Bariatric surgery in obese ESRD patients can improve their eligibility for kidney transplants: Study

A collaborative study between a bariatric and transplant surgery team has introduced new hope for patients suffering from end-stage renal disease (ESRD) who are also struggling with obesity.

The study authors explored the outcomes of metabolic and bariatric surgery in ESRD patients and whether the surgery can improve their eligibility for kidney transplants.

The findings are published in the Journal of the American College of Surgeons (JACS).

“Obesity is a worsening problem in the United States, significantly impacting transplant eligibility. We established the CORT initiative – a collaborative for obesity research in transplantation – recognizing the urgent need to address this issue, especially in underserved populations who suffer the most from obesity-related diseases,” said corresponding study author Anil Paramesh, MD, MBA, FACS, professor of surgery, urology, and pediatrics and director of the kidney and pancreas transplant programs at Tulane University School of Medicine.

Patients with ESRD face many difficulties without a transplant; their only alternative is to prolong life through dialysis, a process that is not only costly and time-intensive but also significantly diminishes quality of life, Dr. Paramesh noted.

The study, conducted between January 2019 and June 2023, followed 183 ESRD patients referred for bariatric surgery, with 36 undergoing weight loss surgery and 10 subsequently receiving kidney transplants. Results showed a 27% reduction in average BMI at the time of transplant, alongside improvements in hypertension and diabetes management. This improvement in the management of comorbid conditions enhanced patients’ overall health and transplant viability.

With obesity being a major cause of transplant exclusion, this collaborative program represents a path forward for patients who previously would be ineligible, Dr. Paramesh said, and may help pave the way for increased patient education and access.

“We’ve seen that bariatric surgery is not just about weight loss; it significantly improves other serious conditions like diabetes, high blood pressure, and sleep apnea. This approach not only helps in reducing the patients’ weight to a level where they can safely receive a transplant, but also addresses the broader issue of health care disparities, particularly affecting Black and lower-income individuals,” said Dr. Paramesh.

However, the study also faced challenges, including a high drop-off rate of patients unwilling or unable to undergo surgery, and unique postoperative complications such as hypotension.

“Our findings indicate a pressing need to enhance patient education and support, making sure that potential candidates understand the benefits of weight loss surgery and its role in improving their eligibility for transplant,” said Dr. Paramesh.

The authors suggest further studies could examine the unique complications ESRD patients may have after weight loss surgery. 

Reference:

Levy, Shauna MD, FACS1; Attia, Abdallah MD1; Omar, Mahmoud MD2; Langford, Nicole RN3; Vijay, Adarsh MD, FACS3; Jeon, Hoonbae MD, FACS3; Galvani, Carlos MD, FACS1; Killackey, Mary T MD, FACS2; Paramesh, Anil S MD, MBA, FACS3. Collaborative Approach toward Transplant Candidacy for Obese End-Stage Renal Disease Patients. Journal of the American College of Surgeons ():10.1097/XCS.0000000000000962, March 12, 2024. | DOI: 10.1097/XCS.0000000000000962

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Prophylactic Efmoroctocog Alfa may improve outcomes in patients with hemophilia A: Study

A recent retrospective study published in the journal of Hematology explored the clinical characteristics and treatment patterns of patients with hemophilia A who were undergoing prophylactic treatment. This comprehensive study utilized data from the Systeme National des Donnees de Sante database which spanned from 2016 to 2019 to highlight the factors such as factor consumption and events of interest in this patient population. This study also evaluated the clinical impact of transitioning these patients to Elocta® which is an extended half-life treatment for hemophilia A.

Among the 545 patients included in the analysis, Elocta® emerged as the most frequently utilized treatment option. The bleeding events affected 15.4% of patients, while 13.9% experienced articular non-bleeding events leading to hospitalization. The surgeries or procedures related to hemophilic arthropathy were reported in 9.9% of cases. The outcomes revealed a mean monthly factor VIII product consumption of 344 IU/kg/month for extended half-life treatment and 331 IU/kg/month for standard half-life products.

The sub-cohort analysis involved a total of 146 patients who transitioned to Elocta® observed promising trends. Although bleeding events did not significantly decrease post-switch, there was a marked reduction in their frequency. Also, bleeding events decreased from a mean of 0.32 events per patient per year to 0.09 events post-switch. Importantly, this reduction did not reach statistical significance. There were no significant differences in factor consumption rates or the occurrence of articular non-bleeding events before and after the initiation of Elocta®. Overall, this study provides valuable insights into the treatment landscape and clinical outcomes for the patients with hemophilia A who are receiving prophylactic regimens in France. 

Source: 

Trossaërt, M., Falk, A., Gautier, L., Kragh, N., Van Hinloopen, O., & Varin, R. (2024). An observational study of haemophilia A patients without inhibitors using the French national claims (SNDS) database. In Hematology (Vol. 29, Issue 1). Informa UK Limited. https://doi.org/10.1080/16078454.2024.2320610

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Rheumatoid arthritis patients more prone to depression, claims JAMA study

Rheumatoid arthritis (RA) is a prevalent autoimmune disease characterized by systemic inflammation. This condition may require lifelong treatment due to its chronic nature, which results in numerous comorbidities. Depression is one of the most common comorbidities in RA patients, with estimates of prevalence ranging from 14% to 48%, which is significantly higher than in the general population.

According to an original investigation on Psychiatry published in JAMA Network Open, clinicians should consistently screen RA patients for depression. It is important for assessment and providing comprehensive mental and physical health care.
Depression is a prevalent comorbidity among individuals with rheumatoid arthritis (RA), but there is limited data on the relationship between RA seropositivity and biologic agents with depression risk. This study aimed to investigate the risk of depression following an RA diagnosis in the South Korean population. This retrospective cohort study involved 38,487 rheumatoid arthritis (RA) patients, and a control group of 192,435 individuals matched 1:5 for age, sex, and index date. Data were obtained from the Korean National Health Insurance Service database. Participants were enrolled from 2010 to 2017 and followed up until 2019.
Key findings from the study are:
  • The study population included 71 % females.
  • A total of 27 063 participants, 20 641 controls and 6422 with RA developed depression.
  • RA patients had a 1.66-fold higher risk of depression than controls with an adjusted hazard ratio [aHR] of 1.66.
  • The SPRA and the SNRA group were associated with an increased depression risk with aHR of 1.64 and 1.73, respectively.
  • RA patients who used biologic or targeted synthetic DMARDs with aHR, 1.33, had a lower depression risk compared with those who were not exposed to these medicines. The aHR was 1.69
  • SPRA and SNRA were associated with a significantly higher risk of depression. This highlights the importance of early screening and intervention for mental health in RA patients.
Study limitations include a limited evaluation of RA severity, result distortion due to unmeasured factors, and lack of information.
We found a strong association between RA and increased depression risk, regardless of age, sex, behavioural factors, and RA serologic status, they said.
Reference:
Jeon KH, Han K, Jung J, et al. Rheumatoid Arthritis and Risk of Depression in South Korea. JAMA Netw Open. 2024;7(3):e241139. doi:10.1001/jamanetworkopen.2024.1139

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Metformin combined with acupuncture knife therapy improves blood sugar, QoL in type 2 diabetes patients: Study

China: A recent study has shown improved clinical symptoms, blood glucose, and quality of life in type 2 diabetes (T2D) patients treated with acupotomy and metformin hydrochloride tablets. The mechanism is suggested to be related to the regulation of inflammatory reactions.

The study, published in Chinese Acupuncture and Moxibustion, was conducted by Zhu Tao, Chengdu University of TCM, Chengdu, Sichuan Province, China, and colleagues aimed to observe the clinical efficacy of acupotomy combined with metformin hydrochloride tablet for type 2 diabetes mellitus and its effect on serum levels of inflammatory factors.

The study included 68 patients with type 2 diabetes; they were randomized into an acupotomy group (34 cases, 2 cases dropped out) and a western medication group (34 cases, 2 cases dropped out).

In the western medication group, metformin hydrochloride tablet was given orally, 0.5-1 g each time, twice a day, for eight weeks continuously. Based on the treatment in the Western medication group, acupoints were taken on both sides of the diaphragm. Shu, gastroenteritis, Ganshu, once a week for 8 consecutive weeks in the acupotomy group once a week for continuously eight weeks.

In the two groups, blood glucose (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], and 2-hour plasma glucose [2 h PG]), blood lipids (total cholesterol [TC], triglyceride [TG], low-density lipoprotein cholesterol [LDL-C] and high-density lipoprotein cholesterol [HDL-C]), TCM syndrome score, insulin (fasting insulin [FINS] and 2-hour insulin [2 h INS]), the dosage of metformin hydrochloride tablet, C-peptide indexes (fasting C-peptide [FC-P] and 2-hour C-peptide [2 h C-P]), and diabetes-specific quality of life (DSQL) score were observed, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-17 were measured by ELISA before and after treatment.

The study led to the following findings:

  • After treatment, the FBG, HbA1c, 2 h PG, TCM syndrome scores, TC, TG, LDL-C, FINS, 2 h INS, FC-P, 2 h C-P, DSQL scores as well as the serum levels of IL-6, TNF-α, IL-17 were decreased compared with those before treatment, HDL-C was increased compared with that before treatment in the two groups; the dosage of metformin hydrochloride tablet was decreased compared with that before treatment in the acupotomy group.
  • After treatment, in the acupotomy group, the FBG, HbA1c, TCM syndrome score, TC, TG, LDL-C, FINS, 2 h INS, FC-P, 2 h C-P, dosage of metformin hydrochloride tablet, DSQL score as well as the serum level of TNF-α were lower than those in the western medication group.

In conclusion, acupotomy combined with metformin hydrochloride tablet can improve clinical symptoms, blood glucose, and quality of life in patients with type 2 diabetes; its mechanism may be related to the regulation of inflammatory reactions.

Reference:

Zhu Tao, et al. “Clinical efficacy of acupuncture combined with metformin hydrochloride tablets in the treatment of type 2 diabetes and its impact on serum inflammatory factor levels.” Chinese Acupuncture 44.03 (2024):245-250. doi:10.13703 /j.0255-2930.20230705-k0002.

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CKD tied to higher prevalence of incomplete revascularization in Chronic coronary syndrome patients, reveals Indian Study

Chronic kidney disease tied to higher prevalence of incomplete revascularization in Chronic coronary syndrome patients suggests a new study published in the Indian Heart Journal.

A study was done to determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS). The study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.2 Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the MACE. Results: CKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P=<0.001). They had higher syntax scores (P = 0.005), CIN (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P=<0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity. Chronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

Reference:

Shereen Ibrahim Farag, Shaimaa Ahmed Mostafa, Hamza Kabil, Mohamed Reda Elfaramawy. Chronic kidney disease’s impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome,

Indian Heart Journal. Volume 76, Issue 1, 2024, Pages 22-26, ISSN 0019-4832,

https://doi.org/10.1016/j.ihj.2023.11.006.

(https://www.sciencedirect.com/science/article/pii/S001948322300192X)

Keywords:

Chronic kidney disease, prevalence, revascularization, Chronic, coronary syndrome patients,Indian Heart Journal, Chronic coronary syndrome; Chronic kidney disease; Incomplete revascularization, Shereen Ibrahim Farag, Shaimaa Ahmed Mostafa, Hamza Kabil, Mohamed Reda Elfaramawy

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Patients of AF on antiarrhythmic drugs have high risk of pacemaker implantation or syncope, reveals study

South Korea: A contemporary large Korean population-based study has revealed an association between antiarrhythmic drugs (AADs) and the risk of pacemaker implantation or syncope in patients with atrial fibrillation (AF). The association was consistent across various subgroups.

The findings, published in the Journal of the American College of Cardiology, have once again brought into light the old concerns about the safety of rhythm control drugs for atrial fibrillation.

“AF patients prescribed antiarrhythmic drugs had several-fold greater risks of cardiac events believed to be related to a decline in heart rate,” the researchers reported.

Compared with other atrial fibrillation patients, AAD users showed more frequent pacemaker implantation or syncope (16.3 versus 4.8 events per 1,000 person-years), syncope (5.5 versus 2.6 events per 1,000 person-years), and pacemaker implantation (11.3 versus 2.2 events per 1,000 person-years).

Early rhythm control therapy with AADs for new-onset atrial fibrillation reduces major adverse cardiovascular events (MACEs). However, negative dromotropic effects of AADs via ion channel blocking may cause bradyarrhythmias. Yun Gi Kim, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea, and colleagues aimed to evaluate the association between AAD use and pacemaker implantation or syncope risk in patients with new-onset AF receiving early rhythm control therapy with AADs.

For this purpose, the researchers extracted data from the Korean National Health Insurance Service system. They screened all new-onset AF diagnoses that occurred from 2013 to 2019, and patients who were prescribed AADs within one year of AF diagnosis were identified. The risk of syncope or pacemaker implantation was compared between AAD users and nonusers.

The study led to the following findings:

  • 770,977 new-onset AF cases were identified and 142,141 patients were prescribed AADs.
  • After multivariate adjustment, AAD use was associated with 3.5-, 2.0-, and 5.0-fold increased risk of pacemaker implantation or syncope, syncope, and pacemaker implantation, respectively.
  • Propensity score–matched analysis revealed similar results, demonstrating a significant association between AAD use and pacemaker implantation or syncope risk.
  • This association was consistent across various subgroups. Women were more susceptible to adverse effects of AADs than men.

The retrospective, observational study left room for selection bias concerning prescribers choosing AADs for healthier atrial fibrillation patients.

According to the research team, “physicians probably use AADs in patients without a history of dizziness, bradycardia, and syncope. The use of AADs in this study showed more than a 3-fold increased risk of pacemaker implantation or syncope despite such potential selection bias.”

Other study limitations include an incomplete prescription and medical history for each person and its limited generalizability due to the enrollment of only East Asian individuals.

In conclusion, the study showed an association between antiarrhythmic drugs and the risk of syncope or pacemaker implantation, with consistent findings across several subgroups. Therefore, a precise evaluation of such risks should be undertaken before prescribing AADs.

Reference:

Kim YG, et al “Association of antiarrhythmic drug therapy with syncope and pacemaker implantation in patients with atrial fibrillation” J Am Coll Cardiol 2024; DOI: 10.1016/j.jacc.2024.01.013.

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Haemophilus influenzae Colonisation in Bronchiectasis patients tied Severity and exacerbation of disease: Study

Bacterial colonization plays a crucial role in the pathogenesis of bronchiectasis, but the clinical significance of specific organisms like Haemophilus influenzae remains poorly understood. A recent retrospective study aimed to investigate the impact of H. influenzae colonization on bronchiectasis patients. This study was published in the journal BMC Pulmonary Medicine by Seo-Hee Yang and colleagues.

Bronchiectasis is characterized by irreversible dilatation of bronchi and recurrent respiratory infections. H. influenzae is among the common colonizers in bronchiectasis, but its effects on disease severity and outcomes are not well-established.

The retrospective study screened adult bronchiectasis patients from a tertiary referral center in South Korea over an 18-year period. Propensity score matching was employed to compare patients with and without H. influenzae colonization. Parameters assessed included bronchiectasis severity index, exacerbation rates, lung function, and mortality.

Key Findings:

  • Out of 4,453 bronchiectasis patients, 79 (1.8%) were colonized with H. influenzae.

  • Following propensity score matching, 78 patients with H. influenzae colonization were compared with 154 non-colonizers.

  • Patients colonized with H. influenzae exhibited a higher bronchiectasis severity index (median 6 vs. 4, p = 0.002) and more extensive radiographic involvement.

  • Incidence of mild exacerbation without hospitalization was significantly higher in H. influenzae colonizers (adjusted incidence rate ratio 0.15, 95% CI 0.12-0.24).

  • Lung function and mortality rates did not significantly differ between the two groups.

The study highlights that H. influenzae colonization in bronchiectasis patients is associated with increased disease severity and a higher incidence of mild exacerbations. However, it did not significantly impact lung function or mortality rates. These findings emphasize the importance of monitoring and managing patients with bronchiectasis, especially those colonized with H. influenzae, to prevent exacerbations and improve outcomes.

Reference:

Yang, S.-H., Song, M. J., Kim, Y. W., Kwon, B. S., Lim, S. Y., Lee, Y.-J., Park, J. S., Cho, Y.-J., Lee, J. H., Lee, C.-T., & Kim, H.-J. Understanding the effects of Haemophilus influenzae colonization on bronchiectasis: a retrospective cohort study. BMC Pulmonary Medicine,2024;24(1). https://doi.org/10.1186/s12890-023-02823-8

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Prolonged Mask Use may Worsen BP and blood sugar control among Hypertensive and Diabetic Patients: Study

A recent study conducted at Nanjing Yimin Hospital, China highlights the potentially detrimental effects of prolonged mask use on patients with hypertension or diabetes. The key findings were published in the latest issue of the Journal of International Medical Research that examined the impacts of extended mask-wearing on individuals with these pre-existing health conditions throughout the pandemic.

The research spanned from February 2022 to January 2023 and analyzed data from patients with hypertension or diabetes who sought care at the outpatient department. The participants were divided into two groups: one who wore masks for 20 or more hours per week (the prolonged mask-wearing group) and the other who wore masks for fewer than 20 hours per week (the control group).

The findings revealed troubling trends among the prolonged mask-wearing group. When compared to their counterparts in the control group, hypertensive patients who wore masks extensively expressed significantly higher diastolic blood pressure (DBP) and mean arterial pressure (MAP). These elevations marked a departure from the similar BP levels observed in both groups one year prior.

Also, the diabetic patients in prolonged mask-wearing group underwent challenges in managing their condition by necessitating a greater need for intensified treatment compared to the control group. This disparity underlines the potential implications of prolonged mask use on glucose control and overall health outcomes for the individuals with diabetes.

The study emphasized the importance of increased monitoring and timely adjustments in treatment for hypertensive and diabetic patients who frequently wear masks. The findings suggest that prolonged mask use may have adverse effects on the blood pressure and glucose control. And so, it is imperative to prioritize regular monitoring and customized interventions to reduce these risks among the vulnerable patient populations.

Source:

He, W., Liu, Y., Zou, Z., Cheng, C., Wang, W., Huang, Z., Wu, G., Zhu, W., & Sun, H. (2024). Effects of prolonged face mask use among patients with hypertension or diabetes during the COVID-19 pandemic. In Journal of International Medical Research (Vol. 52, Issue 3). SAGE Publications. https://doi.org/10.1177/03000605241232946

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Study finds no persistent cough in four out of five individuals with tuberculosis in Africa and Asia

More than 80% of patients with tuberculosis, the world’s most deadly infection, do not have a persistent cough, despite this being seen as a key symptom of the disease. The infection is predominantly transmitted by coughing, but probably also through simply breathing.

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Progesterone protects babies from preterm birth in women with a short cervix, research shows

At around 20 weeks of pregnancy women with a short cervix have an increased risk of preterm birth. Preventing preterm birth in pregnant women with a short cervix is a crucial step in protecting the health of the child. Research from Amsterdam UMC now shows that, in pregnant women with a short cervix around 20 weeks, progesterone is better than a cervical pessary at reducing the risk of severe preterm birth. This study was published in the BMJ.

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