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“For selected patients, expedited achievement of the serum urate (SU) target in more than 75% of patients using one titration step and low xanthine oxidase inhibitor and uricosuric doses is a potential alternative to standard urate-lowering therapy (ULT) regimens,” the researchers reported.

In gout, increased SU, called hyperuricemia, promotes crystal deposition of monosodium urate monohydrate crystals in periarticular and articular structures that can trigger acute episodes of very painful inflammatory arthritis (gout flare). Longstanding hyperuricemia and gout can also lead to joint damage, palpable tophi, and urolithiasis.

Urate-lowering therapy is the central strategy for effectively controlling hyperuricemia and gout, but there has been an unmet need for simpler ULT regimens that achieve the serum urate target and improve the overall quality of gout care. Therefore, Xiaomei Xue, Affiliated Hospital of Qingdao University, Qingdao, China, and colleagues reported a comparative effectiveness trial of febuxostat monotherapy versus benzbromarone add-on to low-dose febuxostat in gout specifically with combined renal urate underexcretion and overload.

The research team conducted a prospective randomized trial on patients with combined-type hyperuricemia and estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2. They were randomly assigned in 1:1 ratio to febuxostat and benzbromarone combination therapy (initially febuxostat at 20 mg/day, with benzbromarone at 25 mg/day added onto 20 mg/day of febuxostat if not at target) or febuxostat monotherapy (initially 20 mg/day, escalating to 40 mg/day if not at target).

The primary endpoint at 12 weeks was the proportion achieving an SU level <360 μmol/L. Other outcomes were altered kidney and liver function, gout flares, and new-onset urolithiasis.

Following were the study’s key findings:

• Two hundred and fifty participants were randomized; 219 completed 12-week treatment.
• More patients in the febuxostat and benzbromarone combination group achieved the SU target compared to patients in the febuxostat monotherapy group (75.5% vs 47.7%; odds ratio 3.37).
• Safety profiles were comparable between the two groups.

The findings showed the superiority of low-dose benzbromarone add-on to low-dose febuxostat compared with febuxostat monotherapy in gout with combined-type hyperuricemia.

“For selected patients, expedited achievement of the SU target in more than 75% of patients using one titration step and low xanthine oxidase inhibitor and uricosuric doses is a potential alternative to standard ULT regimens,” the researchers concluded.

Reference:

Xue, X., Sun, M., Yan, F., Dalbeth, N., He, Y., Li, X., Qi, H., Chen, Y., Yuan, X., Li, M., Ji, A., Terkeltaub, R., & Li, C. Superiority of Low-Dose Benzbromarone Add-On to Low-Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined-Type Hyperuricemia. Arthritis Care & Research. https://doi.org/10.1002/acr.25283

“The open-label randomized clinical trial (STARDUST) of 55 patients with T2D and PAD showed that liraglutide was associated with a significant increase in transcutaneous oxygen pressure (TcPo2) versus conventional treatment of cardiovascular (CV) risk factors,” the researchers reported in JAMA Network Open.

“An increase from baseline of at least 10% of TcPo2 was achieved by 89% of participants treated with liraglutide and 46% of the control group.”

Peripheral artery disease in diabetes may lead to diabetic foot ulcers and lower-extremities amputation. Glucagon-like peptide 1 receptor agonists have proven CV benefits in trials of patients with T2D at high CV risk. Considering this, Paola Caruso, University of Campania “Luigi Vanvitelli,” Naples, Italy, and colleagues aimed to investigate the effect of liraglutide on peripheral perfusion measured as peripheral TcPo2 in patients with type 2 diabetes and PAD.

For this purpose, the researchers conducted an open-label randomized clinical trial (RCT) between 2021 and 2022, with a final follow-up in December 2022. It included Fifty-five individuals with type 2 diabetes, PAD, and TcPo2 between 30 and 49 mm Hg.

Fifty-five participants (mean age, 67.5 years; 78% male) were randomized to receive 1.8 mg of subcutaneous liraglutide (n=27) or conventional treatment of cardiovascular risk factors (control group, n=28) for six months.

Coprimary outcomes were the change in peripheral perfusion from baseline between groups and the comparison of the proportion of individuals who reached a 10% increase of TcPo2 from baseline in each group.

The study led to the following findings:

• Participants had a median (IQR) hemoglobin A1c level of 6.9% and a mean TcPo2 of 40.3 mm Hg.
• Transcutaneous Po2 increased over time in both groups, with significant differences favoring the liraglutide group after 6 months (estimated treatment difference, 11.2 mm Hg).
• The 10% increase in TcPo2 occurred in 89% of participants in the liraglutide group and 46% in the control group (relative risk, 1.91).
• Compared with the control group, individuals in the liraglutide group had a significant reduction of C-reactive protein (−0.4 mg/dL), urinary albumin to creatinine ratio (−119.4 mg/g), and improvement of 6-minute walking distance (25.1 m).

In conclusion, the RCT of patients with type 2 diabetes and PAD, liraglutide increased peripheral perfusion detected by TcPo2 measurement during 6 months of treatment.

“These results support liraglutide use to prevent the clinical progression of PAD in individuals with type 2 diabetes,” the researchers wrote.

Reference:

Caruso P, Maiorino MI, Longo M, et al. Liraglutide for Lower Limb Perfusion in People With Type 2 Diabetes and Peripheral Artery Disease: The STARDUST Randomized Clinical Trial. JAMA Netw Open. 2024;7(3):e241545. doi:10.1001/jamanetworkopen.2024.1545

Treating anxiety and depression reduced emergency room visits and rehospitalizations among people with heart disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

“For patients who had been hospitalized for coronary artery disease or heart failure and who had diagnoses of anxiety or depression, treatment with psychotherapy, pharmacotherapy or a combination of the two was associated with as much as a 75% reduction in hospitalizations or emergency room visits. In some cases, there was a reduction in death,” said lead study author Philip Binkley, M.D., M.P.H., executive vice chair of the department of internal medicine and emeritus professor of internal medicine and public health at The Ohio State University in Columbus, Ohio.

Binkley noted that anxiety and depression are common in people with heart failure, and mental health can have a significant impact on an individual’s risk of other health conditions, disability and death.

In this study, Binkley and colleagues examined the association of mental health treatment with antidepressant medication or psychotherapy, also known as talk therapy or a combination of the two in relation to, emergency room visits, hospitalizations and death in people with blocked arteries or heart failure and with a formal diagnosis of anxiety or depression before hospitalization.

The analysis found using three different statistical models that adjusted for different variables and compared to patients not receiving treatment for anxiety or depression:

• For people who received both medication and talk therapy for anxiety or depression the risk of hospitalization was reduced by 68% to 75% the risk of being seen in the emergency department was reduced by 67% to 74%, and the risk of death from any cause was reduced by 65% to 67%.
• Psychotherapy treatment alone was associated with a 46% to 49% reduction of risk for hospital readmission and a 48% to 53% reduction in emergency room visits.
• Medication treatment alone reduced hospital readmission by 47% to 58% and reduced ER visits by 41% to 49%.
• Follow-up time was variable based on the needs of each patient.

“Heart disease and anxiety/depression interact such that each promotes the other,” Binkley said. “There appear to be psychologic mechanisms that link heart disease with anxiety and depression that are currently under investigation. Both heart disease and anxiety/depression are associated with activation of the sympathetic nervous system. This is part of the so-called involuntary nervous system that increases heart rate, blood pressure and can also contribute to anxiety and depression.”

Binkley considers the large number of people with heart disease and the marked reduction in hospitalizations and emergency room visits and the drop in death to be the strength of the study.

“I hope the results of our study motivate cardiologists and health care professionals to screen routinely for depression and anxiety and demonstrate that collaborative care models are essential for the management of cardiovascular and mental health. I would also hope these findings inspire additional research regarding the mechanistic connections between mental health and heart disease,” he said.

Study details and background:

• 1,563 adults ages 22 to 64 over a three-year period were included, and all participants had a first hospital admission for blocked arteries or heart failure and had two or more health insurance claims for an anxiety disorder or depression.
• Sixty-eight percent of participants were women, and 81% were noted as white race. All were enrolled in Ohio’s Medicaid program during the six months prior to the hospital admission. Health data was from two sources: Ohio Medicaid claims and Ohio death certificate files from July 1, 2009, to June 30, 2012.
• Participants were followed through the end of 2014 or until death or the end of Medicaid enrollment.
• About 23% of participants received both antidepressant medications and psychotherapy; nearly 15 percent received psychotherapy alone; 29% took antidepressants alone; and 33% received no mental health treatment.
• About 92% of participants in the study were diagnosed with anxiety and 55.5% with depression prior to hospitalization.

The study was limited to people enrolled in Medicaid, therefore, it may not be representative of people covered by commercial health insurance plans. In addition, the majority of participants were noted as white race, therefore, these finding are not applicable to people of other races, ethnicities or communities.

Reference:

Cheryl N. Carmin, Raymond L. Ownby, Cynthia Fontanella, Danielle Steelesmith and Philip F. Binkley, Impact of Mental Health Treatment on Outcomes in Patients With Heart Failure and Ischemic Heart Disease,Journal of the American Heart Association, https://doi.org/10.1161/JAHA.123.031117.

The potential effects of antenatal glucocorticoid exposure on children’s health are unclear. We examined the association between gestational exposure to maternal systemic glucocorticoids (SG) and the risk of developing chronic kidney disease (CKD) in childhood. Cox proportional hazard models with stabilized inverse probability of treatment weighting and robust sandwich estimator were used to estimate the average association between SG and incident CKD after adjustment for offspring characteristics (aHR). Results: Among 23,363 singleton-born children, gestational SG exposure was significantly associated with a higher risk of childhood CKD (aHR, 1.69 [95% CI, 1.01-2.84]). Stratified analyses showed stronger associations between SG and childhood CKD within the strata of birth <37 weeks gestational age (aHR, 2.38 [95% CI, 1.19-4.78]), male sex (aHR, 1.89 [95% CI, 1.00-3.55]), gestational exposure in the second trimester (aHR, 6.70 [95% CI, 2.17-20.64]), and total dose >24 mg hydrocortisone equivalent (aHR, 1.91 [95% CI, 1.05-3.47). Study was limited to the Taiwan healthcare delivery system and childhood CKD events through age 10 years. The findings of this study suggest that gestational exposure to systemic glucocorticoids is associated with the occurrence of kidney disease in childhood. If these findings are confirmed, they may inform clinicians who are considering prescribing SG during pregnancy.

Reference:

Tain YL, Li LC, Kuo HC, Hsu CN. Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD. Am J Kidney Dis. 2024 Mar 11:S0272-6386(24)00669-3. doi: 10.1053/j.ajkd.2024.01.523. Epub ahead of print. PMID: 38479460.

Keywords:

Gestational exposure, systemic glucocorticoids, incident, kidney disease , childhood, Tain YL, Li LC, Kuo HC, Hsu CN, American Journal of Kidney Diseases, adolescents; antenatal; children; chronic kidney disease; gestational timing; pregnancy; systemic glucocorticoids.

Lucknow: A shocking incident of cyber fraud has come to light as a woman doctor a professor at a government medical university in Uttar Pradesh, fell victim to a ‘digital arrest’ scam and was duped of Rs 40 lakh.  

The cybercrime, known as ‘digital arrest,’ involves cybercriminals posing as law enforcement or investigative authorities to coerce individuals into transferring money under false pretenses.

According to the woman’s statement, she received a call on March 11, purportedly from Maharashtra, reports IANS.

The caller accused her of involvement in illegal activities using a phone number issued under her ID in July 2023. The call was then transferred to someone claiming to be from the Maharashtra police headquarters, who accused her of fraudulent activities, including money laundering through a fictitious account in Canara Bank, Mumbai. The caller threatened her with an arrest warrant and claimed to have blocked her financial cards, PAN, and Aadhaar.

Also Read:Hyderabad: Man poses as doctor on matrimonial website dupes woman of Rs 6 lakh

According to IANS,“An arrest warrant has been issued in your name. All your financial accounts will be frozen and they will be investigated. Till then you are put under ‘digital arrest’. After that they called me on Skype and showed me many documents which included my phone number, Aadhaar number and which also included my arrest warrant,” she said.

“A staggering amount of Rs 31.31 lakh was transferred by her on March 11, followed by Rs 9 lakh from another account the next day,” police said.  

Furthermore, the scammers instructed the woman to maintain constant communication, provide personal information and refrain from contacting anyone else, citing national security concerns and the purported involvement of police and bank officials in the scam, police said. 

Upon realizing she had been deceived, the professor promptly reported the incident to the cybercrime police station and filed a formal complaint, leading to the registration of an FIR. 

The victim, a widow, had saved the money for her children’s education and her future, making the loss particularly devastating.

Former SP in Cyber Cell and cyber expert, Triveni Singh said that people should be aware that no legitimate agency will request presence on a Skype call for matters of investigation or arrest. There is nothing like a ‘digital arrest’. 

Also Read:Delhi doctor becomes victim of sextortion scam, loses Rs 8.6 Lakh