Which treatment modalities have superior efficacy and reduced complications among patients with Cesarean scar pregnancy?

China: A recent network meta-analysis published in the American Journal of Obstetrics and Gynecology has shed light on the safety and efficacy of treatment modalities for cesarean scar pregnancy (CSP).

The findings suggested that transvaginal resection (TVR), laparoscopy (Lap), hysteroscopic curettage (Hys), and high-intensity focused ultrasound combined with suction curettage (HIFU+SC) procedures exhibited superior efficacy with reduced complications.

The researchers recommended against utilizing methotrexate (both locally guided injection and systemic administration) as a standalone medical treatment.

Cesarean scar pregnancy may lead to various complications. There are many methods for it, but no unified or recognized treatment strategies exist. Therefore, Peiying Fu, Huazhong University of Science and Technology, Wuhan, PR China, and colleagues aimed to observe the safety and efficacy of treatment modalities for CSP patients by conducting a systematic review and network meta-analysis.

For this purpose, the researchers searched the online databases from their inception to January 31, 2024. Additionally, they manually searched for relevant reviews and meta-analyses for additional references.

The study incorporated head-to-head trials involving a minimum of ten women with CSP diagnosis through ultrasound imaging, or magnetic resonance imaging (MRI), encompassing a detailed depiction of any supplementary measures and primary interventions. Trials with a Newcastle-Ottawa Scale (NOS) score below four were excluded due to the low quality.

Following a predefined protocol, group-level data on treatment safety and efficacy, study design, reproductive outcomes, and demographic characteristics were extracted. The quality of the studies was assessed using the Newcastle‒Ottawa scale (NOS) for cohort studies and case series, and Cochrane risk-of-bias tools for randomized controlled trials (RCT).

The study’s main outcomes were safety (complications) and efficacy (initial treatment success), of which summary odds ratios (ORs) and the surface under the cumulative ranking curve (SUCRA) using pairwise and network meta-analysis with random effects.

The researchers reported the following findings:

  • The review included seventy-three trials (7 RCTs) assessing 738369 women and 17 treatment modalities.
  • Network meta-analyses were rooted in data from 7373 trials that reported success rates and 55 trials that reported complications.
  • Transvaginal resection, laparoscopy, hysteroscopic curettage, and High-intensity focused ultrasound combined with suction curettage demonstrated the highest cure rates, as evidenced by SUCRA rankings of 91.2, 88.2, 86.9, and 75.3, respectively.
  • Compared to suction curettage (SC), the odds ratios of efficacy were 5.92 for TVR, 6.76 for Lap, 5.00 for Hys, and 3.27 for HIFU+SC.
  • Complications were more likely to occur after receiving uterine artery chemoembolization (UACE), SC, MTX+Hys, and sMTX; Hys, HIFU+SC, and Lap were safer than the other options derived from finite evidence; and the confidence intervals of all the data were wide.

In conclusion, in the study focused on the efficacy and safety of various treatment modalities for cesarean scar pregnancy, the researchers found that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound with suction curettage emerged as the most effective interventions, with impressive success rates. Methotrexate, administered locally and systemically administered, was discouraged as a standalone medical treatment.

Reference:

Fu P, Sun H, Zhang L, Liu R. Efficacy and Safety of Treatment Modalities for Cesarean Scar Pregnancy: A Systematic Review and Network Meta-Analysis. Am J Obstet Gynecol MFM. 2024 Mar 12:101328. doi: 10.1016/j.ajogmf.2024.101328. Epub ahead of print. PMID: 38485053.

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SIL-TPP bests SIL-TEP hernia repair for treating inguinal hernia indirect inguinal hernia: Study

Over the past century, various hernia repair surgeries have been generated by surgeons. Totally extraperitoneal (TEP) and transperitoneal hernioplasty (TAPP) are commonly used for laparoscopic inguinal hernia repair. Single-incision laparoscopy totally extraperitoneal hernioplasty (SIL-TEP), first introduced by Filipovic-Cugura et al. in 2009, has gained popularity due to its advantages like cosmesis, pain-reducing, and rapid recovery benefits.

In their recent study published in BMC Surgery, Qing Huang and colleagues concluded that the single-incision laparoscopic totally preperitoneal (SIL-TPP) hernia repair is a superior procedure with distinguished advantages like large and simple space. Based on their study findings, they recommend it rather than SIL-TEP for the management of inguinal hernia, especially for indirect hernia.
This study was conducted to evaluate the feasibility of SIL-TPP and compare its outcomes with SIL-TEP. The study involved 256 patients who underwent surgery at the First Hospital of Ningbo University between August 2018 and July 2022.
Key findings from the study results are:
• All patients underwent successful SIL-TPP and SIL-TEP hernia repair without any conversations between the groups.
• Patients’ demographics were comparable between the two groups, comparing the initial 52 cases analysis.
• The mean unilateral hernia operative time was significantly shorter in the SIL-TPP group than in the SIL-TEP group (unilateral: 81.38 ± 25.32 vs. 95.96 ± 28.54).
• Further study of unilateral hernia operative time revealed the mean indirect hernia operative time was significantly shorter in the SIL-TPP group than the SIL-TEP group (indirect: 81.38 ± 25.33 vs. 95.87 ± 28.54).
• The unilateral hernia operation time trend of the initial 52 cases of two group analysis revealed the operation time of SIL-TPP reduced faster than SIL-TEP along with treating number increasing
• comparison of initial equal quantity unilateral hernia patient mean operative time revealed the SIL-TPP group was significantly shorter than the SIL-TEP group (85.77 ± 22.76 vs. 95.87 ± 28.54).
• The rate of peritoneum tearing of the SIL-TPP group was significantly high than that of SIL-TEP
In conclusion, they said SIL-TPP is at least as effective as SIL-TEP. This procedure is safe and superior, and we recommend it rather than SIL-TEP for treating inguinal hernia.
Retrospective study, loss of follow-up, and small sample size were some of the study’s limitations.
References:
Huang, Q., Wang, X., Xiang, X. et al. TPP (totally preperitoneal) making single incision laparoscopic inguinal hernia repair more feasible: a comparison with single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP). BMC Surg 24, 81 (2024). https://doi.org/10.1186/s12893-024-02372-9

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Transient bundle branch block during the perioperative period–A meta-summary of case reports

A temporary intraventricular conduction deficit known as paroxysmal bundle branch block (BBB) may happen on its own or need medical intervention. Anaesthesia, cardiac catheterization, acute pancreatitis, pulmonary embolism, thoracic trauma, abrupt changes in intrathoracic pressure, medications, and poisonings are among the situations that are often linked to it. BBB skews the ECG’s morphology and makes it difficult to discern ST-T alterations. When the BBB is new or seems to have just developed, it is pathogenic and should be treated similarly to an ST-elevation myocardial infarction (STEMI). About 2% of people in a recent registration have left BBB (LBBB). Particularly when the BBB is in the correct position, acute coronary syndrome (ACS) linked to a BBB carries a greater risk of severe cardiac events and death (RBBB).

In order to assess the features, care, and results of temporary BBB in patients of any age during the perioperative phase, a recently published meta-summary examined all available case reports on the topic. 25 case reports of transient BBB during the perioperative phase were reported in the research, with the most common comorbidity being hypertension (37.5%). 23 individuals employed a combination of intravenous and inhalation anaesthetics, and the majority of patients acquired BBB while under general anaesthesia (GA). The majority of patients (21) had paroxysmal (17) LBBB, with the exception of tachycardia (13), and no other hemodynamic abnormalities.

The majority of intraoperative transitory BBBs are paroxysmal, with the more prevalent variety being tachycardia-associated rate-dependent LBBB. The precise aetiology of paroxysmal BBB remains uncertain; nevertheless, the hemodynamic effects of BBB might aid in determining the urgency of treatment and more testing.

Reference –

Nasa, Prashant1,2; Juneja, Deven3; Jain, Ravi4; Golchha, Sandeep5. Transient bundle branch block during the perioperative period–A meta-summary of case reports. Indian Journal of Anaesthesia 67(12):p 1123-1125, December 2023. | DOI: 10.4103/ija.ija_476_23.

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Continuous subcutaneous levodopa–carbidopa infusion safe, effective for treating Parkinson’s disease: Lancet

USA: An international, multisite phase 3 trial published in The Lancet Neurology journal showed the safety and effectiveness of Parkinson’s disease medication delivered through an infusion pump for reducing symptoms for longer periods.

The findings could lead to additional treatment options for patients with this condition. 

Low levels of dopamine in the body can cause Parkinson’s symptoms such as tremors, slowness, and stiffness. For decades, doctors have treated Parkinson’s by giving patients levodopa, the inactive substance in the brain that once converted makes dopamine.

“Levodopa is a replacement strategy. We all make levodopa, but Parkinson’s patients make less of it,” said Espay, co-principal investigator of the trial, James J. and Joan A. Gardner Family Center for Parkinson’s Disease Research Endowed Chair in UC’s Department of Neurology and Rehabilitation Medicine and a physician at the UC Gardner Neuroscience Institute.

Espay said oral levodopa is effective and typically helps people regain normal motor function, but its benefits tend to last less than a few hours after a few years, requiring increases in doses or its frequency.

Levodopa is most commonly administered orally, but this trial tested continuous, 24-hour levodopa delivery through a subcutaneous infusion pump. A total of 381 patients with Parkinson’s disease in 16 countries enrolled in the trial and were randomized to receive levodopa through the infusion pump or through traditional oral medication.

The researchers found levodopa delivered through the infusion pump was safe and led to almost two hours of day (1.72) of additional “on time,” or the time when the medication is working and symptoms are lessened, compared to taking levodopa orally.

Espay said the results of this trial pave the way for this specific infusion pump delivery system to be approved by the Food and Drug Administration and other countries’ respective governing bodies.

“Once approved, this will become an important treatment strategy to consider for patients with Parkinson’s disease experiencing motor fluctuations not adequately controlled with medication,” he said. “Future studies will need to determine the durability of the long-term benefits and whether any safety issues could emerge, as well as how it might compare with deep brain stimulation.”

Two additional subcutaneous delivery systems are also expected to be approved this year, Espay said, and researchers are continuing to study how to improve levodopa formulations and delivery to optimize its effect for patients.

“Levodopa delivery systems are expected to continue to improve over time,” he said. “This is a thriving area of research for the benefits of our patients.”

Reference:

Prof Alberto J Espay, Prof Fabrizio Stocchi, Prof Rajesh Pahwa, Prof Alberto Albanese, Aaron Ellenbogen, Prof Joaquim J Ferreira, Safety and efficacy of continuous subcutaneous levodopa–carbidopa infusion (ND0612) for Parkinson’s disease with motor fluctuations (BouNDless): a phase 3, randomised, double-blind, double-dummy, multicentre trial, The Lancet Neurology, https://doi.org/10.1016/S1474-4422(24)00052-8.

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Overactive bladder in men significantly correlates with sexual dysfunction: Study

Poland: A large representative population-level study has suggested no significant impact of an overactive bladder (OAB) on men’s sexual activity but significantly correlated with erectile dysfunction (ED) and premature ejaculation (PE).

The findings, published in the World Journal of Urology, suggest a need in daily clinical practice for screening overactive bladder symptoms in persons who report premature ejaculation or erectile dysfunction.

The effect of OAB on sexual health has been extensively evaluated for women but much less for men. Therefore, Mikolaj Przydacz, Department of Urology, Jagiellonian University Medical College, Krakow, Poland, and colleagues aimed to evaluate the relationship between overactive bladder and men’s sexual activity and the effect of OAB on erectile dysfunction and premature ejaculation in a large representative cohort of men at the population level.

The basis of the study was computer-assisted web interviews that used validated questionnaires. The most recent census and sample size estimation calculations produced a population-representative pool. 3001 men were included, representative of the population in terms of age and place of residence.

Based on the study, the researchers reported the following findings:

· The frequency of sexual intercourse was higher for respondents without OAB symptoms compared with persons who had OAB, but there was no association between OAB symptoms and number of sexual partners.

· Regression models did not confirm the effect of OAB on sexual activity (odds ratio 0.993).

· Both ED and PE were more prevalent in respondents with OAB symptoms compared with persons who lacked those symptoms.

· The effect of OAB on ED or PE was independent of age, comorbidities, and lifestyle habits (regression coefficients of 0.13 and 0.158 for ED and PE, respectively).

In conclusion, the recent findings underscore the importance of screening for OAB symptoms in patients with premature ejaculation or erectile dysfunction. While OAB failed to notably impact the frequency of sexual activity, it was strongly associated with higher prevalence rates of both premature ejaculation and erectile dysfunction. These associations remained significant even after accounting for age, comorbidities, & lifestyle factors.

Reference:

Przydacz M, Osman N, De Cillis S, Guillot-Tantay C, Herve F, Hüsch T, Illiano E, Fernandez AT, Tutolo M, Vale L, Culha MG, Cancrini F, Doizi S, Geretto P, Raison N, Goldman HB, Chlosta P, Phe V. Overactive bladder negatively affects erectile function and promotes premature ejaculation: findings from large representative population-level study. World J Urol. 2024 Mar 13;42(1):139. doi: 10.1007/s00345-024-04841-5. PMID: 38478079.

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Manual acupuncture improves language function in poststroke motor aphasia: JAMA

A recent multicenter clinical trial published in the Journal of American Medical Association highlighted the efficacy of acupuncture as a potential therapy for post-stroke motor aphasia. Motor aphasia usually seen following stroke significantly impairs the ability of the patients to communicate. Acupuncture has long been recommended as an alternative therapy for post-stroke aphasia, but its true impact had remained uncertain until now, which prompted Boxuan Li and team undertook this study.

The trial spanned from October 21, 2019 to November 13, 2021 and focused on investigating the effects of acupuncture on language function, neurological health and overall quality of life among stroke survivors. The study was conducted in three tertiary hospitals in China and involved a total of 252 randomized patients. This research conducted from February to April 2023 had majority of the participants who were men (78.6%) with an average age of 60.7 years. The participants were divided into one group receiving manual acupuncture (MA) and the other receiving sham acupuncture (SA). Also, both groups underwent conventional treatments and language training.

The results from the modified intention-to-treat analysis demonstrated that the MA group exhibited remarkable improvements compared to the SA group. The primary outcomes were measured by the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks and were significantly higher in the MA group. The difference in AQ was 7.99 points (95% CI, 3.42-12.55), and CFCP scores showed a difference of 23.51 points (95% CI, 11.10-35.93), both statistically significant (P < 0.001).

The positive trend continued at the end of the 6-month follow-up where the MA group showed even more substantial improvements in language function, quality of life and neurological impairment. This randomized clinical trial provides compelling evidence that support the efficacy of acupuncture in treatment post-stroke motor aphasia.

Reference:

Li, B., Deng, S., Zhuo, B., Sang, B., Chen, J., Zhang, M., Tian, G., Zhang, L., Du, Y., Zheng, P., Yue, G., & Meng, Z. (2024). Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia. In JAMA Network Open (Vol. 7, Issue 1, p. e2352580). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.52580

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Psoriatic Arthritis Treatment with Apremilast effective and may Improve Patient Satisfactio: Study

A recent real-world study, the APPRAISE study unveiled the effectiveness, tolerability and patient satisfaction with apremilast treatment for individuals with psoriatic arthritis (PsA) which is a chronic autoimmune condition characterized by joint inflammation and skin lesions, affecting millions worldwide.

This research was conducted across multiple Canadian rheumatology clinics and enrolled a total of 102 adults with active PsA. They were prescribed apremilast between July 2018 and March 2020 and were followed for 12 months with visits recommended every four months to monitor the progress. The primary outcome measure focused on achieving remission or low disease activity defined by a Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) score of 13 or less. 

The results from this study revealed significant improvements in various markers of disease activity despite 44.1% of the patients discontinuing this study within 12 months. Importantly, 63.7%, 67.2%, and 53.8% of patients achieved cDAPSA remission or low disease activity at 4 months, 8 months, and 12 months, respectively.

The patients who continued the study expressed reduced joint inflammation, pain and psoriasis symptoms. Improvement in treatment satisfaction and patient-reported outcomes, including physical and mental well-being, were obvious over the 12-month period. Safety data indicated that apremilast was well-tolerated, with diarrhea, nausea, and migraine being the most common adverse events leading to discontinuation. 

This study expressed positive outcomes of apremilast in real-world settings, by providing patients with effective relief from PsA symptoms and enhancing their overall quality of life. Overall, these findings contribute to the growing body of evidence that support the clinical effectiveness of apremilast in PsA management.

Reference:

Chandran, V., Bessette, L., Thorne, C., Sheriff, M., Rahman, P., Gladman, D. D., Anwar, S., Jelley, J., Gaudreau, A.-J., Chohan, M., & Sampalis, J. S. (2024). Use of Apremilast to Achieve Psoriatic Arthritis Treatment Goals and Satisfaction at 1 Year in the Canadian Real-World APPRAISE Study. In Rheumatology and Therapy (Vol. 11, Issue 2, pp. 443–455). Springer Science and Business Media LLC. https://doi.org/10.1007/s40744-024-00641-w

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13 female MBBS students accuse Assistant Professor of Pharmacology of sexual harassment

In a shocking incident, 13 female MBBS students from Delhi-based Baba Saheb Ambedkar Medical College have accused an Assistant Professor of Pharmacology of sexual harassment during a viva examination.

Based on the complaint by the students, a case has been registered by the police. Meanwhile, soon after the matter came to light, a demonstration was organized by women’s group and the protest soon manifested as a massive Public Outrage outside the college premises. Protesters were seen holding placards denouncing the accused professor and demanding justice.

For more information click on the link below:

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Brain recordings in people before surgery reveal how minds plan what to say prior to speaking

A new study in people undergoing surgery to treat seizures related to epilepsy shows that pauses in speech reveal information about how people’s brains plan and produce speech.

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Partner’s disturbed sleep keeping you up at night? Letting go of unattainable dreams may keep you both happy in bed

We all know that getting a good night’s sleep is vital for physical and mental health. Yet many people share a bed with a partner who can’t help disturbing their sleep, for example through their insomnia, frequently going to the bathroom, snoring, or a tendency to toss and turn in bed. Unsurprisingly, research has shown that poor sleep can lead to increased anger and decreased satisfaction with the relationship. But can we avoid falling in this trap, short of sleeping in separate bedrooms?

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