DMARD Use and Rheumatoid Arthritis Raise Mortality in Bronchiectasis Patients: Study Shows

South Korea: A large-scale study from South Korea has found that individuals living with both bronchiectasis and rheumatoid arthritis face more than double the risk of death compared to those with bronchiectasis alone. The research, published in Therapeutic Advances in Respiratory Disease, also indicates that RA seropositivity and the use of disease-modifying anti-rheumatic drugs may further heighten this risk.  

The study, led by Dr. Hayoung Choi from the Division of Pulmonary, Allergy, and Critical Care Medicine at Hallym University Kangnam Sacred Heart Hospital, analysed data from the Korean National Health Insurance Service covering the years 2010 to 2017. It included 3,355 patients diagnosed with both bronchiectasis and RA — of whom 2,632 were seropositive and 723 were seronegative — and compared them with 16,240 age- and sex-matched individuals who had bronchiectasis but not RA. Participants were followed for a median period of 5.8 years, beginning one year after RA diagnosis or a corresponding index date for the control group.

The study revealed the following findings:

  • Patients with bronchiectasis–RA overlap syndrome (BROS) had a 2.09-fold higher mortality risk compared to those with bronchiectasis alone, even after adjusting for other health factors.
  • Mortality risk was 2.34 times higher in patients with seropositive RA and 1.29 times higher in those with seronegative RA, compared to the bronchiectasis-only group.
  • Individuals with seropositive RA showed a poorer prognosis, indicating that persistent systemic inflammation may play a major role in worsening lung health and speeding up disease progression in this population.
  • Use of disease-modifying anti-rheumatic drugs (DMARDs) was linked to higher mortality in patients with BROS.
  • Although causality was not established, DMARDs—by suppressing immune function—may heighten vulnerability to respiratory infections, a significant concern for people with bronchiectasis.

One of the major strengths of the study is its size, making it one of the most comprehensive investigations into the link between RA and bronchiectasis-related mortality. The authors also emphasise its novel exploration of both RA seropositivity and DMARD exposure. However, they acknowledge limitations, including the reliance on diagnostic codes, which may lead to over- or under-diagnosis, and the absence of detailed clinical data such as lung infection rates, hospitalisation history, microbiological findings, RA disease activity measures, or the presence of RA-associated interstitial lung disease. Additionally, the number of patients on DMARDs was relatively small, which restricted the analysis of drug-related outcomes.

The findings emphasize the need for careful monitoring and tailored treatment approaches for patients with both bronchiectasis and RA, particularly those who are seropositive. The study’s authors call for further research to clarify the role of DMARDs in this context and to develop strategies that can help reduce mortality and improve long-term outcomes for this high-risk group.

Reference:

Choi, H., Han, K., Jung, J. H., Soyza, A. D., Kim, H., Shin, D. W., & Lee, H. (2025). Impact of rheumatoid arthritis, seropositivity and disease-modifying anti-rheumatic drugs on mortality risk in bronchiectasis. Therapeutic Advances in Respiratory Disease. https://doi.org/10.1177_17534666251360071

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Low vitamin B12 levels associated with primary monosymptomatic nocturnal enuresis: Study

A new study published in the Journal of Pediatric Urology found that children who have low or borderline vitamin B12 levels are more prone to experience primary monosymptomatic nocturnal enuresis (PMNE).

Urinary control systems may be impacted by micronutrient deficits, especially those involving vitamin B12. The most prevalent voiding issue in the pediatric population is PMNE, which is defined as involuntary nighttime urination in children past the age at which bladder control would typically be expected. Over the past few decades, nocturnal enuresis has continued to be the subject of substantial scientific inquiry due to its high incidence. Despite much discussion, the etiology of PNE is still not fully known.

Although their precise functions in both healthy and diseased settings are not entirely understood, vitamin B12 and folate are crucial for the metabolism, growth, and maturation of the nervous system. Despite a great deal of study on PNE, there are still a lot of concerns about its precise pathogenesis. Thus, this study wanted to determine whether vitamin B12 insufficiency is a possible risk factor for the development of enuresis and to examine the association between children’s blood vitamin B12 levels and PMNE.

A total of 167 age- and sex-matched healthy controls and 184 children with enuresis, ages 5 to 15, were included in this prospective case-control research. Vitamin B12 levels, age, gender, and family history of enuresis were noted for each participant. Serum B12 levels were classified as “normal” (>300 pg/mL), “deficiency” (<200 pg/mL), and “borderline deficiency” (200-300 pg/mL). 

Almost, 12.5% of the enuresis group had a B12 shortage, 41.3% had a borderline deficiency, and 46.2% had normal levels. These rates were 9.6%, 29.3%, and 61.1% in the control group, respectively (p<0.05). Multivariate analysis revealed that PMNE was strongly correlated with B12 deficiency (OR: 2.05; 95% CI: 1.01-4.08; p=0.049) and family history of enuresis (OR: 8.62; 95% CI: 4.61-16.13; p<0.001).

Overall, these findings suggest a statistically significant correlation between PMNE and vitamin B12 levels. When compared to healthy controls, B12 deficiency or borderline B12 levels were more prevalent. In addition to a family history of enuresis, a B12 deficiency quadrupled the risk of PMNE. The inclusion of vitamin B12 evaluation in clinical judgment for kids with enuresis is supported by this data.

Reference:

Gülyüz, A. (2025). Relationship between serum vitamin B12 levels and primary monosymptomatic nocturnal enuresis: A prospective case-control study. Journal of Pediatric Urology. https://doi.org/10.1016/j.jpurol.2025.07.032

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Pain Meets Peace: Study Evaluates Dexmedetomidine in Chronic Pain with Anxiety and Depression

Chronic pain frequently coexists with anxiety and depression, complicating treatment outcomes and exacerbating patients’ suffering. Dexmedetomidine (DEX), a selective α2-adrenoreceptor agonist used primarily in perioperative settings, has shown promise in alleviating these co-occurring symptoms due to its analgesic and anxiolytic properties. However, its application in chronic pain patients who also suffer from anxiety and depression remains under-researched. To investigate this, a recent retrospective cohort study evaluated patients who received intravenous DEX during interventional pain management procedures.

The study enrolled 306 chronic pain patients who exhibited no less than mild symptoms of anxiety and depression, as assessed by the GAD-7 and PHQ-9 questionnaires. Participants were divided into two groups: those receiving DEX (n=106) and those undergoing local analgesia (LA) (n=184). Propensity score matching ensured balanced characteristics between the DEX and LA groups, facilitating a robust comparison of outcomes.

Results

The findings demonstrated that at one-month follow-up, DEX administration was associated with significantly greater reductions in anxiety (GAD-7 score reduced by -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score reduced by -6.19 for DEX vs. -3.92 for LA). Pain relief was also greater in the DEX cohort (-3.32 vs. -2.62 based on the NRS), indicating DEX’s effectiveness in managing both physical and psychological distress. Patient satisfaction scores were notably higher in the DEX group, reflecting improvements in anxiety management and overall procedural experiences. Sensitivity analyses reinforced these findings, particularly among patients exhibiting both anxiety and depression, and indicated that approximately 18-32% of anxiety and depression improvements could be directly attributed to pain alleviation. Despite these promising results, limitations included the retrospective design, single-center scope, and short follow-up duration, which may affect generalizability and long-term efficacy assessment. The research suggests DEX may serve as a dual-purpose treatment for chronic pain patients with anxiety and depressive symptoms, acting independently on mood regulation beyond analgesic effects. However, further randomized controlled trials are necessary to confirm DEX’s effectiveness, explore neurobiological mechanisms, and determine optimal dosing strategies to enhance outcomes in varied patient populations. Such efforts could lead to integrated approaches in managing chronic pain alongside psychological comorbidities, optimizing therapeutic strategies for multifaceted patient needs.

Key Points

– A retrospective cohort study evaluated the effects of intravenous dexmedetomidine (DEX) in 306 chronic pain patients with mild to moderate symptoms of anxiety and depression, assessing its potential benefits beyond standard local analgesia (LA).

– Participants were divided into two groups: those receiving DEX (n=106) and those receiving LA (n=184), with propensity score matching applied to ensure comparability in demographics and clinical characteristics between the groups.

– Results at one-month follow-up indicated that DEX treatment produced significantly greater reductions in anxiety (GAD-7 score: -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score: -6.19 for DEX vs. -3.92 for LA), highlighting DEX’s multifaceted role in managing pain and psychological distress.

– The DEX cohort reported greater pain relief measured by the Numeric Rating Scale (NRS) (-3.32 for DEX vs. -2.62 for LA), along with higher patient satisfaction scores, which emphasized the therapeutic value of DEX in enhancing patient experiences during procedural interventions.

– Sensitivity analyses confirmed the robustness of these findings, especially among patients with concomitant anxiety and depression, revealing that 18-32% of the improvements in anxiety and depression could be attributed to pain relief obtained from DEX treatment.

– Limitations of the study include its retrospective design, the single-center nature of the research, and the relatively short follow-up period, which may restrict the generalizability of the results and necessitate further randomized controlled trials to validate DEX’s efficacy and explore underlying mechanisms in diverse patient populations.

Reference –

Yiting Ren et al. (2025). Dexmedetomidine For Chronic Pain Patients With Anxiety And Depression: A Propensity Score Matching Cohort Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03087-x.

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Evidence gaps remain for AI eye imaging devices approved for patient care

Regulator-approved AI models used in eye care vary widely in providing evidence for clinical performance and lack transparency about training data, including details of gender, age and ethnicity, according to a new review led by researchers at UCL (University College London) and Moorfields Eye Hospital.

The analysis, published in the journal npj Digital Medicine, examined 36 regulator-approved “artificial intelligence as a medical device” (AIaMD) tools in Europe, Australia and the US, and found concerning trends.

Of the devices reviewed, 19% had no published peer-reviewed data on accuracy or outcomes. In evaluating the available evidence for the remainder, the researchers found that across 131 clinical evaluations, only 52% of studies reported patient age, 51% reported sex, and only 21% reported ethnicity. The review also highlights that most validation used archival image sets, with limited diversity or inadequate reporting of basic demographic characteristics and uneven geographical distributions.

Very few studies compared the AI tools head-to-head with each other (8%) or with the standard of care of human doctors (22%). Strikingly, only 11 of the 131 studies (8%) were interventional – the kind that test devices in real-life clinical settings and affect clinical care. This means real-world validation is still scarce.

More than two-thirds of the AI tools target diabetic retinopathy in a screening context, either singly or together with glaucoma and macular degeneration, while other common sight-threatening conditions and settings remain largely unaddressed.

Almost all the devices examined (97%) are approved in the European Union, but only 22% have Australian clearance with just 8% are authorised in the U.S. This uneven regulatory landscape means devices cleared on one continent may not meet standards elsewhere.

The authors argue these shortcomings must be addressed. They call for rigorous, transparent evidence and data that meets the FAIR principles of Findability, Accessibility, Interoperability, and Reusability, since lack of transparency can hide biases.

Lead author Dr Ariel Ong (UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust) said: “AI has the potential to help fill the global gap in eye care. In many parts of the world, there simply aren’t enough eye specialists, leading to delayed diagnoses and preventable vision loss. AI screening could help identify disease earlier and support clinical management, but only if the AI is built on solid foundations.

“We must hold AI tools to the same high standards of evidence as any medical test or drug. Facilitating greater transparency from manufacturers, validation across diverse populations, and high-quality interventional studies with implementation-focused outcomes are key steps towards building user confidence and supporting clinical integration.”

Senior author Jeffry Hogg, from the University of Birmingham, said: “Our review found that the evidence available to evaluate the effectiveness of individual AIaMDs is extremely variable, with limited data on how these devices work in the real world. Greater emphasis should be placed on accurate and transparent reporting of datasets. This is critical to ensuring devices work equally well for all people, as some populations may be underrepresented in the training data.”

In practical terms, the study suggests several next steps. The authors encourage manufacturers and regulators to adopt standardised reporting – for example, publishing detailed “model cards” or trial results at each stage of development. They note that regulatory frameworks for AIaMDs may benefit from a more standardised approach to evidence reporting, which would give clarity to both device developers and end users. The review also highlights new guidance, such as the EU AI Act, that could raise the bar for data diversity and real-world trials.

The researchers hope their work will inform policymakers and industry leaders to ensure that AI in eye care is both equitable and effective. Robust oversight, they argue, will help deliver on the promise of faster, more accurate eye disease detection—without leaving any patient group behind.

Reference:

Ong, A.Y., Taribagil, P., Sevgi, M. et al. A scoping review of artificial intelligence as a medical device for ophthalmic image analysis in Europe, Australia and America. npj Digit. Med. 8, 323 (2025). https://doi.org/10.1038/s41746-025-01726-8

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Chronic hives: Researchers identify most effective, safest treatments

A new international study led by researchers at McMaster University has identified the most effective and safest treatments for people suffering from chronic urticaria, more commonly known as chronic hives.

Published in The Journal of Allergy and Clinical Immunology on July 15, 2025, the study is the first comprehensive network meta-analysis to compare more than 40 treatment options for chronic hives, a condition that affects about one per cent of people and can severely impact quality of life, sleep, and productivity. The study examined 93 randomized controlled trials involving over 11,000 participants.

Prior to now, patients and clinicians had to consult a growing list of treatment options without up-to-date evidence.

The research identified the following treatments as most effective:

  • Omalizumab, an injectable antibody, and remibrutinib, a new oral medication, are among the most effective treatments for reducing hives, itch, and swelling.
  • Dupilumab, another injectable antibody, also showed promise, particularly for reducing hives.
  • Cyclosporine may be effective but carries a higher risk of side-effects such as kidney toxicity and high blood pressure.

“This first comprehensive analysis of all advanced treatment options for chronic urticaria provides a clear and evidence-based ‘menu of treatment options’ for patients and their clinicians to choose from,” says Derek Chu, senior author and assistant professor with McMaster’s Department of Medicine.

Chu says the study makes clear which treatment options were the most effective and safe.

Reference:

Chu, Alexandro W.L. et al., Comparative efficacy and safety of biologics and systemic immunomodulatory treatments for chronic urticaria: Systematic review and network meta-analysis, Journal of Allergy and Clinical Immunology.

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Updated Clinical Practice Guideline on Adult Sinusitis: Emphasis on Patient Education, Shared Decision-Making, and Evidence-Based Treatment

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline (CPG): Adult Sinusitis Update today in Otolaryngology–Head and Neck Surgery. The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing adult sinusitis and to provide explicit and actionable guidance that can be implemented across all clinical practices.

“With sinusitis affecting about one in eight adults in the United States each year, this CPG update empowers both patients and their healthcare providers with evidence-based recommendations that can lead to better outcomes,” said Spencer C. Payne, MD, Chair of the Guideline Update Group.

“Key changes from the 2015 guideline include expanding ‘watchful waiting’ as the preferred initial approach for most bacterial sinus infections, since most people get better on their own. We’ve also provided clearer guidance on when antibiotics are truly needed, what the first-choice antibiotic should be, and new information about advanced treatments like biologics for chronic sinusitis with nasal polyps. Most importantly, we’ve emphasized that not all sinus symptoms require antibiotics, and there are effective symptomatic treatments like nasal saline rinses and steroid sprays that can provide relief. We encourage patients to have open conversations with their healthcare providers about these options to find the right treatment approach for their specific situation.”

Sinusitis affects approximately 12% of adults in the United States resulting in over 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life ranging from $12 to 20 billion. One in five antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy. Despite the high prevalence and economic impact of sinusitis, considerable practice variations exist across and within the multiple disciplines involved in managing the condition.

This CPG update provides 14 research-based key action statements that address such areas as unnecessary antibiotic use, conservative-treatment first approaches, objective confirmation for chronic cases, and targeted therapy options based on specific patient characteristics.

In the development of this CPG update, the guideline update group considered new evidence from 14 guidelines, 194 systematic reviews, and 133 randomized controlled trials. The group, which was led by AAO-HNSF, included representatives from the fields of otolaryngology, infectious disease, family medicine, allergy and immunology, advanced practice nursing, a patient advocate, and staff. Before the guideline was published, it went through public and peer review for comments.

Reference:

Spencer C. Payne, Margo McKenna, Jennifer Buckley, Clinical Practice Guideline: Adult Sinusitis Update, Otolaryngology–Head and Neck Surgery, https://doi.org/10.1002/ohn.1344.

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Depression often associated with early menopause: Why some women are at greater risk?

Premature menopause has been described as a life-changing diagnosis with profound physical, psychological, and social consequences. Affected women not only experience the effects of estrogen deficiency, but they also experience the unanticipated loss of reproductive function. However, some women are more adversely affected by these changes than others. A new study helps explore reasons for these differences. Results are published online today in Menopause, the journal of The Menopause Society.

Premature menopause, medically known as premature or primary ovarian insufficiency (POI), is a condition in which the ovaries cease to function normally before the age of 40. It has been linked to an elevated lifetime risk for depression and anxiety. A recent meta-analysis revealed an odds ratio of 3.3 for depression and 4.9 for anxiety in women with POI compared with those without the condition. The increased risk is understandable given the combined experience of infertility and the additional burdens resulting from estrogen deficiency, such as hot flashes, vaginal dryness, reduced bone mineral density, and an increased risk of cardiovascular disease, among others. For some women, infertility means altered life goals, loss of sense of control, social stigma, and disrupted social roles.

However, not all women experience depression or the same level of depression when presented with the same diagnosis. In this new study, researchers gathered data from nearly 350 women with POI to try to identify the specific variables that contribute to the likelihood of depressive symptoms. Their first observation was the high prevalence of depression among participants. Nearly one-third (29.9%) of the women with POI suffered from depressive symptoms.

The researchers additionally found that a younger age at POI diagnosis, severe menopause symptoms, fertility-related grief, and lack of emotional support were risk factors. No significant difference was found in depressive symptoms between women using estrogen plus progestogen therapy and those not using hormone therapy, underscoring the role of psychosocial factors. Interestingly, a genetic cause for POI was associated with lower depressive symptoms. Another unexpected result was that, even though a higher burden of menopause symptoms was independently associated with depressive symptoms, hot flashes (specifically night sweats) were not.

This is the first known large-scale study to investigate specific variables that are associated with depressive symptoms in women with POI. The researchers believe its results highlight the importance of comprehensive care addressing both physical and psychological aspects of menopause at an early age.

Survey results are published in the article “Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study.”

“The high prevalence of depressive symptoms in those with POI highlights the importance of routine screening in this vulnerable population. Although hormone therapy is recognized as the standard of care for those with POI for management of some menopause-related symptoms and preventive care, it is not first-line treatment for mood disorders. This was evident in this study in which there was no difference in depressive symptoms between those using hormones and those not using hormone therapy. Addressing behavioral-health concerns with evidence-based interventions should be part of any comprehensive POI care plan,” says Dr. Monica Christmas, associate medical director for The Menopause Society.

Reference:

van Zwol‐Janssens, Charissa MD; Louwers, Yvonne V. MD, PhD; Laven, Joop S.E. MD, PhD; Schipper, Jits MD, PhD; Jiskoot, Geranne PhD. Depressive symptoms in women with premature ovarian insufficiency (POI): a cross-sectional observational study. Menopause ():10.1097/GME.0000000000002614, July 15, 2025. | DOI: 10.1097/GME.0000000000002614

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Acid Reflux Medication Linked to Supraglottoplasty in Infants with Laryngomalacia: JAMA

USA: A recent study published in JAMA Otolaryngology-Head & Neck Surgery has found a connection between the use of acid reflux medications and the likelihood of undergoing supraglottoplasty in infants diagnosed with laryngomalacia.

The research, led by Dr. Habib Zalzal from the Department of Otolaryngology at Children’s National Hospital, Washington, DC, sought to determine whether gastroesophageal reflux disease (GERD) medications influence the need for surgical intervention in infants with nonsevere laryngomalacia—a condition characterized by noisy breathing due to soft, floppy tissue above the vocal cords.

The retrospective cohort study analyzed medical records from 395 infants under six months of age who were initially evaluated for nonsevere laryngomalacia at a pediatric otolaryngology airway clinic between 2014 and 2023. Participants were divided into two groups based on the initial management approach: those treated conservatively through observation (n=320) and those who received GERD medications (n=75).

The primary focus of the study was to compare how often infants in each group eventually required supraglottoplasty, a surgical procedure performed to relieve airway obstruction caused by laryngomalacia.

The key findings of the study were as follows:

  • The overall rate of supraglottoplasty among all infants analyzed was 4.1%.
  • In the observation-only group, 3.4% of infants underwent surgery.
  • In the GERD medication group, 6.7% of infants required supraglottoplasty.
  • This reflects a modest increase in surgery among infants treated with acid suppression therapy.
  • The difference in surgery rates between the two groups was −3.2%, indicating limited statistical precision.
  • Female sex and the severity of laryngomalacia based on endoscopic findings were stronger predictors of surgery than GERD medication use.

Despite its limitations, including the retrospective design and single-institution data, the study highlights an important clinical consideration: acid reflux medications, commonly prescribed for infants with laryngomalacia despite limited evidence of benefit, may not significantly reduce the need for surgery and could be associated with a slightly higher likelihood of surgical intervention.

Ultimately, the findings support a more cautious approach to prescribing GERD medications in this population, especially for those with mild symptoms who are otherwise stable. Clinicians are encouraged to weigh the potential risks and benefits of acid suppression therapy and continue relying on individualized assessment, including endoscopic findings, when deciding the best course of treatment.

The researchers concluded, “The study found that infants with nonsevere laryngomalacia had similar rates of supraglottoplasty whether they were treated with GERD medications or simply observed. Female infants and those with more severe laryngomalacia seen on endoscopy were more likely to need surgery after a period of watchful waiting.”

Reference:

Zalzal H, Pershad A, Behzadpour H, Rana MS, Zalzal G. Association Between Acid Reflux Medication and Supraglottoplasty in Infant Laryngomalacia. JAMA Otolaryngol Head Neck Surg. Published online May 29, 2025. doi:10.1001/jamaoto.2025.1201

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Behavioral Therapy Noninferior to Drug Treatment for Overactive Bladder in Parkinson’s Disease: JAMA

A new study published in the Journal of American Medical Association showed that behavioral therapy is as effective as drug therapy in managing overactive bladder (OAB) symptoms in patients with Parkinson’s disease. These results support considering behavioral therapy as a first-line treatment option in clinical guidelines for urinary symptoms in PD.

The symptoms of OAB in PD might be exacerbated by the negative effects of medication. Exercise-based behavioral treatment for the pelvic floor muscles prevents drug side effects. Thus, to determine if behavioral treatment is superior than solifenacin medication therapy for OAB symptoms in people with Parkinson’s disease, this study was carried out.

In 4 US Veterans Affairs health care systems, a 12-week randomized noninferiority experiment comparing behavioral treatment to solifenacin was carried out between 2018 and 2023. In addition to having a Montreal Cognitive Assessment (MOCA) score of 18 or higher (range: 0-30) and an International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB) symptom score of 7 or higher (range: 0-16; a higher score indicates worse symptoms), eligible participants were diagnosed with PD by a movement disorder neurologist. Following stratification by sex, recruitment site, severity of OAB, and severity of PD motor symptoms, participants were randomized 1:1. Analysis took place between October 2023 and April 2024.

The behavioral treatment included urge suppression techniques and training for the pelvic floor muscles. Starting at 5 mg per day, solifenacin treatment can be increased to 10 mg per day as necessary. The main result was the 12-week ICIQ-OAB score, which was within a 15% noninferiority margin for all groups. For eight weeks, adverse events were evaluated every two weeks and then again at twelve weeks.

A total of 77 individuals with Parkinson’s disease (65 [84%] men; mean [SD] age, 71.3 [8.9] years; mean [SD] years with PD, 6.6 [5.8]) were randomly assigned to either behavioral therapy (n = 36) or medication therapy (n = 41). The trial was finished by 73 individuals (4 dropped out in the drug group). MOCA score (mean [SD], drug, 23.9 [3.1]; behavioral, 24.8 [3.3]) and ICIQ-OAB score (mean [SD], drug, 9.1 [1.7]; behavioral, 8.5 [1.4]) were among the baseline variables that were equal for each group.

Within the a priori noninferiority margin of 15%, ICIQ-OAB scores at 12 weeks post-randomization showed clinically meaningful improvement across groups (mean [SD] score, drug, 5.8 [2.4]; behavioral, 5.5 [2.0]; P =.02). Falls and dry mouth were reported more often in the medication group than in the behavioral group. Overall, the findings of this trial found that behavioral treatment can help PD patients with their OAB symptoms just as well as medication therapy.

Reference:

Vaughan, C. P., Morley, J. F., Lehosit, J., McGwin, G., Muirhead, L., Khakharia, A., Johnson, T. M., 2nd, Evatt, M. L., Sergent, T., Burgio, K. L., & Markland, A. D. (2025). Behavioral compared with drug therapy for overactive bladder symptoms in Parkinson disease: A randomized noninferiority trial: A randomized noninferiority trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.1904

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Placental Extract Gel Enhances Periodontal Healing; Periostin Emerges as Promising Biomarker: Study

According to a new study adjunctive application of placental extract gel in surgical periodontal therapy significantly improved healing outcomes. Additionally, periostin has shown potential as a reliable biomarker for monitoring periodontal wound healing.

The elimination of the causative agent and the facilitation of tissue regeneration are the fundamental objectives of periodontal therapy. Various adjunctive agents have been investigated to optimize treatment outcomes with surgical interventions. Periostin is a matricellular protein predominantly expressed in periodontal tissues, playing a key role in tissue remodeling, inflammation, and wound healing. The human placental extract has been used in periodontal surgery and compared with open flap debridement alone, with gingival crevicular fluid (GCF) periostin levels assessed to gauge periodontal wound healing. Sixteen systemically healthy patients diagnosed with Stage III Grade C periodontitis were enrolled in the study. Participants were randomly assigned to either the test group (n = 8) or the control group (n = 8), with a total of nine males and seven females distributed across the groups. The test group underwent open flap debridement (OFD), followed by applying human placental extract gel absorbed into a gelatin sponge, while the control group received only OFD. Clinical parameters were assessed at baseline and 3 month post-treatment. GCF periostin levels were measured at baseline, 6 weeks, and 3 months. Results: The test group demonstrated a mean probing pocket depth (PPD) reduction of 4.75 ± 1.28 mm, compared to 3.12 ± 1.12 mm in the control group, with the difference being statistically significant. The relative attachment level (RAL) gain was 4.37 ± 1.18 mm in the test group and 2.75 ± 0.70 mm in the control group; however, this difference was not statistically significant. At 3 months, the mean healing index score was 4.50 ± 0.53 in the test group and 3.62 ± 0.51 in the control group, with a statistically significant intergroup difference. The Plaque Index (PI), Gingival Index (GI), and Gingival Bleeding Index (BI) showed moderate reductions at 3 months; however, intergroup differences were not statistically significant, except for BI, where the difference at 3 months was -0.180. The adjunctive use of placental extract gel in surgical periodontal therapy demonstrated beneficial effects on healing outcomes. In addition, periostin shows promise as a biomarker for periodontal wound healing.

Reference:

Rathana, M., Paramashivaiah, R., Prabhuji, M.L.V. et al. Role of placental extracts in enhancing periodontal flap surgery healing: insights from periostin biomarker analysis. Eur J Med Res 30, 623 (2025). https://doi.org/10.1186/s40001-025-02891-y

Keywords:

Placental, Extract, Gel, Enhances, Periodontal, Healing, Periostin, Emerges, Promising, Biomarker, Rathana, M., Paramashivaiah, R., Prabhuji, M.L.V, Periodontitis, Surgical periodontal therapy, Human placental extract, Periostin, Wound healing, Marker

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