Higher body mass index linked to slower rates of glaucoma progression: Study

A recent study from Duke University suggest that higher body mass index (BMI) may help slow the progression of glaucoma which is a leading cause of blindness. The key findings were published in the British Journal of Ophthalmology.

The study analyzed data from a total of 2,839 eyes of 1,584 glaucoma patients and provided new insights into how lifestyle factors may influence the rate of retinal nerve fibre layer (RNFL) loss in these individuals. Over a mean follow-up period of 4.7 years, the patients underwent approximately 5.1 spectral-domain optical coherency tomography (SD-OCT) tests and this study looked into the effects of BMI and personal histories of tobacco and alcohol use on glaucoma progression. The results show that while tobacco and alcohol consumption did not significantly impact the progression of the disease, a higher BMI was associated with a markedly slower rate of RNFL loss.

This study found that for each additional unit of BMI, the rate of RNFL thinning lowered by 0.014 micrometers per year where this statistically significant finding suggests a protective effect of higher body weight against glaucoma progression. Also, underweight subjects experienced significantly faster rates of structural loss that highlights potential risks associated with low BMI in glaucoma management.

The lack of significant association between tobacco and alcohol use and the rate of RNFL change was somewhat unexpected, given the well-documented impacts of these factors on other chronic diseases. This observation suggests that the pathways which link these habits to glaucoma progression may differ from those affecting other health conditions. This study opens a new avenue in our understanding of glaucoma management and careful practice that encourage weight gain as a protective strategy should be maintained until further research is conducted.

Glaucoma affects millions worldwide and is often associated with an irreversible loss of vision due to damage to the optic nerve. Current treatment strategies focus primarily on lowering intraocular pressure and this research suggests that managing body weight could also be a consideration in the comprehensive care of glaucoma patients. As these findings add a significance to the mystery of glaucoma progression and further studies will be imperative to understand the mechanisms by which BMI may protect against RNFL loss and to explore potential interactions with other risk factors.

Source:

Youssif, A. A., Onyekaba, N.-A., Naithani, R., Abdelazeem, K., Fathalla, A. M., Abdel‐Rhaman, M. S., Jammal, A. A., & Medeiros, F. A. (2024). Social history and glaucoma progression: the effect of body mass index, tobacco and alcohol consumption on the rates of structural change in patients with glaucoma. In British Journal of Ophthalmology (p. bjo-2023-323186). BMJ. https://doi.org/10.1136/bjo-2023-323186

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Active military service may heighten women’s risk of having low birthweight babies, reveals study

Active military service may heighten a woman’s risk of having a low birthweight baby, suggests a review of the available scientific evidence published online in the journal BMJ Military Health.

The findings highlight the need for more research specifically focused on women in the armed forces, and their reproductive health in particular, conclude the study authors.

Worldwide, increasing numbers of women are on active service in their country’s armed forces. The UK Armed Forces, for example, has set a target of 30% female representation by 2030. And more and more countries are deploying women in combat units, and in other challenging environments, such as submarines, note the study authors.

Mounting evidence suggests that stress experienced during pregnancy is associated with birth complications, such as preterm delivery and low birthweight. And a military career and lifestyle expose service personnel to a wide range of physical, mental, and environmental stressors that could potentially influence pregnancy outcomes.

The study authors therefore wanted to explore the potential impact of active military service on the risks of preterm labour and birth, low birthweight, and stillbirth.

They scoured research databases for relevant studies, and included 21 that met all the eligibility criteria in their analysis. The studies, which involved 650,628 women serving in the US military, were all published between 1979 and 2023.

Ten of the studies included a comparison group-usually the wives of active service personnel. By way of a proxy for those that didn’t include a comparator, the study authors drew on national data from the US National Vital Statistics for any given year.

Analysis of the study results indicated no heightened risk of preterm birth among pregnant active service women. But there were significant methodological differences; most studies had a moderate to high risk of bias; and several included only small sample sizes, caution the study authors.

There was no observed association between branch of military service and increased risk of preterm birth, although again this should be interpreted cautiously as 5 studies included mixed service samples and the study design varied considerably, say the study authors.

There was no clear evidence for an increased risk of stillbirth among women on active military service, either.

But nearly two thirds (62.5%) of the studies concluded that women on active service may be at heightened risk of having a low birthweight baby, including one study with the lowest risk of bias. And 4 of the 5 studies that included a comparison group also indicated an increased risk of low birthweight.

Seven of the 8 studies reporting on low birthweight were carried out in single-service settings. Both of those from the US Air Force suggested a higher prevalence of low birthweight babies born to active duty military personnel.

But some 53% and 38% of the studies reporting on preterm birth and low birthweight, respectively, didn’t have a matched comparison group and relied on a proxy drawn from national statistical data.

This introduces a risk of systematic error as the baseline characteristics of the two groups are inherently different, caution the study authors.

Women on active military service will also be medically screened before any tours of duty and will have fewer co existing conditions, while national data will include high risk and multiple pregnancies, they explain.

Only observational studies were included in the review, and the data collection methods and/or adjustment for influential factors varied, acknowledge the study authors. Only 8 studies reported on smoking status despite a high prevalence of smoking in the military and the fact that smoking is associated with several health issues before and during pregnancy.

The data also focused exclusively on the US military, which although unsurprising given that it is one of the largest in the world, this does limit the generalisability of the findings to armed forces personnel elsewhere, highlight the study authors.

Nevertheless, they conclude: This review highlights a need for more female-specific research in armed forces, beyond the US military setting, to inform military maternity pathways and policies in ways that safeguard mothers and their babies while enhancing military readiness.”

Reference:

Morris KAL, McKee MEffect of active-duty military service on neonatal birth outcomes: a systematic reviewBMJ Mil Health Published Online First: 22 April 2024. doi: 10.1136/military-2023-002634.

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Injection and energy-based treatments tied to highest response rates among patients with striae: Study

Canada: In dermatology, the quest for effective treatments for striae, commonly known as stretch marks, has been a perennial pursuit. A systematic review published in the latest edition of Dermatologic Surgery has shed light on the diverse treatment modalities and their outcomes, offering valuable insights for patients and practitioners.

The review found varied treatment options for striae, likely indicating a lack of effective treatments due to the diversity in striae subtypes. The researchers stressed that improved outcomes in striae management may be achieved with additional research on factors predicting treatment response.

For patients grappling with the physical and psychological impact of striae, the review offers a beacon of hope by providing a comprehensive overview of available treatment options and their respective efficacy profiles. “Understanding that viable treatment options available can empower patients to take proactive steps towards addressing their concerns,” the researchers wrote.

Striae are fine lines on the body following rapid skin stretching (i.e., following puberty, pregnancy, weight change). Ilya Mukovozov, Toronto Dermatology Centre, North York, Ontario, Canada, and colleagues aimed to assess the current literature on treatment outcomes associated with striae.

For this purpose, the researchers performed a systematic search on Embase, MEDLINE, and PubMed with no publication date or language restrictions. It included all articles with original data and treatment outcomes.

The researchers reported the following findings:

· One hundred fifty-one studies on the treatment of striae met inclusion criteria (83% female, mean age at diagnosis = 30.2), and 4,806 treatment outcomes of striae were described.

· Energy-based devices were the most reported modality (56%), followed by topicals (19%) and combinations (12%).

· The highest rates of complete response were injection-based devices for striae distensae (7%), CO2 lasers for striae alba (4%), and platelet-rich plasma injections for striae rubra (31%).

The findings revealed numerous treatment options for striae, and no treatment is consistently effective for each subtype.

“Future studies should aim to measure the degree of treatment response by subtype and patient characteristics,” the researchers wrote.

In conclusion, the systematic review serves as a seminal contribution to the field of dermatology, offering a roadmap for navigating the complex landscape of striae treatment. By synthesizing existing evidence and delineating key areas for future research, it paves the way for advancements that promise to alleviate the burden of striae for individuals worldwide.

Reference:

Zhu, Catherine Keying*; Mija, Lorena Alexandra†; Koulmi, Kaouthar BSc*; Barankin, Benjamin MD, FRCPC, FAAD‡; Mukovozov, Ilya MD, PhD, FRCPC, DABD, FAAD‡. A Systematic Review on Treatment Outcomes of Striae. Dermatologic Surgery ():10.1097/DSS.0000000000004151, March 7, 2024. | DOI: 10.1097/DSS.0000000000004151

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Highest dexmedetomidine dose best for AFONI in patients undergoing oromaxillofacial surgeries: Study

Recently published study aimed to evaluate the efficacy of different doses of dexmedetomidine (DEX) for awake fibreoptic nasotracheal intubation (AFONI) in patients undergoing oromaxillofacial and oral malignancy surgeries. This randomised, double‑blind study included 90 patients aged 18–60 years and with American Society of Anesthesiologists physical status I/II. The patients were divided into three groups receiving different doses of DEX: 0.5 µg/kg DEX, 1 µg/kg DEX, and 1.5 µg/kg DEX. The primary outcome measure was the airway obstruction score, and secondary outcome measures included intubation scores, 5‑point fibreoptic intubation comfort score, and sedation assessment using the Ramsay sedation score (RSS).

The study found that the airway obstruction score, vocal movement, coughing, limb movement, and fibreoptic intubation comfort score did not differ significantly between the three DEX groups. However, the mean RSS was significantly greater in the Group receiving the highest dose of DEX (1.5 µg/kg DEX) compared to the other two groups. The study concluded that all three doses of DEX, when combined with topical spray and airway block, provided comparable airway obstruction scores and favorable conditions for AFONI.

The study revealed that 1.5 µg/kg DEX provided superior intubation conditions compared to lower doses, although not statistically significant. It was found that high doses of DEX resulted in favorable intubation conditions but increased the chances of airway obstruction and desaturation. Additionally, high doses of DEX led to a significant decrease in heart rate, systolic and diastolic blood pressure, and respiratory rate compared to lower doses.

In conclusion, the study demonstrated that graded doses of DEX provided comparable airway obstruction and intubation scores but had differing effects on sedation, hemodynamic variables, and the risk of airway obstruction. The authors suggested that further large-scale trials are necessary to evaluate the role of DEX as a single agent for conscious sedation in patients with anticipated difficult airways.

Key Points –

– The study evaluated the efficacy of different doses of dexmedetomidine (DEX) for awake fibreoptic nasotracheal intubation (AFONI) in patients undergoing oromaxillofacial and oral malignancy surgeries.

– Three groups of patients received different doses of DEX (0.5 µg/kg DEX, 1 µg/kg DEX, and 1.5 µg/kg DEX), and the primary outcome measure was the airway obstruction score, with secondary measures including intubation scores, fibreoptic intubation comfort score, and sedation assessment using the Ramsay sedation score (RSS).

– The study found that all three doses of DEX provided comparable airway obstruction scores and favorable conditions for AFONI, but the highest dose of DEX (1.5 µg/kg) resulted in superior intubation conditions, higher sedation levels, decreased hemodynamic variables, and increased risk of airway obstruction and desaturation.

Reference –

Arora, Sanya; Govardhane, Balasaheb T.; Srinivasan, Vanchula; Karandikar, Gayatri. Evaluation of different doses of dexmedetomidine for awake fibreoptic nasotracheal intubation in patients undergoing oromaxillofacial and oral malignancy surgeries: A randomised, double-blind study. Indian Journal of Anaesthesia 68(5):p 447-453, May 2024. | DOI: 10.4103/ija.ija_1004_23.

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FDA approves immunotherapy drug combo for non-muscle invasive bladder cancer

The U.S. Food and Drug Administration (FDA) has approved the immunotherapy-boosting drug N-803, which is marketed under the brand name Anktiva, to be used in combination with the immunotherapy Bacillus Calmette-Guerin (BCG) for the treatment of patients with BCG-unresponsive non–muscle-invasive bladder cancer.

The decision was based on results of the QUILT 3.032 clinical trial, which was led by Dr. Karim Chamie, associate professor urology at the David Geffen School of Medicine at UCLA and a researcher at the UCLA Health Jonsson Comprehensive Cancer Center.

Findings from the phase 2/3 trial were presented at the 2022 American Society of Clinical Oncology annual meeting and published in NEJM Evidence. Chamie, who was the principal investigator for the trial, reported that this combination treatment resulted in longer overall survival and was more effective and safer than other treatments available for BCG-unresponsive non–muscle-invasive bladder cancer.

“The FDA approval of N-803 heralds a new era in the management of BCG-unresponsive non–muscle-invasive bladder cancer,” said Chamie. “By leveraging the body’s immune system to mount a targeted attack against cancer cells, N-803 offers a compelling alternative for patients who have exhausted conventional treatment options. What makes this really remarkable, is its ability to spare patients from invasive procedures, like a cystectomy, significantly enhancing the quality of life for patients.”

Roughly, 80% of new bladder cancer diagnoses are non-muscle invasive bladder cancer, which is found in the tissue that lines the inner surface of the bladder and hasn’t spread into the bladder wall. Patients with this type of cancer usually undergo surgery to remove the tumor followed by treatment with a bacteria-based immunotherapy called BCG, which is placed directly into the bladder. The treatment triggers an inflammatory response in the bladder that helps prevent cancer recurrence.

However, even with this treatment, the cancer can come back and many patients don’t respond well to further BCG treatment, leaving limited treatment options. For some patients, they may require surgery to remove the bladder entirely, facing significant risks like bleeding, kidney issues and infections, especially for older patients.

The QUILT 3.032 study evaluated the addition of the investigational drug N-803 to the treatment regimen to see if it can help boost the effectiveness of BCG.

Developed by ImmunityBio, N-803 is a protein the helps activate the body’s immune cells to fight cancer by promoting the proliferation and activation of natural killer cells and CD8+ T cells, which are crucial components of the body’s immune response against cancer cells.

Investigators enrolled 171 patients (81% male with a median age of 72) with non–muscle-invasive bladder cancer who didn’t respond well to BCG treatment from clinical locations across the country. The UCLA Health team enrolled 28 patients, making UCLA the top enrolling center.

The participants were then divided into two cohorts: one with carcinoma in situ and the other with papillary disease.

For the carcinoma in situ cohort, 71% of patients had a complete response ranging over 47 months, meaning they no longer had evidence of the disease or had any symptoms of the cancer. The response lasted for a median duration of 26.6 months. At 24 months, a cystectomy, surgical removal of the bladder, was avoided in over 90% of patients. All of the participants the study (100%) were still alive after a two-year follow-up.

For the papillary cohort, 57% remained disease-free after 12 months, and 48% after 24 months. Additionally, 94% of the patients in this group also avoided cystectomy.

“The treatment was particularly effective for carcinoma in situ patients, with a high complete response rate and long-lasting response,” Chamie said. “Even for papillary disease, the treatment showed good results in keeping the cancer from coming back and avoiding the need for cystectomy. Overall, the treatment was safer and more effective than other options available for BCG-unresponsive non–muscle-invasive bladder cancer.”

Reference:

Authors: Karim Chamie, Sam S. Chang, Eugene Kramolowsky, Mark L. Gonzalgo, Piyush Kumar Agarwal, Jeffrey C. Bassett, Marc Bjurlin, and Patrick Soon-Shiong, IL-15 Superagonist NAI in BCG-Unresponsive Non–Muscle-Invasive Bladder Cancer, NEJM Evidence, DOI: 10.1056/EVIDoa2200167.

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FDA approves over the counter naloxone hydrochloride spray for opioid overdose

The US Food and Drug Administration (FDA) has approved over-the-counter naloxone hydrochloride nasal spray for emergency treatment of opioid overdose.

Amneal’s Naloxone HCI Nasal Spray, manufactured in the U.S., is a generic equivalent to OTC NARCAN® HCI Nasal Spray, a medication that is widely used to help treat drug overdose from opioids, including heroin, fentanyl and prescription opioid medications.

“With today’s launch, Amneal is proud to help address this public health emergency by providing naloxone nasal spray at an affordable price and without a prescription. Our business is deeply rooted in a commitment to helping others. By enhancing access to naloxone nasal spray, we hope to get this affordable emergency treatment into the hands of even more people who could potentially save countless families and communities from further heartache and loss,” said Chirag and Chintu Patel, Co-Chief Executive Officers.

More than two-thirds of all drug overdose fatalities in 2022 involved illicit, synthetic opioids like fentanyl, which is the culprit in more deaths under age 50 than any other cause, including heart disease, cancer, homicide, suicide, and other accidents. According to the Centers for Disease Control and Prevention, in about 46% of overdose deaths, another person is present and has the potential to intervene.

Amneal Naloxone HCI Nasal Spray is now available. According to IQVIA®, U.S. annual commercial sales for NARCAN® Naloxone HCl Nasal Spray 4mg for the 12 months ended February 2024 were $266 million. In addition, there are significant volumes of the product acquired directly by U.S. states and municipalities. NARCAN® is a registered trademark of Emergent Operations Ireland Limited.

About Naloxone Nasal Spray

Naloxone Hydrochloride (Naloxone HCI) Nasal Spray is designed to rapidly reverse the effects of a life-threatening opioid emergency by binding to opioid receptors and reversing or blocking the effects of opioids. It can restore normal breathing within two to three minutes in a person whose breath has slowed, or even stopped, as a result of an overdose from opioids-including heroin, fentanyl and prescription opioid medications. Naloxone HCI Nasal Spray contains the same active ingredient and dose as NARCAN® Naloxone HCI Nasal Spray, 4 mg. It is easy to carry and can be safely used even if opioids are not present.

When using this product some people may experience symptoms when they wake up, such as shaking, sweating, nausea, or feeling angry. This is to be expected.

About the Opioid Crisis

The opioid epidemic was declared a national public health emergency in 2017 and has continually been renewed by the U.S. Secretary of Health and Human Services.4,5 Ending the epidemic is a top strategic priority of the U.S. government and Congress.6 Since 2000, about one million people in the U.S. have died of drug overdoses, the majority of which were due to opioids. Drivers of this crisis include the misuse of prescription pain medication and the unwitting use of drugs laced with fentanyl-which is 50 times more potent than heroin and 100 times more potent than morphine. In 2022, roughly twice as many people died in the U.S. from opioid-related overdoses than from motor vehicle crashes.

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Is intratympanic oxytocin effective for treating cisplatin induced ototoxicity? Study sheds light

Turkey: In a groundbreaking experimental study, researchers have compared the effectiveness of intratympanic oxytocin and dexamethasone in combating cisplatin-induced ototoxicity, a common side effect of cisplatin chemotherapy.

The study, published in the Indian Journal of Otolaryngology and Head & Neck Surgery, revealed that intratympanic oxytocin may be an option that can be used in the treatment, however, it is not as effective as dexamethasone in preventing cisplatin ototoxicity.

Cisplatin is a potent chemotherapy drug widely used in treating various cancers. However, its clinical utility is limited by ototoxicity, characterized by irreversible damage to the inner ear structures, leading to hearing loss and balance disorders. Traditional treatments for cisplatin-induced ototoxicity, such as systemic steroids, have shown limited efficacy and significant side effects.

Although widely used, there is still no valid treatment for ototoxicity caused by the antineoplastic drug cisplatin. In the study, Burak Mustafa Taş, Kırıkkale University School of Medicine, Kırıkkale, Turkey, and colleagues aimed to investigate the efficacy of intratympanic resveratrol and intratympanic dexamethasone treatment in cisplatin-induced cytotoxicity. They also compared intratympanic atosiban (oxytocin antagonist) and oxytocin in cisplatin ototoxicity.

The study separated 30 rats (60 ears) into five groups. Cisplatin, dexamethasone, oxytocin, atosiban, and 0.9% NaCl were administered intraperitoneally to all groups separately. On all the groups, Auditory Brainstem Response and Distortion Product Otoacoustic Emission tests were performed before and 72 hours after the procedure.

Following were the study’s key findings;

  • Pre-treatment values were higher than post-treatment values in all groups.
  • There was no significant prolongation of the post-treatment Auditory Brainstem Response I-IV interval in the oxytocin and dexamethasone groups.
  • There was no significant decrease in the frequencies of 2832 and 4004 after treatment in the oxytocin and dexamethasone group compared to pre-treatment in Distortion Product Otoacoustic Emission.

These findings suggest that intratympanic oxytocin holds promise as a novel therapeutic approach for the prevention of cisplatin-induced ototoxicity. Oxytocin, known for its role in social bonding and stress regulation, may exert protective effects on the inner ear through its anti-inflammatory and antioxidant properties.

The investigators believe that further research is warranted to elucidate the underlying mechanisms of oxytocin-mediated cochlear protection and to optimize dosing regimens for clinical translation. If validated in human studies, intratympanic oxytocin could offer a safer and more effective alternative to traditional treatments for cisplatin-induced ototoxicity, potentially improving the quality of life for cancer patients undergoing chemotherapy.

Reference:

Taş, B.M., Özel, G., Azman, M. et al. Comparison of Intratympanic Oxytocin and Dexamethasone in Cisplatin Ototoxicity: An Experimental Study. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04701-z

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Ibuprofen sodium dihydrate as effective as combo with Acetaminophen for Endodontic Pain Relief: Study

A recent study found that the combination of acetaminophen (APAP) and a new formulation of ibuprofen, also called as ibuprofen sodium dihydrate (ISD), does not improve pain relief for patients with severe dental pain linked to apical periodontitis when compared to ISD alone. The critical findings were published in the Journal of Endodontics.

This double-blind, randomized study included a total of 64 adult patients presenting at an emergency dental service with acute symptoms of irreversible pulpitis or necrosis, as well as symptomatic apical periodontitis associated with a severe form of dental pain. Each participant was assigned to receive a single dose of either 768 mg of ISD combined with 1000 mg of APAP or 768 mg of ISD alone.

The study utilized the Heft-Parker Visual Analogue Scale (VAS) to evaluate the effectiveness of these treatments. Assessments were recorded every 15 minutes over a four-hour period following medication. This research also tracked the time to the first sign of pain relief, time to meaningful pain relief and time to achieve 50% pain reduction.

The findings revealed that both treatment groups underwent a significant reduction in pain within the first two hours following medication administration. However, after 120 minutes, the decrease in pain levels plateaued, with no substantial differences noted between the two groups in terms of VAS scores at any time point or in the recorded times to pain relief milestones.

The results of this study are particularly significant as they challenge the common practice of combining ibuprofen with acetaminophen for more effective pain management. ISD which is a newer formulation of ibuprofen is designed to be absorbed more quickly could potentially offer faster pain relief. This study suggests that ISD alone is equally effective as when combined with acetaminophen for treating severe dental pain associated with apical periodontitis.

The benefits of these findings are considerable for clinical practices in settings where rapid pain relief is paramount. The clinicians may consider simplifying their pain management strategies for endodontic conditions by potentially reducing medication intake for patients without compromising the efficacy. Further research may explore different combinations or dosages, but this study adds pivotal knowledge to the field of pain management in dental care by suggesting that simpler may be just as effective.

Reference:

Palya, M., Chevere, J. M., Drum, M., Fowler, S., Nusstein, J., Reader, A., & Ni, A. (2024). Pain Reduction of Ibuprofen Sodium Dihydrate Alone and in Combination with Acetaminophen in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation. In Journal of Endodontics. Elsevier BV. https://doi.org/10.1016/j.joen.2024.04.005

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PAD useful screening test for dysphagia in patients with stroke: Study

South Korea: In a critical advancement for stroke care, a recent study has validated the Practical Assessment of Dysphagia (PAD) test as a reliable tool for evaluating swallowing difficulties in stroke patients. The findings, published in the Dysphagia journal, underscore the importance of accurate and efficient dysphagia assessment in improving patient outcomes post-stroke.

The study showed the emergence of the PAD test as a robust screening tool for post-stroke dysphagia. Researchers found significant inter- & intra-rater reliabilities (Kappa coefficient), high internal consistency, and strong correlations between PAD scores & videofluoroscopic swallowing study results. High specificity and sensitivity further solidified its status as a go-to screening tool.

As stroke remains a leading cause of disability worldwide, the validation of tools like the PADT represents a significant stride toward enhancing stroke care and rehabilitation efforts. By empowering healthcare providers with reliable and valid assessment tools, the research contributes to optimizing patient outcomes and reducing the burden of post-stroke complications.

Dysphagia, or difficulty swallowing, is a common complication following stroke, posing significant risks such as aspiration pneumonia and malnutrition. The PADT, a bedside screening tool designed to assess swallowing function, has gained traction in clinical practice due to its simplicity and efficiency. However, until now, its reliability and validity in the context of stroke patients have remained relatively unexplored.

Hyo Jong Kim, Chungbuk National University College of Medicine, Seowon-gu, Cheongju, Republic of Korea, and colleagues aimed to investigate the validity and reliability of the Practical Assessment of Dysphagia test as a quantitative and organ-specific test for stroke patients.

For this purpose, the researchers used PAD test data from 109 patients with stroke. Cronbach’s α value was used to analyze the internal consistency of the PAD. Based on the correlation between PAD and the videofluoroscopic swallowing study (VFSS), concurrent validity was evaluated. The diagnostic accuracy of the PAD test in stroke patients was measured using the area under the receiver operating characteristic (ROC) curve.

The key findings include:

  • Intra- and inter-rater reliabilities (Intra-class Correlation Coefficient (ICC) = 0.98 and 0.99, respectively) were significant for the total PAD score.
  • The functional dysphagia scale (FDS) score and penetration-aspiration score (PAS) correlated significantly with PAD.

The results of the ROC curve analysis with various cut-off points showed high sensitivity and specificity of the PAD test. The PAD has high validity and reliability. Therefore, it is a useful screening test for dysphagia in patients with stroke.

In conclusion, the study validates the Practical Assessment of Dysphagia Test as a reliable and valid tool for assessing swallowing difficulties in stroke patients. With its implications for clinical practice, the PADT stands poised to improve dysphagia management and enhance the quality of care for stroke survivors.

Reference:

Kim, H.T., Min, HJ. & Kim, H.J. Reliability and Validity Analyses of the Practical Assessment of Dysphagia Test in Stroke. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10708-z

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Case Report Highlights Rare Association: Progesterone-Only Contraceptive may Induce Ischemic Colitis

USA: In a noteworthy development in the field of gastroenterology, a recently published case report has shed light on a rare but potentially significant association between the use of progesterone-only contraceptives and the development of ischemic colitis, a condition characterized by inflammation and injury to the colon due to reduced blood flow.

In the case study published in ACG Case Reports Journal, the researchers have reported a unique case of biopsy-confirmed ischemic colitis (IC) in a previously healthy 30-year-old woman who presented with abdominal pain and bloody diarrhea two months after initiation of progesterone-only oral contraceptive.

The case report underscores the importance of vigilance in recognizing and managing adverse effects of commonly used medications.

The case concerns a 30-year-old white woman with no significant medical history presented to the emergency department with a 3-week history of worsening crampy abdominal pain, bloody diarrhea, and nausea. She denied any history of alcohol usage or smoking. Her vital signs on admission were stable. Abdominal examination was positive for normal bowel sounds and diffuse tenderness to palpation but was negative for guarding or rigidity. Her only medication was progesterone-only contraceptives for the past two months.

She responded to conservative management with antiemetics, and intravenous fluids, and was asked to discontinue progesterone-only contraceptive pill on discharge. Her symptoms improved over 2 weeks after discharge while off of her progesterone-only contraceptive. On a 3-month outpatient visit, she denies any recurrence of symptoms.

Progesterone is a hormone crucial for maintaining pregnancy and is known to exert vasoconstrictive effects on blood vessels, which can compromise blood flow to various organs, including the colon. While such an association had been documented previously in a handful of case reports and small-scale studies, the present case provided further evidence to support this intriguing link.

Ischemic colitis occurs with a temporary lack of adequate blood supply to the intestines, specifically in vulnerable areas such as the sigmoid colon and splenic flexure, which lack sufficient collateral blood vessels. Although primarily seen in older individuals with atherosclerotic risk factors, IC can also be triggered by hormonal contraceptives in young women. Although estrogen-containing oral contraceptives are known to increase thromboembolic risk, the impact of progesterone is not well understood.

In conclusion, the case is the first biopsy-proven case of IC resulting from a progesterone-only contraceptive pill. Despite the widespread progesterone-only contraceptive use, IC occurrence within this patient population remains unrecognized.

Although potential patient-related variables may contribute to disease onset in the absence of a known hypercoagulable state, the precise cause remains elusive.

“There is a need for further studies to better comprehend the impact of progesterone on coagulation, particularly concerning the mesenteric vasculature,” the researchers wrote.

Reference:

Rajamanuri, Medha MD1; Garg, Meher AS2; Siddiqui, Harris MD1; Pannala, Sreeram MD3. Progesterone-Only Contraceptive-Induced Ischemic Colitis. ACG Case Reports Journal 11(4):p e01313, April 2024. | DOI: 10.14309/crj.0000000000001313

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