Archive for category: News

Taking the progestogen-only contraceptive pill desogestrel continuously for more than five years is associated with a small increased risk of developing a type of brain tumour called an intracranial meningioma, finds a study from France published by The BMJ today.

However, the researchers stress that the risk is low compared with some other progestogens (for every 67,000 women taking desogestrel, one might need surgery for meningioma) and disappeared one year after stopping treatment.

Intracranial meningiomas are typically non-cancerous brain tumours that occasionally require surgery. They are more common in older women, but many studies lack information on the specific type of progestogen used, and risk has not been measured for continuous, current, and long term use.

To address this knowledge gap, researchers set out to assess the real-life risk of intracranial meningioma associated with short-term (less than 1 year) and prolonged (1-7 or more years) use of oral contraceptives containing desogestrel 75µg, levonorgestrel 30µg, or levonorgestrel 50-150 µg combined with oestrogen.

Their findings are based on data from the French national health data system (SNDS) for 8,391 women (average age 60; 75% older than 45) who had undergone surgery for intracranial meningioma in 2020-2023. Each case was matched to 10 control women without meningioma (total 83,910) of the same age and area of residence.

Potentially influential factors, including use of a known high-risk progestogen in the six years before the study, were taken into account.

The results show a small increased risk associated with use of desogestrel for more than five continuous years.

An increased risk was not found for shorter durations or when desogestrel had been discontinued for more than one year, but it was if other progestogens of known associated increased risk of meningioma had been used in the six years before desogestrel.

This excess risk was greater in women older than 45 years, those with a meningioma located in the front or middle of the skull, and after prolonged use of one of the known high risk progestogens before desogestrel.

The authors estimate that 67,000 women would need to use desogestrel for one woman to need surgery for intracranial meningioma, and 17,000 women if current use was for more than five years.

Reassuringly, no increased risk of meningioma was found for levonorgestrel, alone or combined with oestrogen, regardless of duration of use.

This is an observational study so can’t establish cause and effect, and the authors acknowledge that some information may be missing from the SNDS database. Nor were they able to account for genetic predisposition and exposure to high dose radiation – factors that may have affected the results.

However, by using comprehensive, real-life data, including history of using other known high risk progestogens, they were able to improve reliability and minimise bias.

As such, they suggest that desogestrel should be discontinued if an intracranial meningioma is identified and patients monitored rather than undergoing immediate surgery.

Although direct evidence is still lacking, stopping treatment when desogestrel related meningioma is diagnosed may preclude the need for surgery, says neurosurgeon Gilles Reuter in a linked editorial.

“It is already common knowledge that stopping cyproterone, nomegestrol, chlormadinone, promegestone, medroxyprogesterone, or medrogestone precludes the need for surgery,” he explains. “Now we know that stopping desogestrel may also avoid unnecessary potentially harmful treatments.”

Reference:

https://www.bmj.com/content/389/bmj-2024-083981

A new study published in the journal of BMC Nephrology revealed that kidney disease (KD) caused by an infection with the hepatitis B virus (HBV), can be reduced by anti-HBV therapy.

Chronic HBV infection is linked to extrahepatic comorbidities, such as renal symptoms, in addition to potential liver-related sequelae including cirrhosis and hepatocellular carcinoma (HCC). Kidney disease (KD) and HBV infection have been linked in a number of studies. According to research that looked at Medicare and Medicaid claims data from 2006 to 2015, patients with HBV had a greater frequency of KD than matched controls, and this prevalence rose with time. Moreover, an elevated risk of developing end-stage renal disease (ESRD) has also been linked to untreated HBV.

This research investigated whether KD development is linked to HBV-related liver illness, if anti-HBV medication reduces these risks, and whether patients with HBV have a greater chance of developing KD using a big US-based electronic medical record (EMR) database. From 2006 to 2020, information was retrieved from the IQVIA Ambulatory EMR database. To improve balance across analyses, propensity score matching was used. Hazard ratios (HRs) with 95% CIs for the start of KD between groups were estimated using a Cox proportional hazards model.

The majority of occurrences were beyond the age of 55. Among patients with and without HBV (n = 11,772 each), those with HBV had a more than twofold higher risk of developing KD compared to matched controls without HBV infection.

By the time they were 75 years old, patients with HBV and concurrent hypertension, diabetes, or obesity were more likely to develop KD (19% with HBV vs. 6% without HBV). In patients with HBV and concurrent comorbidities, the cumulative probability of developing KD exceeded the additive risk of developing KD for those with the comorbidities without HBV or just with HBV. Advanced liver disease was not substantially linked to KD in HBV patients.

Antiviral-treated individuals were less likely to develop KD than untreated HBV patients. Overall, the aging HBV population is significantly impacted by these discoveries. All of these results point to the necessity of prospective research to fully comprehend how antiviral medications affect the onset of KD. 

Source:

Ito, K. L., Zhang, Y., Li, B., King, A., Yee, L. J., Frenette, C., Abramov, F., Flaherty, J. F., & Malkov, V. A. (2025). Chronic hepatitis B virus infection increases the risk of kidney disease while antiviral therapy for hepatitis B virus can decrease kidney disease risk. BMC Nephrology, 26(1), 171. https://doi.org/10.1186/s12882-025-03991-x

Aortic valve narrowing (aortic stenosis) with concomitant cardiac amyloidosis is a severe heart disease of old age that is associated with a high risk of death. Until now, treatment has consisted of valve replacement, while the deposits in the heart muscle, known as amyloidosis, often remain untreated. An international research consortium led by MedUni Vienna and University College London has now been able to demonstrate for the first time that combined treatment consisting of heart valve replacement and specific drug therapy offers a significant survival advantage for patients. The study results have been published in the European Heart Journal.

As part of the study conducted by the research team led by Christian Nitsche (Department of Medicine II, Clinical Division of Cardiology, MedUni Vienna) and Thomas Treibel (Department of Cardiovascular Imaging, University College London), data from 226 patients with aortic stenosis and concomitant cardiac amyloidosis from ten countries were examined. Aortic stenosis is a narrowing of the heart valve that directs blood from the left ventricle into the bloodstream. In cardiac amyloidosis, misfolded proteins are deposited in the heart muscle. Both diseases occur in older people and often together. Until now, it was unclear whether treating amyloidosis in addition to valve surgery would benefit patients.

The analysis now published showed that both aortic valve replacement and treatment with the drug tafamidis for amyloidosis were associated with a significantly lower risk of death. The survival benefit was highest in patients who received both forms of treatment. “Our results even show that patients with both conditions who received valve replacement and specific amyloidosis therapy had similar long-term survival rates to people with aortic stenosis without amyloidosis,” emphasises study leader Christian Nitsche.

Targeted tests necessary

Both aortic stenosis and cardiac amyloidosis impair the heart’s pumping function and can lead to death if left untreated. Targeted therapy can slow the progression of amyloidosis, while valve replacement treats the mechanical stress caused by the narrowed heart valve. Around ten percent of patients with aortic stenosis also have amyloidosis, but this is often not diagnosed in everyday clinical practice. “Our findings also suggest that patients with severe aortic valve stenosis should be screened for amyloidosis so that we can offer them targeted life-prolonging treatment options,” emphasises Christian Nitsche.

Reference:

Christian Nitsche, Stephan Dobner, Hannah R Rosenblum, Kush P Patel, Simone Longhi, Ali Yilmaz, Marco Merlo, Maria Papathanasiou, Jan Griffin, Marish I F J Oerlemans, Francisco Gama, Ashraf Hamdan, Andrew D Kelion, Andreas Schuster, Sigita Glaveckaité, Nuriye Akyol, Aldostefano Porcari, Lara Schlender, Teresa Capovilla, Maximilian Autherith, Laurenz Hauptmann, Kseniya Halavina, João L Cavalcante, Marianna Fontana, Paul R Scully, James C Moon, Julia Mascherbauer, Robin Ristl, Elena Biagini, Stefan Stortecky, Matthew S Maurer, Thomas A Treibel, AS-Amyloidosis Consortium, Cardiac transthyretin amyloidosis treatment improves outcomes after aortic valve replacement for severe stenosis, European Heart Journal, 2025;, ehaf362, https://doi.org/10.1093/eurheartj/ehaf362.

A new study published in the Journal of the College of Physicians and Surgeons – Pakistan showed that for cutaneous warts, intralesional vitamin D3 is a cost-effective and efficient therapy alternative.

Common benign skin lesions called cutaneous warts are brought on by an infection with the human papillomavirus (HPV). In around 65–78% of instances, they resolve on their own and are often asymptomatic. The majority of wart patients seek treatment because they are unsightly and occasionally because of the pain or tenderness that specific wart types (such as plantar and periungual warts) cause.

Warts can be treated using a variety of modalities, such as topical medications (such as salicylic acid, trichloroacetic acid, etc.) and physical destructive techniques (such as electrocoagulation, cryotherapy, or laser therapy). Immunotherapeutic techniques are gaining popularity in the treatment of warts because of their shown effectiveness and simplicity of administration. Instead of merely removing the skin lesions, they work by promoting the host cell-mediated immunity to eradicate the virus.

Intralesional vitamin D has emerged as a promising therapy option for cutaneous warts in a number of recent trials. Thus, to ascertain the function of intralesional vitamin D3 in the management of cutaneous warts, Sabahat Shah and colleagues carried out this investigation.

This study from May to November 2023, was carried out from the dermatology department of P.N.S. Shifa Hospital in Karachi, Pakistan. 30 individuals with cutaneous warts of different sizes and lengths of time were chosen. Lignocaine (0.2 ml, 20 mg/ml) was used to anesthetize the warts before injecting vitamin D3 (0.2 ml, 15 mg/ml) into the base of the warts. The injections were administered again every 2 weeks for a maximum of four sessions, or until full recovery, whichever came first. The patients were monitored for 6 months following the final injection, and a maximum of two warts were treated each session.

The patients’ average length of sickness was 14.3 ± 6.5 months, and their average age was 32.20 ± 11.9 years. 10 (33.4%) of the 30 patients were female, and 20 (66.6%) were male. 3 instances (10%) had a modest reaction, 7 cases (23.3%) had a moderate response, and 20 cases (66.6%) had full clearance.

Mild injection site swelling and irritation were the only adverse effects seen in 17 (56.6%) instances, and they both resolved on their own in a matter of days. Overall, one possible therapy option for cutaneous warts is intralesional vitamin D3. The use of this therapy technique is increased by its affordability and absence of significant adverse effects.

Source:

Shah, S., Khan, S., & Sabah, N. U. (2025). Role of intralesional vitamin D3 in the treatment of cutaneous warts. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP, 35(5), 642–645. https://doi.org/10.29271/jcpsp.2025.05.642

Researchers have found in a new research that in hemodialysis (HD) patients, baseline HDL-C levels and changes in LDL-C over three years were significant predictors of all-cause mortality. However in contrast, no significant risk factors were identified in the peritoneal dialysis (PD) group.