurrence (LRR) in patients with early-stage breast cancer and low genomic risk.

The findings, published in JAMA Network Open by David Gibbes Miller from the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, and colleagues, highlight the importance of treatment adherence and suggest the potential role of genomic biomarkers in guiding de-escalation strategies.
The study addressed a critical question in breast cancer management: whether omission of RT or ET is associated with higher rates of recurrence among women with favorable tumor biology. Although treatment de-escalation is often considered for older women with early-stage breast cancer, limited evidence exists on whether younger patients could also safely undergo less intensive treatment with guidance from biomarker testing, such as the Oncotype DX 21-gene recurrence score (ODX RS).
The researchers examined outcomes for 2249 women aged 50 to 69 years, all of whom had hormone receptor–positive, ERBB2-negative, stage T1N0 breast cancer with an ODX RS of 18 or below. All patients underwent lumpectomy between January 2007 and January 2023. Among them, 92.3 percent also received RT alongside ET. Patients were classified based on adherence to ET, defined as taking ET for at least five years or continuing treatment at the last follow-up. The median follow-up period was 63.3 months, allowing long-term assessment of outcomes.
The key findings of the study were as follows:
  • The 72-month cumulative incidence of locoregional recurrence (LRR) was 8.0% in patients who did not receive radiotherapy (RT), compared with 1.1% in those who underwent RT, showing a significant difference.
  • Patients receiving RT had the lowest recurrence risk regardless of endocrine therapy (ET) adherence.
  • The combination of RT and adherence to ET resulted in a 72-month LRR of 1.1%.
  • RT with ET nonadherence showed a similar 72-month LRR of 0.9%.
  • ET alone, when adhered to but without RT, was linked to a higher 72-month LRR of 5.5%.
  • The highest recurrence rate, 11%, occurred in patients who received neither RT nor adhered to ET.
An important observation was that receipt of RT did not significantly impact overall survival, suggesting that its main benefit lies in local disease control rather than extending lifespan. Still, the analysis clearly indicates that adherence to at least one adjuvant modality remains vital in reducing recurrence among patients even when they have low genomic risk.
The authors note that while the absolute recurrence risk remains low for this group, the relative reduction achieved through adjuvant therapy is meaningful. They argue that the ODX RS may serve as a valuable tool in determining which younger patients might accept modestly higher recurrence risks in exchange for reduced therapy burden. However, they caution that each treatment approach carries its own risks and adverse effects, making shared decision-making between clinicians and patients essential.
“The cohort study demonstrates that both radiotherapy and endocrine therapy significantly lower the chances of locoregional recurrence in women with early-stage, low genomic risk breast cancer. For patients unwilling to receive both therapies, adherence to at least one still provides substantial benefit, reinforcing the importance of individualized treatment plans based on genomic testing and patient preferences,” the authors concluded.
Reference:
Miller DG, Boe LA, Wen HY, et al. Adjuvant Radiation and Endocrine Therapy in Early-Stage Breast Cancer With Low Genomic Risk. JAMA Netw Open. 2025;8(9):e2532305. doi:10.1001/jamanetworkopen.2025.32305

Powered by WPeMatico

MSD Pharma gets CDSCO panel nod for New Indications of Pembrolizumab in India

New Delhi: The Subject Expert Committee functioning under the Central Drugs Standard Control Organization (CDSCO) has granted approval for additional indications of Pembrolizumab (Keytruda) Injection 100 mg/4 ml, manufactured by MSD Pharmaceuticals, expanding its use for advanced cancers in India. However, the nod came with a condition that the firm should conduct a Phase IV study in India in these indications.

The recommendation was made after the drug maker MSD Pharmaceuticals presented the proposal for the grant of approval of the following additional indications of the drug Pembrolizumab Injection 100 mg/mL based on the safety and efficacy data generated from global clinical trials in these indications, along with the request for a local clinical trial waiver.

i. KEYTRUDA (pembrolizumab) in combination with chemoradiotherapy (external beam radiation therapy followed by brachytherapy), is indicated for the treatment of FIGO 2014 Stage III – IVA locally advanced cervical cancer in adults who have not received prior definitive therapy.

ii. KEYTRUDA (pembrolizumab), in combination with fluoropyrimidine and platinum-containing chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction adenocarcinoma in adults whose tumors express PD-L1 with a CPS≥1.

iii. KEYTRUDA® (pembrolizumab), in combination with gemcitabine and cisplatin, is indicated for the first-line treatment of locally advanced unresectable or metastatic biliary tract carcinoma in adults.

Pembrolizumab is a PD-1 blocking antibody used to treat various types of cancer, including metastatic melanoma, non-small-cell lung cancer, cervical cancer, head and neck cancer, and Hodgkin’s lymphoma.

Pembrolizumab binds with high affinity to the cell surface receptor programmed cell death protein 1 (PD-1) and antagonizes its interaction with its known ligands PD-L1 and PD-L2. Under normal circumstances, the binding of the ligands of PD-1 to the receptor inhibits the TCR-mediated T-cell proliferation and cytokine production. This inhibitory signal appears to play a role in self-tolerance and collateral damage minimization after immune responses against a pathogen and maternal tolerance to fetal tissue.

Also Read:Intas Pharma Told to Narrow Margins, Extend Duration in Pembrolizumab Trial Protocol

The binding of pembrolizumab to PD-1 prevents this inhibitory pathway, causing a physiological shift towards immune reactivity and enhancing tumor immunosurveillance and anti-tumor immune response.

At the recent SEC meeting for Oncology, the expert panel reviewed the proposal presented by MSD Pharmaceuticals for additional indications of Pembrolizumab (Keytruda) Injection 100 mg/4 ml.

The committee noted that the proposed indications are approved in major countries, including the USA, the EU, the UK, Japan, and Australia.

The committee further noted, “There is no clinical data available in Indian patients for these indications; however, the firm has generated safety data in a Phase IV study conducted in India in other indications.”

After detailed deliberation, the committee recommended approval of the proposed additional indications with a condition to conduct a Phase IV study in India in these indications.

Accordingly, the expert panel suggested that the firm should submit the Phase IV study protocol within three months of approval of the additional indication.

Also Read: Padcev plus Keytruda significantly improves survival for certain patients with bladder cancer when given before, after surgery: Pfizer

Powered by WPeMatico

Nocturnal Blood Pressure Dips Linked to Rapid Central Vision Loss in Normal-Tension Glaucoma: Study

Korea: Patients with normal-tension glaucoma (NTG) who experience pronounced drops in nocturnal blood pressure are at a significantly higher risk of rapid central visual field loss, a new study published in the American Journal of Ophthalmology has shown. 

The research found that over half of NTG patients classified as “over-dippers” exhibited fast central visual field progression, emphasizing the need for careful monitoring in this high-risk group.
The study was led by Dr. Jimin Park from the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, along with a team of colleagues. The investigators aimed to explore the link between nocturnal blood pressure fluctuations and the rate of central visual field deterioration in patients with early-to-moderate NTG, a common subtype of glaucoma characterized by optic nerve damage despite normal intraocular pressure.
In this prospective cohort study, 199 untreated NTG patients underwent 24-hour ambulatory blood pressure monitoring (ABPM) in their usual daily settings and were followed for a minimum of two years, with an average follow-up of 4.9 years. Based on their nighttime blood pressure patterns, participants were categorized as non-dippers, dippers, or over-dippers. Central visual field progression was measured using the mean total deviation of the 12 central points (MTD10), with “fast progression” defined as a decline of more than 0.5 dB per year.
The study led to the following findings:
  • Over-dippers showed a mean MTD10 decline of -0.53 dB/year, faster than dippers (-0.27 dB/year) and non-dippers (-0.23 dB/year).
  • 60% of over-dippers experienced fast central visual field progression.
  • 23.5% of dippers and 19.8% of non-dippers experienced fast central visual field progression.
  • The percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant predictor of rapid central visual field loss, with an odds ratio of 1.062.
These findings highlight a crucial clinical insight: pronounced nocturnal blood pressure dips can accelerate central visual field deterioration in NTG patients. Central vision is vital for daily tasks such as reading and recognizing faces, and rapid loss in this area can substantially impair quality of life. The study suggests that ophthalmologists should closely monitor NTG patients exhibiting significant nocturnal BP reductions and consider integrated management strategies that address both ocular and systemic cardiovascular factors.
While the study provides valuable evidence linking blood pressure patterns to glaucoma progression, the authors note that further research is needed to determine whether interventions to stabilize nocturnal blood pressure can slow visual field loss. Nevertheless, the current findings underscore the importance of personalized care in NTG, particularly for patients at risk of rapid central visual field decline.
Dr. Park and colleagues’ research demonstrates that over-dipping during sleep is a key risk factor for accelerated central visual field loss in NTG, affecting more than half of these patients. Early identification and vigilant monitoring of at-risk individuals could play a critical role in preserving central vision and preventing functional impairment in glaucoma patients.
Reference:
Park, J., Song, W. K., Yoon, J., Kim, K. E., & Kook, M. S. (2025). Fast Central Visual Field Progression in Patients with Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2025.09.018

Powered by WPeMatico

Previous use of LNG-IUS associated with decreased endometrial growth in women undergoing IVF/ICSI: Study

Long-acting reversible contraceptive methods are among the
most effective contraceptives available today and are an advantageous choice of
contraception for women who wish to conceive in the future. Among these is the
levonorgestrel intrauterine system (LNG-IUS), the use of which has increased in
recent years. The LNG-IUS releases levonorgestrel locally, causing the cervical
mucus to thicken, thereby decreasing spermatozoa motility, which creates a
hostile environment for the spermatozoa. Further, it causes atrophy of the
endometrium. The combination of these effects prevents fertilisation and
implantation. As LNG-IUS is a reversible contraceptive method, removal should
result in a return to baseline fertility. However, current literature on this
topic is contradicting. While some studies have shown that the use of LNG-IUS
does not affect the return to baseline/ normal fertility after removal, others
have found delayed conception after removal. Endometrial development plays an
essential role in achieving pregnancy, as a sufficient endometrial thickness
(EMT) is needed for successful embryonic implantation into the uterine wall. A
previous study investigated the effect of combined oral contraceptive pill
(OCP) use on the endometrium and found that long-term use of OCPs may have a
negative effect on endometrial growth.

As OCPs and LNG-IUSs are both hormonal contraceptive methods
containing progestin, it can be hypothesised that the use of LNG-IUS may also
affect endometrial growth and thereby fertility. Consequently, the objective of
this study was to investigate whether previous use of the LNG-IUS negatively
influences the EMT in women undergoing in vitro fertilisation
(IVF)/intracytoplasmic sperm injection (ICSI) treatment.

This study was a register-based multicentre historical
cohort study. The study has been reported in accordance with Strengthening the
Reporting of Observational Studies in Epidemiology (STROBE).

It was a Multicentre historical cohort study from eight
Danish public and private fertility clinics. 12786 women aged 18–46 years
contributing with an EMT measurement from 22464 different IVF/ICSI treatment
cycles between 2000 and 2021 were taken. Exposure was previous use of LNG-IUS,
combined oral contraceptive pills (OCPs), progesterone -only pills (POPs), no/
other contraception or combined, cumulated use of contraception when more
contraceptives had been used during the inclusion period. Further, ever use of
LNG-IUS was categorised into 0–3 years, > 3–6 years, > 6–9 years and
>9 years. Mixed effect logistic regression adjusted for age, BMI, smoking,
educational level, total FSH dose and fertility clinic was used.

Statistically significantly higher odds of EMT ≥7mm were
found for OCPs [odds ratio (OR) 3.53 (95% confidence interval (95% CI)
1.29–9.65)], POPs [OR 6.43, (95% CI 1.45–28.63)] and no/other contraception [OR
6.67, (95% CI 2.37–18.74]) relative to LNG-IUS in IVF/ICSI cycles. Further, all
duration categories of ever use of LNG-IUS were associated with statistically
significantly lower odds of obtaining an EMT ≥7mm compared to no/other
contraception.

In this study, previous use of LNG-IUS was associated with
statistically significantly lower odds of obtaining an EMT ≥7mm when compared
to other contraceptive methods in IVF/ICSI cycles. Further, authors found a
statistically significant association between ever use of LNG-IUS and a thin
endometrium compared to no/other previous use of contraceptives regardless of
the duration of use.

In conclusion, this study showed that previous use of
LNG-IUS might have a negative impact on the EMT in IVF/ICSI cycles. However,
authors acknowledge that this present study has limitations, which should be
considered when interpreting the results. Future research should accommodate
these limitations to create evidence-based knowledge on the potential prolonged
negative impact of LNG-IUS on the endometrium and its receptivity in IVF/ICSI
cycles.

Source: Mette Peters Michaelsen;
Laura Cæcilie Nielsen; Michelle Poulsen; BJOG: An International
Journal of Obstetrics & Gynaecology, 2025; 0:1–8
https://doi.org/10.1111/1471-0528.18295

Powered by WPeMatico

TAVR Outcomes in ESRD Patients Remain Poor, Large Study Shows

USA: Patients with end-stage renal disease (ESRD) who undergo transcatheter aortic valve replacement (TAVR) continue to face significantly worse outcomes compared to those without kidney failure, and these risks are not reduced even when treated at high-volume centers, according to a study published in The Annals of Thoracic Surgery.

The research was conducted by Dr. Esteban Aguayo and colleagues from the Department of Surgery, David Geffen School of Medicine, UCLA, who evaluated national outcomes of TAVR among patients with ESRD. Although TAVR is widely regarded as a less invasive and safer alternative to surgical aortic valve replacement in the general population, the study highlights that patients with severe kidney disease remain at heightened risk of mortality, prolonged hospitalizations, and frequent readmissions.
Using data from the National Readmissions Database between 2016 and 2021, the investigators analyzed more than 411,000 adult patients who underwent TAVR. Of these, approximately 7.3 percent were identified as having ESRD. Patients were grouped according to their renal status, and outcomes such as in-hospital mortality, 30-day readmission, length of hospital stay, procedural complications, and hospitalization costs were assessed. The study also examined whether institutional experience, defined by procedural volume, influenced these outcomes by comparing low-volume hospitals with high-volume centers.
The findings revealed the following:
  • ESRD was linked to a 79% higher likelihood of in-hospital death compared with non-ESRD patients.
  • The risk of 30-day readmission was 87% greater in ESRD patients.
  • ESRD patients stayed in the hospital 1.3 days longer on average.
  • Hospitalization costs for ESRD patients were about $1,000 higher.
  • Non-ESRD patients benefited from lower mortality and readmission risks when treated at high-volume hospitals.
  • This protective effect of high-volume centers was not observed in ESRD patients.
  • Patients with ESRD continued to face persistently high rates of mortality and readmissions regardless of hospital volume.
The authors emphasized that these findings highlight the importance of individualized decision-making when considering TAVR in patients with ESRD. While the procedure may offer symptom relief and an alternative to open-heart surgery, its benefits are limited by the elevated risks inherent in this population. The study suggests that optimal patient selection, thorough pre-procedural evaluation, and strategies aimed at minimizing complications are essential to improving outcomes.
Dr. Aguayo and his team concluded that ESRD patients undergoing TAVR represent a particularly vulnerable group, and that high procedural volumes alone are insufficient to overcome their adverse prognosis. The research calls for more focused efforts to refine risk stratification and develop tailored management approaches to address the challenges of performing TAVR in patients with advanced kidney disease.
Reference:
Aguayo E, Kwon OJ, Won M, Mallick S, Coaston T, Vadlakonda A, Tabibian K, Sanaiha Y, Shemin RJ, Benharash P, Impact of Transcatheter Aortic Valve Replacement Volume on Outcomes in Patients with End Stage Renal Disease, The Annals of Thoracic Surgery (2025), doi: https://doi.org/10.1016/j.athoracsur.2025.08.009.

Powered by WPeMatico