ECG Abnormalities common in Hypokalemia but poor predictors of acute illness and short-term mortality: Study

Denmark: A recent multicenter cohort study has shed light on the prevalence and prognostic significance of electrocardiographic (ECG) abnormalities in patients with hypokalemia. The study, conducted across multiple medical centers, underscores the importance of vigilant monitoring and proactive management of electrolyte imbalances to mitigate potential cardiac complications.

The study published in the Journal of Internal Medicine found ECG abnormalities common in hypokalemic patients. However, they are poor predictors of acute illness and short-term mortality under the current standard of care.

Hypokalemia, characterized by low levels of potassium in the blood, is a common electrolyte disorder with diverse etiologies ranging from gastrointestinal losses to renal disorders and medication side effects. While its clinical manifestations vary widely, cardiac involvement represents a significant concern due to the critical role of potassium in maintaining myocardial excitability and contractility.

Helene Kildegaard, University of Southern Denmark, Odense, Denmark, and colleagues aimed to determine the prevalence and prognostic value of ECG abnormalities in hypokalemic patients in a multicentered cohort study.

The study included all adult patients with an ECG and potassium level <4.4 mmol/L recorded at arrival to four emergency departments (ED) in Denmark and Sweden. The researchers investigated the relationship between potassium levels and heart rate, QRS duration, corrected QT (QTc) interval, ST-segment depressions, T-wave flattening, and T-wave inversion using computerized measurements from ECGs. Within strata of potassium levels, they further estimated the hazard ratio (HR) for 7-day mortality, ventricular arrhythmia or cardiac arrest diagnosis, and admission to the intensive care unit (ICU). They compared patients with and without specific ECG abnormalities matched 1:2 on propensity scores.

The study led to the following findings:

  • Among 79,599 included patients, decreasing potassium levels were associated with a concentration-dependent increase in all investigated ECG variables.
  • ECG abnormalities were present in 40% of hypokalemic patients ([K+] <3.5 mmol/L), with T-wave flattening, ST-segment depression, and QTc prolongation occurring in 27%, 16%, and 14%.
  • In patients with mild hypokalemia ([K+] 3.0–3.4 mmol/L), a heart rate >100 bpm, ST-depressions, and T-wave inversion were associated with increased HRs for 7-day mortality and ICU admission, whereas only a heart rate >100 bpm predicted both mortality and ICU admission among patients with [K+] <3.0 mmol/L.
  • HR estimates were, however, similar to those in eukalemic patients.
  • The low number of events with ventricular arrhythmia limited evaluation for this outcome.

“The findings showed that although electrocardiogram abnormalities are common, they are poor predictors of acute illness and short-term mortality,” the researchers wrote.

As healthcare providers strive to optimize patient outcomes, the insights gleaned from this multicenter cohort study offer valuable guidance in navigating the complexities of managing electrolyte disturbances and mitigating associated cardiac risks. Vigilance, early intervention, and a multidisciplinary approach remain paramount in safeguarding the cardiac health of individuals with hypokalemia.

Reference:

Kildegaard, H., Brabrand, M., Forberg, J. L., Platonov, P., Lassen, A. T., & Ekelund, U. (2024). Prevalence and prognostic value of electrocardiographic abnormalities in hypokalemia: A multicenter cohort study. Journal of Internal Medicine, 295(4), 544-556. https://doi.org/10.1111/joim.13757

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Premature menopause may increase risk of musculoskeletal pain and sarcopenia, claims study

Musculoskeletal pain is a prevalent menopause symptom, which helps explain why women typically experience more pain than men, especially around the age of 50 years. Beyond pain, muscle function and mass are also affected by menopause. A new study suggests premature surgical menopause can lead to an increased risk of muscle disorders. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

The highly publicized Study of Women’s Health Across the Nation spotlighted a number of symptoms that are common during the menopause transition. Among other findings, it confirmed that muscle stiffness complaints were most prevalent during menopause, affecting 54% of US women aged 40 to 55 years.

This is also the time when ovarian hormone levels decrease significantly. In women who have experienced premature menopause, either spontaneous or surgical, the decrease is even more prominent. In addition, testosterone levels have also been shown to fall significantly in women with premature menopause.

These facts led researchers to conduct a new study specifically designed to evaluate the effect of different types of menopause on muscle discomfort and function in late-postmenopausal women aged 55 years and older. The study, which included nearly 650 women, concluded that women experiencing premature surgical menopause were more likely to develop musculoskeletal discomfort and sarcopenia than those with natural menopause at age 45 years or older. They theorized that the pain and decline in muscle mass in the late-postmenopause stage was more closely linked to hormone deficiency than to chronologic age alone.

Survey results are published in the article “Association of muscle disorders in late postmenopausal women according to the type of experienced menopause.”

“This study highlights the potential long-term musculoskeletal effects of premature surgical menopause, which causes a more abrupt and complete loss of ovarian hormones, including estrogen and testosterone, than natural menopause. The use of hormone therapy until the natural age of menopause has the potential to mitigate some of the adverse long-term effects of early estrogen loss,” says Dr. Stephanie Faubion, medical director for The Menopause Society.

Reference:

Vallejo MS, Blümel JE, Chedraui P, Tserotas K, Salinas C, Rodrigues MA, Rodríguez DA, Rey C, Ojeda E, Ñañez M, Monterrosa-Castro Á, Gómez-Tabares G, Espinoza MT, Escalante C, Elizalde A, Dextre M, Calle A, Aedo S. Association of muscle disorders in late postmenopausal women according to the type of experienced menopause. Menopause. 2024 Apr 30. doi: 10.1097/GME.0000000000002367.

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USPSTF issues updated recommendation on breast cancer screening that supports screening starting in women at age 40

USA: In a move aimed at improving early detection and reducing mortality rates associated with breast cancer, the US Preventive Services Task Force (USPSTF) has released its latest recommendation statement on breast cancer screening. The updated guidelines, published in the Journal of the American Medical Association (JAMA), provide valuable insights into the benefits and potential harms of various screening modalities, empowering healthcare providers and patients to make informed decisions regarding breast cancer prevention and detection.

The USPSTF’s newly published final recommendations support breast cancer screening starting in women at age 40, but they don’t go as far as many screening advocates had hoped.

In addition to the recommendation for biennial breast cancer screening for women ages 40 to 74, the take force stuck with its draft recommendations from 2023, reporting that it found insufficient evidence for screening women 75 and older. The USPSTF concluded that there was insufficient evidence to recommend supplemental screening with MRI or ultrasound in women, irrespective of breast density.

Breast cancer remains a significant public health concern, with millions of women worldwide being diagnosed each year. Early detection through screening plays a crucial role in improving survival rates and facilitating timely interventions. However, the optimal age to initiate screening, the frequency of screening mammography, and the utility of additional screening modalities such as magnetic resonance imaging (MRI) have been topics of debate and ongoing research.

A systematic review was commissioned by USPSTF to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, modality, screening interval, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.

The recommendation updates the 2016 recommendation on breast cancer screening. In 2016, the USPSTF recommended biennial screening mammography for women aged 50 to 74 years and individualizing the decision to undergo screening for women aged 40 to 49 years based on factors such as individual risk and personal preferences and values.

For the current recommendation, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The USPSTF again finds that the evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram and the balance of benefits and harms of screening mammography in women 75 years or older. Current evidence suggests that digital mammography and DBT are effective primary screening modalities.

The USPSTF concludes, “the current evidence is insufficient to assess the balance of harms and benefits of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram.”

In conclusion, to achieve the benefit of screening and mitigate disparities in breast cancer mortality by ethnicity and race, it is important that all persons with abnormal screening mammography results receive equitable and appropriate follow-up evaluation and additional testing, inclusive of indicated biopsies, and that all persons with breast cancer diagnosis receive effective treatment.

Reference:

US Preventive Services Task Force. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. Published online April 30, 2024. doi:10.1001/jama.2024.5534

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Erenumab reduces rosacea-associated flushing and erythema symptoms: JAMA

A recent study published in the Journal of American Medical Association found promising results after investigating the use of erenumab which is a drug primarily used for migraine prevention, for treating rosacea symptoms. 

The open-label trial conducted at the Danish Headache Center of Copenhagen University Hospital, Rigshospitalet involved 30 participants who were administered 140 mg of erenumab subcutaneously every four weeks for a total of 12 weeks. The study was conducted from June 2020 to May 2021 to assess the effectiveness of erenumab in reducing the severe redness and flushing associated with rosacea. The primary focus of the research was to assess the change in the number of days participants experienced moderate to extreme flushing when compared to their condition at the beginning of the study. The secondary outcomes included changes in days with moderate to severe erythema or facial redness.

The key findings from the trial were;

At the end of the 12-week period, the participants reported a significant reduction in the number of days with flushing, this was from an average of 23.6 days at baseline to 16.7 days.

Also, the days with noticeable redness decreased from 15.2 to 7.1 days on average. These changes suggest that erenumab could potentially offer relief to the individuals with distressing rosacea symptoms.

While the treatment was generally well-tolerated, some adverse effects were noted, including mild to moderate constipation, transient worsening of flushing, bloating and upper respiratory tract infections.

These side effects are in line with what has been previously documented with the use of erenumab in migraine treatment. Only one serious adverse event was reported which was a case of gallstones that lead to hospitalization, which did not convince the research team as mediated by the drug.

The findings are significant as they point towards a new application for CGRP-receptor inhibitors like erenumab in treating skin conditions beyond their current use in neurology. CGRP (Calcitonin Gene-Related Peptide) has been linked to the pathogenesis of rosacea influencing vascular and inflammatory processes in the skin. Erenumab may help manage symptoms that are often resistant to other treatments by inhibiting this pathway. Despite these promising results, larger randomized clinical trials are imperative to confirm these findings and better understand the potential of CGRP inhibitors in treating rosacea.

Source:

Wienholtz, N. K. F., Christensen, C. E., Do, T. P., Frifelt, L. E. W., Snellman, J., Lopez-Lopez, C. L., Egeberg, A., Thyssen, J. P., & Ashina, M. (2024). Erenumab for Treatment of Persistent Erythema and Flushing in Rosacea. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2024.0408

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FDA approves dissolving stent for endovascular treatment of peripheral artery disease below knee

The US Food and Drug Administration has approved Esprit BTK everolimus-eluting scaffold system for chronic limb-threatening ischemia (CLTI) below the knee.It is first drug-eluting resorbable scaffold approved for peripheral artery disease.

The Esprit BTK System is designed to keep arteries open and deliver a drug (Everolimus) to support vessel healing prior to completely dissolving.

Until today, there were no stents or drug-coated balloons approved for use below the knee in the U.S. The standard of care has been balloon angioplasty, which relies on a small balloon delivered via a catheter to the blockage to compress it against the arterial wall, opening the vessel and restoring blood flow. However, blockages treated only with balloon angioplasty have poor short- and long-term results, and in many instances the vessels become blocked again, requiring additional treatment.

The Esprit BTK System is a first-of-its-kind dissolvable stent and is comprised of material similar to dissolving sutures. The device is implanted during a catheter-based minimally invasive procedure via a small incision in the leg. Once the blockage is open, the Esprit BTK scaffold helps heal the vessel and provides support for approximately three years until the vessel is strong enough to remain open on its own.

“The FDA approval of Abbott’s Esprit BTK System marks a significant milestone in our fight against peripheral artery disease below the knee and should usher in a new era of improved outcomes for people worldwide,” said Sahil A. Parikh, M.D., Columbia University Irving Medical Center, and one of the principal investigators of the LIFE-BTK trial. “By introducing a treatment option that is superior to balloon angioplasty, Abbott is changing the landscape of CLTI therapy.”

The LIFE-BTK trial, which evaluated Abbott’s Esprit BTK System, was presented in October 2023 as a late-breaking clinical trial at the 35th Transcatheter Cardiovascular Therapeutics (TCT) Conference in San Francisco and simultaneously published in the New England Journal of Medicine. The results of the trial demonstrated that the Esprit BTK System reduces disease progression and helps improve medical outcomes compared to balloon angioplasty, the current standard of care.

PAD is highly prevalent, yet many people have never heard of the condition. More than 20 million people in the U.S. are living with this painful disease and only 10% of those people have been diagnosed. CLTI is a serious form of PAD that occurs when arteries become clogged with plaque, preventing blood flow and oxygen from reaching the lower leg and foot. People living with CLTI often experience extreme pain, open wounds that don’t heal and, in some cases, may have to resort to amputation. Over a five-year period, CLTI has a lower survival rate than breast, colorectal and prostate cancer combined.

“At Abbott, we’ve recognized the significant burden of disease and limited treatment options available for people living with the most severe form of PAD. That’s why we’re revolutionizing treatments with resorbable scaffold technology below the knee,” said Julie Tyler, senior vice president of Abbott’s vascular business. “Our resorbable program is focused on meeting unmet needs in the peripheral anatomy to help people live better and fuller lives.”

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Omega-6 fatty acid arachidonic acid may reduce risk of bipolar disorder, finds study

A genetic propensity to higher circulating levels of lipids containing arachidonic acid, an omega-6 polyunsaturated fatty acid found in eggs, poultry, and seafood, has been found to be linked with a lower risk for bipolar disorder, according to a new study in Biological Psychiatry, published by Elsevier. This new evidence paves the way for potential lifestyle or dietary interventions.

Bipolar disorder is a debilitating mood disorder characterized by recurring episodes of mania and depression. Although its etiology is still unclear, previous studies have shown that bipolar disease is highly heritable. The findings of this study indicate a link between bipolar disorder and altered metabolite levels, supporting the notion that circulating metabolites play an important etiological role in bipolar disease and other psychiatric disorders.

Lead investigator David Stacey, PhD, Australian Centre for Precision Health, University of South Australia; UniSA Clinical and Health Sciences; and South Australian Health and Medical Research Institute, Adelaide, Australia, explains, “Accumulating evidence indicates a role for metabolites in bipolar disorder and other psychiatric disorders. By identifying metabolites that play causal roles in bipolar disorder, we hoped to be able to highlight potential lifestyle or dietary interventions.”

By applying Mendelian randomization, a powerful causal inference method, the researchers identified 33 out of 913 metabolites studied present in the blood that were associated with bipolar disorder, most of them lipids.

Researchers also found that a bipolar disorder risk gene cluster (FADS1/2/3), which encodes enzymes associated with lipid metabolism, mediated the association between bipolar disorder and the levels of arachidonic acid and other metabolites.

Commenting on the findings, John Krystal, MD, Editor of Biological Psychiatry, says, “Arachidonic acid is typically a widely present omega-6 fatty acid in the body and brain that contributes to the health of cell membranes. This study provides a fascinating step forward in the effort to develop blood biomarkers of bipolar disorder risk, particularly in those patients with bipolar disorder and risk gene variations in the FADS1/2/3 gene cluster.”

Dr. Stacey notes, “Intriguingly, we observed a pattern whereby a genetic propensity to higher levels of lipids containing an arachidonic acid fatty acid side chain was associated with a lower risk of bipolar disorder, while the inverse was true of lipids containing a linoleic acid side chain. Since arachidonic acid is synthesized from linoleic acid in the liver, this suggests arachidonic acid synthesizing pathways are important for bipolar disorder.”

Given its presence in human milk, arachidonic acid is considered essential for infant brain development and is added to infant formula in many countries. Therefore, it may exert an effect on bipolar disorder risk by affecting neurodevelopmental pathways, which would be consistent with contemporary views of bipolar disorder as a neurodevelopmental disorder. Arachidonic acid can be sourced directly from meat and seafood products or synthesized from dietary linoleic acid (e.g., nuts, seeds, and oils).

Dr. Stacey concludes, “To our knowledge, ours is the first study to highlight a potential causal role between arachidonic acid and bipolar disorder. Preclinical studies and randomized controlled trials will be necessary to determine the preventive or therapeutic value of arachidonic acid supplements, perhaps with a particular focus on people with a compromised arachidonic acid synthesizing pathway or with poor natural dietary sources. Our findings also support potential avenues for precision health interventions focused on early life nutrition to ensure that infants and children are receiving enough arachidonic acid and other polyunsaturated fatty acids to support optimal brain development, which may also reduce the risk of bipolar disorder.”

Reference:

David Stacey, Beben Benyamin, S. Hong Lee, Elina Hyppönen, A Metabolome-Wide Mendelian Randomization Study Identifies Dysregulated Arachidonic Acid Synthesis as a Potential Causal Risk Factor for Bipolar Disorder, Biological Psychiatry, https://doi.org/10.1016/j.biopsych.2024.02.1005

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High serum Vitamin D levels significantly linked to protection of caries development in children, reveals study

High serum Vitamin D levels are significantly linked to the protection of caries development in children, reveals a study published in the Dentistry Journal.

This systematic review critically evaluates the association between serum Vitamin D levels and dental caries incidence in the permanent teeth of children and adolescents. The search strategy comprised three databases (PubMed, Scopus, Embase), up to November 2023, targeting studies on the correlation between Vitamin D and dental caries in permanent dentition. The eligibility criteria focused on observational studies involving children and adolescents aged 12 to 19 years with permanent dentition. The screening process, guided by the PRISMA guidelines and the Newcastle–Ottawa Scale for quality assessment, resulted in the inclusion of eight studies conducted across various global regions from 2013 to 2023. The analysis revealed that Vitamin D insufficiency and deficiency were prevalent among the study populations, ranging from 17.3% to 69.4%. Specifically, children and adolescents with Vitamin D insufficiency (<50 nmol/L) were found to have significantly higher odds of developing caries, with odds ratios (ORs) ranging from 1.13 to 2.57. Conversely, two studies indicated a protective effect of higher Vitamin D levels, with an OR of 0.80 and 0.59, respectively, for caries among children and adolescents with serum levels ≥ 50 nmol/L, suggesting an inverse relationship between Vitamin D status and caries risk. The results indicate both the protective role of adequate serum levels of Vitamin D above 20 ng/mL and the increased risk associated with insufficient levels below this threshold. However, the variations in study quality, methodologies and geographic settings underscore the challenges in drawing universal conclusions. Despite these limitations, our review suggests that improving Vitamin D status could be a beneficial component of preventive strategies against dental caries in children and adolescents, warranting further research to clarify the clinical significance of our findings.

Reference:

Buzatu R, Luca MM, Bumbu BA. A Systematic Review of the Relationship between Serum Vitamin D Levels and Caries in the Permanent Teeth of Children and Adolescents. Dentistry Journal. 2024; 12(4):117. https://doi.org/10.3390/dj12040117

Keywords:

High, serum, Vitamin D levels, significantly, protection, caries, development, children, study, Dentistry Journal, vitamin D; dental caries; permanent dentition; child; adolescent; stomatology, Buzatu R, Luca MM, Bumbu B

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Sibling death in childhood tied to increased risk of early-onset cardiovascular disease: JAMA

Denmark: Individuals who experience the death of a sibling in childhood may be at greater risk of early-onset cardiovascular disease (CVD), a recent study published in JAMA Network Open.

The researchers suggest that extra support to these individuals may help mitigate the potential negative effects of bereavement on cardiovascular health.

The cohort study of more than 2.0 million participants born in Denmark revealed that sibling death in childhood and early adulthood was linked with increased risk of overall and most specific early-onset cardiovascular diseases among bereaved siblings, strength of associations varied by cause of age and death difference between sibling pairs.

There has been an increase in the incidence and prevalence of CVD over the past few decades among children, adolescents, and young adults, posing a concerning economic loss and public health burden. Previous studies have indicated that psychological stress following bereavement may lead to CVD development. The loss of a child, a spouse, a parent, or other family members was linked with increased risks of type-specific CVDs, including stroke, ischemic heart disease (IHD), myocardial infarction (MI), atrial fibrillation (AF), cerebrovascular disease, pulmonary embolism, and heart failure.

Sibling death is a highly traumatic event, but empirical evidence is limited on the association of sibling death in childhood and early adulthood with subsequent risk of incident CVD. To fill this knowledge gap, Chen Huang, Fudan University, Shanghai, China, and colleagues aimed to evaluate the association between sibling death in the early decades of life and subsequent risk of incident early-onset CVD in a population-based cohort study.

The study included 2 098 659 individuals born in Denmark from 1978 to 2018. Follow-up started at age 1 year or the date of the first sibling’s birth, whichever occurred later, and it ended at the first diagnosis of CVD, emigration, the date of death, or December 31, 2018, whichever came first. The outcome was early-onset CVD.

The study revealed the following findings:

  • The study included 2 098 659 individuals (51.30% male; median age at death of sibling, 11.48 years).
  • During the median follow-up of 17.52 years, 1286 and 76 862 individuals in the bereaved and nonbereaved groups, respectively, were diagnosed with CVD.
  • Sibling death in childhood and early adulthood was associated with a 17% increased risk of overall CVD (HR, 1.17; cumulative incidence in bereaved individuals, 1.96%; cumulative incidence in nonbereaved individuals at age 41 years, 1.35%; cumulative incidence difference: 0.61%).
  • Increased risks were also observed for most type-specific CVDs, in particular for myocardial infarction (HR, 1.66), heart failure (HR, 1.50), and ischemic heart disease (HR, 1.52).
  • The association was observed whether the sibling died due to CVD (HR, 2.54) or non-CVD (HR, 1.13) causes.
  • The increased CVD risk was more pronounced for individuals who lost a twin or younger sibling (HR, 1.25) than an elder sibling (HR, 1.11).

The findings show an increased risk of overall and most type-specific early-onset CVDs with sibling death in childhood and early adulthood; the strength of these associations differed by death cause and the age difference between sibling pairs. The risk was the highest shortly after the bereavement, particularly for adolescents, but persisted in the long run.

“The findings highlight the need for extra attention and both mental and social support to bereaved siblings to reduce CVD risk later in life,” the researchers wrote.

Reference:

Huang C, Peng J, Lee PMY, et al. Sibling Death in Childhood and Early Adulthood and Risk of Early-Onset Cardiovascular Disease. JAMA Netw Open. 2024;7(1):e2350814. doi:10.1001/jamanetworkopen.2023.50814

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Local application of Ivermectin ointment safe and effective therapy for patients with Demodex blepharitis: Study

Local application of Ivermectin ointment safe and effective therapy for patients with Demodex blepharitis suggests a study published in Graefe’s Archive for Clinical and Experimental Ophthalmology.

A study was done to evaluate the efficacy of topical ivermectin 1% ointment, for the treatment of Demodex blepharitis. A retrospective study was designed to review electronic medical records of patients seen between January 2017 and December 2022, who had a diagnosis of Demodex blepharitis, treated with topical ivermectin 1% with at least 6 months of follow-up (Centro de Ojos Quilmes, Buenos Aires, Argentina). The presence of collarettes was graded from 0 to 4. An imaging system (Keratograph) was used, to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NIKBUT), and degree of conjunctival redness. In addition, the ocular surface disease index (OSDI) test was performed. Results were compared before and after ivermectin treatment, which was performed once a day for 2 months. Results: A total of 2157 patients (4314 eyes) were included. The mean age was 50.43 ± 15.3 years, and the follow-up time was 26.1 ± 8.5 months. No one discontinued treatment due to intolerance, although 14 cases (0.6 %) reported occasional discomfort. The grade of collarettes decreased with statistical significance, from 3.37 ± 0.7 to 0.1 ± 0.3 (p < 0.01), as well as conjunctival redness from 1.32 ± 0.3 to 0.94 ± 0.4 (p < 0.01) and OSDI score from 58.74 ± 17.9 to 17.1 ± 10.5 (p = 0.02). TMH and NIKBUT improved without statistical difference. Treatment with ivermectin 1% topical ointment, once daily for 2 months, was effective in reducing the presence of collarettes and in improving symptoms in patients with Demodex blepharitis.

Reference:

Valvecchia, F., Greco, L., Perrone, F. et al. Topical ivermectin ointment treatment of Demodex blepharitis: a 6-year retrospective study. Graefes Arch Clin Exp Ophthalmol 262, 1281–1288 (2024). https://doi.org/10.1007/s00417-023-06281-0

Keywords:

Local application, Ivermectin, ointment, safe, effective therapy, patients Demodex blepharitis, study, Graefe’s Archive for Clinical and Experimental Ophthalmology, Valvecchia, F., Greco, L., Perrone, Demodex, Ivermectin, Blepharitis, Ocular surface

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New AAO-HNSF guideline provides evidence-based recommendations for Age-related Hearing Loss

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published the Clinical Practice Guideline: Age-Related Hearing Loss today in Otolaryngology-Head and Neck Surgery. This clinical practice guideline (CPG) sheds lights on a global public health problem affecting approximately 466 million people worldwide and identifies quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of age-related hearing loss (ARHL) in patients 50 years and older.

“Age-related hearing loss is underdiagnosed and undertreated despite being the most common sensory deficit in the aging population. With almost 50% of the population over 75 reporting hearing loss, having a clinical practice guideline allows all clinicians to provide better healthcare to those with hearing loss based on research and best practices. Not only does this CPG provide screening recommendations and management of the hearing loss, it also educates clinicians and care partners how to communicate with those suffering from hearing loss,” said Betty S. Tsai Do, MD, the CPG Development Group Chair.

ARHL is the most common sensory disorder in the older population. Between ages of 65 to 74, one in three adults experience hearing loss. ARHL is a type of hearing loss that occurs over time as individuals age. It develops gradually and symmetrically, meaning it affects both ears similarly and is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. It is caused by both genetic and environmental factors such as exposure to loud noises, medication that can harm the ears, cigarette smoking, and alcohol consumption.

This guideline presents clinicians with an evidenced-based framework, which includes 11 evidenced-based Key Action Statements (KAS), to prioritize identifying patients at risk of ARHL as well as managing it.

“I am excited to see a key action statement focusing on social determinants of health and how it impacts access and patient preferences on the management of hearing healthcare. The focus of individualized healthcare is the future of medicine, and as such, it is important that this CPG incorporated that into the recommendations,” shared Dr. Tsai Do.

The ARHL CPG recommends that all patients aged 50 and above should be screened for hearing loss because detecting hearing loss early and taking appropriate steps can help minimize the negative effects associated with untreated hearing loss.

“Our guideline development group used the AAO-HNSF methodology to create evidence-based recommendations on the management of age-related hearing loss. We hope that the CPG will be useful in improving awareness and decreasing the morbidity of untreated age-related hearing loss in an effort to improve a patient’s overall health and quality of life,” said Dr. Tsai Do.

The guideline development group (GDG) consisted of experts in otolaryngology (ear, nose, and throat), otology (ear), audiology (hearing), neurology (nervous system, including the brain), geriatrics (care of aging population) and primary care. The group also included a consumer representative, a public health expert, and staff members from the AAO-HNSF.

Reference:

Betty S. Tsai Do, Matthew L. Bush, Heather M. Weinreich, Seth R. Schwartz, Samantha Anne, Oliver F. Adunka, Kaye Bender, Teresa A. Keenan, Ana H. Kim, Denée J. Moore, Carrie L. Nieman, Catherine V. Palmer, Clinical Practice Guideline: Age-Related Hearing Loss, Otolaryngology Head & Neck Surgery, https://doi.org/10.1002/ohn.750.

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