DSPN risk higher in patients with longer diabetes duration, higher A1C: Insights from Diabetes Prevention Program

USA: A recent study has revealed a higher average A1C and diabetes duration to be significant factors in the risk of developing distal symmetric polyneuropathy (DSPN).

Results from the Diabetes Prevention Program Outcome Study, published in Diabetes Care, informed the conclusions.

Distal symmetrical polyneuropathy (DSPN) is a common complication associated with diabetes mellitus, characterized by damage to peripheral nerves leading to sensory deficits, pain, and impaired motor function. The prevalence of DSPN among individuals with diabetes has been extensively studied, but the impact of various factors on its occurrence remains a subject of investigation.

To fill this knowledge gap, Christine G. Lee, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, and colleagues aimed to assess associations between distal symmetric polyneuropathy and Diabetes Prevention Program (DPP) treatment groups, diabetes status or duration, and cumulative glycemic exposure approximately 21 years following DPP randomization.

The DPP included 3,234 adults ≥25 years old at high risk for diabetes. They were randomized to intensive lifestyle (ILS), metformin, or placebo intervention for diabetes prevention. Following the DPP ending, 2,779 joined the Diabetes Prevention Program Outcomes Study (DPPOS).

Open-label metformin was continued, placebo was discontinued, ILS was provided as semiannual group-based classes, and all participants were offered quarterly lifestyle classes. At DPPOS year 17, signs and symptoms of DSPN were assessed in 1,792 participants. To evaluate DSPN associations with treatment group, diabetes status/duration, and cumulative glycemic exposure using multivariable logistic regression models.

The study led to the following findings:

  • At 21 years after DPP randomization, 66% of subjects had diabetes. DSPN prevalence did not differ by initial DPP treatment assignment (ILS 21.5%, metformin 21.5%, and placebo 21.9%).
  • There was a significant interaction between treatment assignment to ILS and age on DSPN.
  • At DPPOS year 17, the odds ratio for DSPN compared to ILS with placebo was 17.4% lower with increasing 5-year age intervals.
  • DSPN prevalence was slightly lower for those at risk for diabetes (19.6%) versus those with diabetes (22.7%) and was associated with longer diabetes duration and time-weighted HbA1c.

In conclusion, the likelihood of distal symmetric polyneuropathy was similar across DPP treatment groups, while higher for those with diabetes, higher cumulative glycemic exposure, and longer diabetes duration. For older adults, ILS may have long-term benefits on DSPN.

Insights from studies like the DPP provide valuable guidance for healthcare professionals in implementing strategies to mitigate or prevent DSPN risk in individuals with prediabetes or diabetes.

“Lifestyle modifications, early detection, and optimal glycemic control remain paramount in managing diabetes-related neuropathic complications,” the researchers wrote.

Reference:

Christine G. Lee, Adam Ciarleglio, Sharon L. Edelstein, Jill P. Crandall, Dana Dabelea, Ronald B. Goldberg, Steven E. Kahn, William C. Knowler, Maxwell T. Ma, Neil H. White, William H. Herman, Diabetes Prevention Program Research Group; Prevalence of Distal Symmetrical Polyneuropathy by Diabetes Prevention Program Treatment Group, Diabetes Status, Duration of Diabetes, and Cumulative Glycemic Exposure. Diabetes Care 2024; dc232009. https://doi.org/10.2337/dc23-2009

Powered by WPeMatico

Exploring etidronate treatment for arterial calcification: A pilot study on ACDC

USA: In a pilot study published in Vascular Medicine, etidronate was shown to slow the progression of vascular calcification in the lower extremities for patients with arterial calcification due to deficiency of CD73 (ACDC).

The researchers found that etidronate treatment slowed the progression of further vascular calcification in the lower extremities as measured by computed tomography (CT), but the treatment had no effect on reversing vascular and/or periarticular joint calcifications.

Arterial calcification due to CD73 deficiency is a rare genetic disease resulting in calcium deposits in arteries and small joints causing resting pain, claudication, deformities, and severe joint pain. Currently, no standard treatments exist for ACDC. Previous studies have identified etidronate as a potential targeted ACDC treatment, using in vitro and in vivo disease models with patient-derived cells.

Etidronate, a bisphosphonate with established efficacy in inhibiting bone resorption and preventing osteoporosis, has garnered interest for its potential role in mitigating pathological calcification in ACDC. By binding to hydroxyapatite crystals and interfering with their formation and growth, etidronate exhibits anti-calcification properties that could translate into therapeutic benefits for individuals with ACDC.

In the study, Elisa A Ferrante, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA, and colleagues tested the effectiveness and safety of etidronate in attenuating the progression of lower-extremity arterial calcification and vascular blood flow based on the ankle-brachial index (ABI) and computed tomography (CT) calcium score.

For this purpose, the researchers conducted an open-label, nonrandomized, single-arm pilot study for etidronate treatment enrolling adult patients with a confirmed genetic diagnosis of ACDC. They took daily etidronate for 14 days every 3 months and were examined at the NIH Clinical Center bi-annually for 3 years.

They received a baseline evaluation and yearly follow-up after treatment. Study visits included exercise tolerance tests with ABIs, imaging studies, clinical blood and urine testing, and full dental exams.

The study found that etidronate treatment appeared to have slowed the progression of further vascular calcification in lower extremities as measured by CT but has no impact in reversing vascular and/or periarticular joint calcifications in the small ACDC cohort.

“Despite the small sample size, these findings potentially suggest that etidronate could be considered for patients with progressive vascular calcification due to ACDC, particularly given the total lack of any other treatment options for this disease,” the authors wrote.

“In addition, the knowledge gained for the pathology, natural history, and clinical presentation of ACDC has been invaluable and will inform the development of novel therapies and larger clinical trials for this and other calcifying vascular diseases.”

Reference:

Ferrante, E. A., Cudrici, C. D., Rashidi, M., Fu, P., Huffstutler, R., Carney, K., Chen, M. Y., St Hilaire, C., Smith, K., Bagheri, H., Katz, J. D., Ferreira, C. R., Gahl, W. A., Boehm, M., & Brofferio, A. (2024). A pilot study to evaluate the safety and effectiveness of etidronate treatment for arterial calcification due to deficiency of CD73 (ACDC). Vascular Medicine. https://doi.org/10.1177/1358863X241235669

Powered by WPeMatico

Oxygen saturation testing effective tool to evaluate pulp status of avulsed teeth after replantation: Study

China: A prospective observational study involving 51 avulsed and replanted immature permanent teeth showed a pulse oximeter test as an effective tool to evaluate the pulp status.

“An oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation,” the researchers wrote in the Journal of Endodontics. This non-invasive technique monitors O2 saturation levels, facilitating early diagnosis of revascularization success or failure.

Replantation of avulsed immature permanent teeth is a delicate procedure in dental practice, often necessitating meticulous post-operative care to ensure successful outcomes. Avulsion, the complete displacement of a tooth from its socket, particularly affects immature permanent teeth which are still undergoing root development. Successful replantation of these teeth is contingent upon various factors, including maintaining proper blood supply to the periodontal tissues and preventing ischemic injury.

Evaluating pulp status is crucial for avulsed immature permanent teeth following replantation. Oxygen saturation tests may offer valuable assistance in addition to commonly used radiographic and clinical examinations providing clinical evidence. Considering this, Jinghui Yang, Wuhan University, Wuhan, China, and colleagues aimed to analyze the pulse oximeter efficacy in evaluating pulp status in avulsed and replanted immature permanent teeth.

For this purpose, the researchers performed a prospective observational study including 51 avulsed and replanted immature permanent teeth. Routine radiographic and clinical examinations were performed and used as a basis for pulp status diagnosis during the 1-year follow-up period. Meanwhile, the researchers recorded oxygen saturation values of these teeth using a modified pulse oximeter at each visit.

Following were the study’s key findings:

· Seven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group).

· Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred.

· For oxygen saturation tests, teeth in the success group showed an immediate post-replantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week post-replantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit.

· No increase trend was found for teeth in the failure group as abnormal clinical and/or radiographic manifestations emerged.

In conclusion, an oxygen saturation test is a reliable diagnostic method for evaluating the pulp status of avulsed teeth as early as 2 weeks after replantation.

“The application of oxygen saturation testing after the replantation of avulsed immature permanent teeth represents a valuable advancement in dental care,” the researchers wrote.

Reference:

Yang J, Liu Z, Chen Z, Yang G, Yuan G. Application of oxygen saturation test after replantation of avulsed immature permanent teeth: A prospective observational study. J Endod. 2024 Apr 9:S0099-2399(24)00229-2. doi: 10.1016/j.joen.2024.04.003. Epub ahead of print. PMID: 38604473.

Powered by WPeMatico

Fluid accumulation tied to major adverse kidney events in critically ill patients: Study

Switzerland: A recent study published in Annals of Intensive Care has shown a significant association between fluid accumulation and major adverse kidney events in critically ill patients’ first 30 days after ICU admission (MAKE30).

This association was shown to be independent of pre-existing chronic kidney disease (CKD) and strongest in patients with acute kidney injury (AKI) stage 3.

In critically ill patients, fluid management is a critical aspect of care, particularly those in intensive care units (ICUs). While fluid resuscitation is often necessary to stabilize hemodynamics and organ perfusion, excessive fluid accumulation can lead to complications, including AKI.

Fluid accumulation (FA) is known to be associated with acute kidney injury during ICU stay but data is scarce on mid-term renal outcome. Debora M. Hofer, Bern University Hospital, Bern, Switzerland, and colleagues aimed to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission.

For this purpose, the researchers conducted a retrospective, single-center cohort study comprising adult ICU patients with sufficient data to compute FA and MAKE30. Fluid accumulation was defined as a positive cumulative fluid balance greater than 5% of body weight.

The researchers examined the association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay. In addition, they performed a sensitivity analysis for the stage of AKI and the presence of CKD.

The study revealed the following findings:

  • Out of 13,326 included patients, 8.3% met the FA definition.
  • FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96) and all sub-components: need for renal replacement therapy (aOR 3.83), persistent renal dysfunction (aOR 1.72), and 30-day mortality (aOR 1.70).
  • The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3.
  • FA was independently associated with the creatinine trajectory over the whole observation period.

In the study, fluid accumulation was independently associated with MAKE30 in a mixed cohort of critically ill patients. The association was independent of pre-existing CKD and strongest in patients with AKI stage 3. FA independently and substantially affects short- and mid-term creatinine trajectory over 3 or 30 days following ICU admission.

“This may hint towards FA being a major risk factor for reduced renal recovery and patients with FA, particularly those with severe acute kidney should be considered “at risk” for renal recovery. There is no clarity on its therapeutic relevance for kidney-independent ICU outcomes,” the researchers wrote. “Further high-quality investigations are needed.”

Reference:

Hofer, D. M., Ruzzante, L., Waskowski, J., Messmer, A. S., & Pfortmueller, C. A. (2024). Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study. Annals of Intensive Care, 14(1), 1-10. https://doi.org/10.1186/s13613-024-01281-7

Powered by WPeMatico

Hypertensive disorders of pregnancy increase risk of cardiovascular death after giving birth: Study

Rutgers Health researchers have found that hypertensive disorders in pregnancy are strongly associated with fatal cardiovascular disease for up to a year after birth.

Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy — chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia — all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure.

Eclampsia, a condition whereby hypertensive disorders cause seizures, was associated with a nearly 58-fold increase in fatal cardiovascular disease, according to a study published in Paediatric and Perinatal Epidemiology.

“Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School. “This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum.”

 The researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, but that number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

“We’ve gotten better at predicting, diagnosing, and treating preeclampsia in this country, so the risk of death is falling for any individual patient with that condition,” said Cande Ananth, chief of the Division of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School and senior author of the study.

Unfortunately, Ananth noted, the sharp increase in the number of patients who develop chronic hypertension has more than offset the improved ability to treat it.

“Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain,” he said. “While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals.”

Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications, the study authors said. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke.

Guidelines for ongoing care for up to one year after delivery are needed for each hypertensive disorder, the researchers conclude.

References:  Rachel Lee, Justin S. Brandt, K. S. Joseph, Cande V. Ananth First published: 20 February 2024 https://doi.org/10.1111/ppe.13055

Powered by WPeMatico

Wide Awake Local Anaesthesia No Tourniquet safe in upper limb orthopaedic procedures: study

Wide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Jad Lawand et al conducted a study to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis.

A PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries.

Two authors performed an independent and blind title and abstract screening. For the full-text review phase, two authors screened the eligible articles independently and blindly, and any discrepancy was discussed with the senior author to reach a consensus.

Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis.

Key findings of the study were:

• 2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients.

• A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%).

• The most reported complications were superficial infection (41%, n=123/300), other/specified (12%, n=37/300), and recurrent disease (6.7%, n=20/300).

• A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p=0.42).

• In a subgroup analysis that classified included studies by mean age of participants into three age groups:65 years, encompassing 20, 30, and 7 studies, respectively, no statistically significant differences in complication rates were noted (p=0.58).

• Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p=0.025).

The authors concluded that – “WALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures.”

Further reading:

Complications and side effects of Wide Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta analysis

Jad Lawand, Ashraf Hantouly et al

International Orthopaedics

https://doi.org/10.1007/s00264-024-06104-9

Powered by WPeMatico

New Study Reveals Comparable Postoperative Risks of Tofacitinib and Biologics in Ulcerative Colitis Patients

In a significant breakthrough, a recent multicenter retrospective study has shed light on the postoperative outcomes of ulcerative colitis (UC) patients treated with tofacitinib versus biologics prior to total colectomy. Researchers found that Preoperative tofacitinib was as safe as biologics in patients with UC undergoing colectomy. The findings, published in The American Journal of Gastroenterology offers valuable insights into the comparative safety profiles of these treatment modalities, potentially reshaping clinical decision-making in UC management.

Patients with ulcerative colitis (UC) who are treated with immunosuppressive drugs face a significant risk of colectomy, a surgical procedure to remove the colon. Hence, researchers set out to examine the risk of postoperative complications associated with exposure to tofacitinib, prior to colectomy, and compare it with the risk associated with biologics, commonly used to treat UC in patients undergoing colectomy for medically refractory disease by conducting a multicenter, retrospective, observational study. 
Also Read: Healthy diet early in life may protect against inflammatory bowel disease later
Notably, the patient pool comprised 301 individuals across multiple centers treated with tofacitinib, anti-tumor necrosis factor-α agents, vedolizumab, and ustekinumab. Primary outcomes focused on the occurrence of any complication within both early (30 days) and late (90 days) postoperative periods, while secondary outcomes examined specific complications such as infections, sepsis, surgical site issues, venous thromboembolic events (VTE), hospital readmissions, and redo surgeries.
Findings:
  • The study revealed no significant disparities in outcomes between patients treated with tofacitinib and those receiving biologics.
  • Although there were slight variations, such as a marginally higher incidence of early VTE with anti-tumor necrosis factor-α agents and late VTE with vedolizumab, these differences did not hold significance upon multivariate analysis.
  • Of particular note, urgent colectomy emerged as a notable risk factor for early complications, hospital readmission, and the necessity for redo surgery, underscoring the critical importance of timely intervention in the management of UC.
  • Additionally, patients receiving high steroid doses were found to be at increased risk of early complications, surgical site issues, and the need for repeat surgery.
  • On a positive note, the study highlighted the benefits of laparoscopic surgery, which was associated with a reduced risk of early complications, infections, and late hospital readmissions.
Also Read: Mood interventions may reduce inflammation in Crohn’s and Colitis
These findings underscore the potential advantages of minimally invasive approaches in improving postoperative outcomes for UC patients undergoing colectomy. Overall, the study’s findings represent a significant step forward in elucidating the postoperative risks of different treatment modalities in UC management. With further research and validation, these insights have the potential to inform personalized treatment approaches tailored to the individual needs of UC patients, ultimately enhancing their quality of life and long-term outcomes.

Further reading: Dragoni G, Innocenti T, Amiot A, et al. Rates of Adverse Events in Patients With Ulcerative Colitis Undergoing Colectomy During Treatment With Tofacitinib vs Biologics: A Multicenter Observational Study. Am J Gastroenterol. Published online March 19, 2024. doi:10.14309/ajg.0000000000002676

Powered by WPeMatico

FDA approves Benralizumab as Add-On Maintenance Therapy for kids aged 6 to 11 with severe asthma

AstraZeneca’s FASENRA® (benralizumab) is now approved by the US Food and Drug Administration (FDA) for add-on maintenance treatment for patients with severe asthma aged 6 to 11 with an eosinophilic phenotype.1 FASENRA was first approved in 2017 as an add-on maintenance for the treatment of severe eosinophilic asthma (SEA) in patients aged 12 and older.1

This additional indication for FASENRA was supported by evidence from TATE, an open-label, multinational, non-randomized, parallel assignment Phase III trial, as well as adequate and well-controlled trials in adult and adolescent populations.2 In the TATE study, FASENRA met the primary endpoints, demonstrating pharmacokinetics (PK) and pharmacodynamics (PD) in children aged 6 to 11 years old with SEA were consistent with those seen in prior trials.

The safety and tolerability of FASENRA in the trial was also consistent with the known profile of the medicine.2 The recommended dose for FASENRA is 30 mg for patients 6 years and older who weigh 35 kg or more. For patients aged 6 to 11 who weigh less than 35 kg, a new 10 mg dose will be available.1 FASENRA is administered by subcutaneous injection every 4 weeks for the first 3 doses, and then every 8 weeks.

Lynda Mitchell, MA, CAE, CEO, of the Allergy & Asthma Network, said: “We welcome additional treatment options for children living with severe asthma, a condition that remains complicated to manage, further helping to address the unmet need in this patient population and reducing the burden of disease for the broader asthma community.”

Asthma is the most common chronic childhood disease and can cause serious symptoms such as coughing, wheezing and difficulty breathing.3 Children with severe asthma and their families face a significant burden, including impaired school performance, substantially higher healthcare resource use and a poorer quality of life.4 Severe asthma is a debilitating type of asthma that can be complicated and challenging to treat.4

Liz Bodin, Vice President, US Respiratory & Immunology, AstraZeneca said: “We’re proud that FASENRA has helped more than 100,000 patients in the US to date. Expanding options for children whose quality of life has been drastically impacted by severe eosinophilic asthma with the help of FASENRA is an exciting step in our mission to revolutionize asthma care.”

FASENRA is currently approved as an add-on maintenance treatment for patients aged 6 and older with SEA in the US.1

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Known hypersensitivity to benralizumab or excipients.

WARNINGS AND PRECAUTIONS

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., anaphylaxis, angioedema, urticaria, rash) have occurred after administration of FASENRA. These reactions generally occur within hours of administration, but in some instances have a delayed onset (i.e., days). Discontinue in the event of a hypersensitivity reaction.

Acute Asthma Symptoms or Deteriorating Disease

FASENRA should not be used to treat acute asthma symptoms, acute exacerbations, or acute bronchospasm.

Reduction of Corticosteroid Dosage

Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of therapy with FASENRA. Reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Parasitic (Helminth) Infection

It is unknown if FASENRA will influence a patient’s response against helminth infections. Treat patients with pre-existing helminth infections before initiating therapy with FASENRA. If patients become infected while receiving FASENRA and do not respond to anti-helminth treatment, discontinue FASENRA until infection resolves.

ADVERSE REACTIONS

The most common adverse reactions (incidence ≥ 5%) include headache and pharyngitis.

Injection site reactions (e.g., pain, erythema, pruritus, papule) occurred at a rate of 2.2% in patients treated with FASENRA compared with 1.9% in patients treated with placebo.

USE IN SPECIFIC POPULATIONS

A pregnancy exposure registry monitors pregnancy outcomes in women exposed to FASENRA during pregnancy. To enroll call 1-877-311-8972 or visit www.mothertobaby.org/Fasenra.

The data on pregnancy exposure from the clinical trials are insufficient to inform on drug-associated risk. Monoclonal antibodies such as benralizumab are transported across the placenta during the third trimester of pregnancy; therefore, potential effects on a fetus are likely to be greater during the third trimester of pregnancy.

INDICATION

FASENRA is indicated for the add-on maintenance treatment of patients with severe asthma aged 6 years and older, and with an eosinophilic phenotype.

FASENRA is not indicated for treatment of other eosinophilic conditions

FASENRA is not indicated for the relief of acute bronchospasm or status asthmaticus

Powered by WPeMatico

Youth with mood disorders less likely to acquire driver’s license and have higher rates of road accidents: JAMA

USA: A recent cohort study of 1879 youths with and 84 294 youths without a mood disorder revealed that youth with mood disorders are 30% less likely to acquire a driver’s license than those without. Also, they had a significantly higher rate of moving violations, crashes, and license suspensions.

The findings published in JAMA Network Open suggest that opportunities may exist to improve driving autonomy among youths with mood disorders while concurrently ensuring safe mobility.

Driving is a rite of passage for many youths, symbolizing independence and freedom. However, for those living with mood disorders, the journey to obtaining a driver’s license and navigating the responsibilities of driving can be fraught with unique challenges.

Mood disorders, such as bipolar disorder and depression, affect millions of youths worldwide. These conditions can significantly affect several aspects of daily life, including decision-making, impulse control, and emotional regulation—essential skills for safe driving. The understanding of how mood disorders are associated with youth driving outcomes is limited. To widen the knowledge about the same, Christopher E. Gaw, Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio, and colleagues aimed to examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.

For this purpose, the researchers undertook a cohort study among New Jersey residents born between 1987 to 2000, age eligible to acquire a driver’s license from 2004 to 2017, and patients of the Children’s Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years.

Among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017, rates of licensure and driving outcomes among youths who were licensed were compared.

The investigators assessed the acquisition of a driver’s license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months following licensure. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for driving and licensing outcomes.

The study led to the following findings:

  • Among 86 173 youths (median age at the end of the study, 22.8 years; 49.8% were females), there were 1879 youths with and 84 294 youths without a mood disorder.
  • A greater proportion of youths with mood disorders were female (65.2%) compared with those without mood disorders (49.4%).
  • At 48 months after licensure eligibility, 75.5% and 83.8% of youths with and without mood disorders, respectively, had acquired a license.
  • Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70).
  • Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10,000 driver-months; aRR, 1.19); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25) and license suspensions (aRR, 1.95).

In conclusion, the study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than those without mood disorders.

“These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk,” the researchers wrote.

Reference:

Gaw CE, Metzger KB, Pfeiffer MR, et al. Driver’s Licensure and Driving Outcomes Among Youths With Mood Disorders. JAMA Netw Open. 2024;7(4):e245543. doi:10.1001/jamanetworkopen.2024.5543

Powered by WPeMatico

New Vision Training Method Shows Promise in Slowing Myopia Progression in Children: JAMA

In a notable study conducted across three hospitals, researchers have discovered a potentially game-changing approach to combatting the alarming rise of myopia in children. The findings, published in a recent issue of JAMA Pediatrics, highlight the efficacy and safety of a novel vision training technique known as naked-eye 3-dimensional vision training (NVT). Researchers found that naked-eye 3-dimensional vision training (NVT) is safe and hopeful in preventing pediatric myopia progression. 

Myopia, commonly known as nearsightedness, has become a growing concern globally, particularly with its early onset in childhood. The condition, characterized by difficulty seeing distant objects clearly, poses significant risks when left unchecked, including the development of high myopia, which can lead to irreversible retinal damage and even loss of central vision. To address this pressing issue, the research team embarked on a randomized clinical trial involving children aged 6 to 18 years diagnosed with myopia within a certain range of severity.
Also Read: Repeated low-level red light therapy exhibits clinical significance as short-term alternative for childhood myopia control: Study
Over the course of the study, which spanned from May 2022 to February 2023, participants were divided into two groups: one receiving daily 20-minute sessions of NVT and the other continuing with their usual activities without any vision training. The primary goal of the study was to assess whether NVT could effectively halt the progression of myopia, as measured by changes in axial length—a key indicator of eye elongation associated with myopia—over a period of six months. Secondary outcomes included evaluating changes in spherical equivalent refraction (SER), another crucial measure of visual impairment.
Findings:
  • Remarkably, the results revealed a significant difference between the two groups.
  • Children who underwent NVT exhibited less change in axial length (0.18 mm) and spherical equivalent refraction (-0.25 D) compared to their counterparts in the control group.
  • In contrast, those in the control group experienced greater changes in both axial length (0.23 mm) and spherical equivalent refraction (-0.35 D) over the same period.
  • One of the most encouraging aspects of the study was the absence of any adverse reactions related to the NVT treatment during the follow-up period.
Also Read: Eyesight problems rising among children, Delhi AIIMS Doctor advise precautions

This underscores the safety profile of the intervention, further supporting its potential as a viable option for managing myopia in children. While the results are promising, researchers acknowledge the need for further investigation to confirm the long-term benefits and optimal implementation of NVT. Nonetheless, the findings represent a significant step forward in the quest to combat myopia and safeguard children’s eye health. As the prevalence of myopia continues to rise worldwide, with profound implications for public health, innovative approaches like NVT offer hope for stemming its progression and preserving vision for future generations. With continued research and collaboration, the prospect of a world where myopia is no longer a looming threat to children’s eye health grows ever closer.

Further reading: Xie R, Zhao F, Yu J, et al. Naked-Eye 3-Dimensional Vision Training for Myopia Control: A Randomized Clinical Trial. JAMA Pediatr. Published online April 08, 2024. doi:10.1001/jamapediatrics.2024.0578

Powered by WPeMatico