Iron deficiency common and tied to adverse outcomes in patients with HF with reduced EF: Study

India: A recent study published in Cureus has shed light on iron deficiency, a silent threat in patients with heart failure with reduced ejection fraction (HFrEF).

The study of nearly 400 patients in India showed that more than half of patients with HFrEF and three-quarters of patients with iron deficiency exhibited anemia, demonstrating a significant association between iron deficiency and anemia in heart failure (HF).

“Iron deficiency emerges more than a mere comorbidity in HF, becoming a prognostic factor with multifaceted outcomes,” the researchers wrote. Its impact extends beyond cardiovascular consequences, including adverse manifestations such as ascites, anemia, dyspnea, edema, a heightened risk of mortality, and elevated jugular venous pressure (JVP).

Previous studies have shown iron deficiency as a clinically significant and prevalent comorbidity in HFrEF patients. Despite its high prevalence, its impact on mortality, clinical outcomes, and several physiological parameters remains a topic of ongoing investigation. The study findings are anticipated to contribute valuable insights into the prognosis and management of HFrEF patients, potentially informing future interventions and improving patient outcomes.

Against the above background, Nitin Sarate, Seth Gordhandas Sunderdas Medical College, and King Edward Memorial Hospital, Mumbai, India, and colleagues aimed to assess the clinical profile of iron deficiency and its implications on mortality and morbidity in patients with HFrEF.

For this purpose, the researchers conducted a prospective cohort study at King Edward Memorial Hospital, India, comprising 371 patients with HFrEF. Participants underwent comprehensive laboratory and clinical assessments, evaluating iron deficiency with symptoms, signs, dyspnea, comorbidities, elevated JVP, past medical history, and various biochemical and hematological parameters.

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

  • 50% of HFrEF participants were iron deficient, of whom 80% had anemia against 43% anemics in iron repletes (n = 186).
  • Of the 185 iron-deficient patients, 11.86% had absolute iron deficiency, and 38% had functional iron deficiency.
  • Iron deficiency significantly correlated with increased mortality in HFrEF patients.
  • A large positive correlation was observed between absolute iron deficiency and dyspnea severity (r2 = 0.949).
  • Statistically significant differences were found in hemoglobin (anemia), serum ferritin, serum iron, total iron-binding capacity, and transferrin saturation between iron-deficient and iron-replete patients. However, there was no statistically significant difference in left ventricular ejection fraction between iron-deficient and replete patients.

In conclusion, the current literature stresses the adverse impact of iron deficiency on health-related QoL, exercise capacity, and mortality in patients with heart failure, prompting interest in interventions to correct iron deficiency.

“Nevertheless, further research will be crucial to refine strategies for optimal identification and management of iron deficiency in HFrEF patients, elucidating the intricate mechanisms that underlie its association with adverse outcomes in this population,” the research team wrote.

Reference:

Sarate N, Sonawane R, Pai V, Karatela S, Mulkalwar A. Iron Deficiency: A Silent Threat in Patients With Heart Failure With Reduced Ejection Fraction. Cureus. 2024 Feb 4;16(2):e53542. doi: 10.7759/cureus.53542. PMID: 38445122; PMCID: PMC10912968.

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Endoscopic Carpal Tunnel Release associated with increased risk of revision when compared with Open procedure: JAMA

Carpal tunnel release (CTR) is among the most common operations performed in orthopedics and is generally safe and effective. Controversy persists regarding the risks and benefits of Endoscopic Carpal tunnel release (ECTR) vs Open Carpal Tunnel Release (OCTR), with one concern being the potential for incomplete release of the transverse carpal ligament (TCL) during ECTR. Revision surgeries have been estimated to occur in 1% to 5% of patients.

Peter C. Ferrin et al conducted a study to estimate the incidence of revision CTR following ECTR compared with OCTR.

This retrospective cohort study used data from the US Veterans Health Administration. Participants included all adults (age 18 years) undergoing at least 1 outpatient CTR. The primary outcome was time to revision CTR, defined as repeat ipsilateral CTR during the study period. Secondary outcomes were indications for revision, findings during revision, and additional procedures performed during revision.

The key findings of the study were:

• Among 134 851 wrists from 103 455 patients (92 510 [89.4%] male; median [IQR] age, 62 [53-70] years) undergoing at least 1 CTR, 1809 wrists underwent at least 1 revision at a median (IQR) of 2.5 (1.0-3.8) years.

• In competing-risks analysis, the cumulative incidence of revision was 1.06% (95% CI, 0.99%-1.12%) at 5 years and 1.59% (95% CI, 1.51%-1.67%) at 10 years.

• ECTR was associated with increased hazard of revision CTR compared with OCTR (adjusted hazard ratio [aHR], 1.56; 95% CI, 1.34-1.81; P < .001).

• The risk difference for revision CTR associated with ECTR compared with OCTR was 0.57% (95% CI, 0.31%-0.84%) at 5 years (number needed to harm, 176) and 0.72% (95% CI, 0.36%-1.07%) at 10 years (number needed to harm, 139).

• Regardless of index CTR technique, the most common indication for revision was symptom recurrence (1062 wrists [58.7%]).

• A reconstituted transverse carpal ligament (TCL) was more common after ECTR compared with OCTR, whereas scarring of the overlying tissues and of the median nerve itself were more common following OCTR.

• Incomplete transverse-carpal-ligament release was observed in 251 of the wrists undergoing revision CTR (13.94%) and was more common among revisions following ECTR (odds ratio, 1.62; 95% CI, 1.11-2.37; P = .01).

The authors concluded that – “In this cohort study of revision CTR in the Veterans Health Administration, ECTR was associated with increased risk of revision compared with OCTR, but the absolute risk was low regardless of technique. Intraoperative findings at revision varied significantly according to index CTR technique.”

Further reading:

Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression Peter C. Ferrin et al JAMA Network Open. 2024;7(1):e2352660. doi:10.1001/jamanetworkopen.2023.52660

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Tobacco Product Use may Increase Suicidal Behaviors Among Pre-Adolescent Children: JAMA

A recent cohort study published in the Journal of American Medical Association uncovered a distressing association between the use of tobacco products and suicidal behaviors. This study among the pre-adolescent children in the United States spanned from September 2022 to September 2023 and analyzed data from the Adolescent Brain Cognitive Development study which comprised a total of 11,868 children aged 9 and 10 years old.

Despite the young age of the participants, the use of tobacco products, including e-cigarettes and vaping has been rising. This surge in tobacco product usage has been linked to an increased risk of nonsuicidal self-injury (NSSI), suicidal ideation (SI) and suicide attempts (SAs) among these children.

The study utilized data that were collected through youth reports and hair toxicologic tests and found that children who reported using tobacco products were at a significantly higher risk of suicidal behaviors. Over three years of follow-up, children acknowledging tobacco product use were found to be three to five times more likely to engage in suicide attempts compared to their non-using counterparts. This heightened risk persisted even after adjusting for various suicide risk factors and potential confounders. Negative urgency was observed to be a significant independent risk factor for suicide attempts among these young tobacco users.

This research highlights that this risk extends beyond traditional cigarette smoking to include a range of tobacco products by underlining the urgent need for further investigation and preventive measures. Continued research efforts are imperative to illuminate the underlying mechanisms that drive this association and to safeguard the mental well-being of the youngest members of society.

Source:

Lee, P. H., Tervo-Clemmens, B., Liu, R. T., Gersten, M. B., Jung, J.-Y., Janes, A. C., & Gilman, J. (2024). Use of Tobacco Products and Suicide Attempts Among Elementary School–Aged Children. In JAMA Network Open (Vol. 7, Issue 2, p. e240376). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.0376

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Wrist device that monitors activity could help provide early warning of Alzheimer’s, states new research

Monitoring daily activity patterns using a wrist-worn device may detect early warning signs of Alzheimer’s disease, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The researchers analyzed movement data from wristwatch-like devices called actigraphs worn by 82 cognitively healthy older adults who were participants in a long-running study of aging. Some of the participants had detectable brain amyloid buildup as measured by PET scan. Buildup of the protein amyloid beta in the brain is a key feature of Alzheimer’s disease.

Using a sensitive statistical technique, the researchers found significant differences between this “amyloid-positive” group and “amyloid-negative” participants in mean activity in certain afternoon periods and differences in variability of activity across days in a broader range of time windows.

The new study was published online February 21 in the journal SLEEP.

“We need to replicate these findings in larger studies, but it is interesting that we’ve now seen a similar difference between amyloid-positive and amyloid-negative older adults in two independent studies,” says Adam Spira, PhD, professor in the Department of Mental Health at the Bloomberg School.

The new study’s results partly confirm findings from an earlier study in a smaller sample, also led by Spira, and suggest that actigraphs someday could be a tool to help detect incipient Alzheimer’s disease before significant cognitive impairment sets in. Data from the prior study came from participants in the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) and the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies.

For their new study, Spira and colleagues investigated the potential of actigraph-based monitoring in 82 community-dwelling individuals whose average age was about 76. Each participant had a PET scan to measure brain amyloid and wore an actigraph 24 hours per day for one week. Using a sensitive statistical technique called FOSR (function-on-scalar regression), the researchers found that the 25 amyloid-positive participants, compared to the 57 amyloid-negative participants, had higher mean activity during the early afternoon, 1:00 to 3:30 p.m., and less day-to-day variability in activity from 1:30 to 4:00 p.m. and 7:30 to 10:30 p.m.

In more conservative analyses, some of these time windows with differences were no longer statistically significant. Nonetheless, the higher afternoon activity and lower afternoon variability echoed the investigators’ prior findings.

Alzheimer’s disease, the leading cause of dementia, is estimated to affect more than 6 million older adults in the U.S. The Alzheimer’s disease process is still not fully understood but is characterized by amyloid plaques and tangles in the brain, which typically begin to accumulate a decade or two before Alzheimer’s is diagnosed.

The only approved treatments that may slow the disease course are those that target amyloid beta and reduce the plaques. Many researchers believe that such treatments can be much more effective if given earlier in the disease course-ideally, years before dementia becomes evident.

Abnormal patterns of sleep and waking activity have been studied as potential early indicators of Alzheimer’s. Alzheimer’s patients typically have abnormal sleep-wake rhythms, and prior studies have found evidence that amyloid accumulation may disrupt sleep-wake rhythms relatively early in the disease process. There is also evidence that sleep loss promotes amyloid accumulation, suggesting a “vicious circle.”

Such findings hint at the possibility that older adults might someday, among other measures, wear wristwatch-like devices that would automatically track and analyze their sleep and waking activity. Individuals with anomalous activity patterns could then consult their physicians for more in-depth Alzheimer’s screening.

The individuals in the new study were participants in a long-running study, the Baltimore Longitudinal Study of Aging, which is conducted by the Intramural Research Program of the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). Several members of the NIA team were co-authors of the study.

Standard, non-FOSR statistical methods did not detect any significant differences in activity or sleep patterns, suggesting the methods may be less sensitive to amyloid deposition.

In the earlier actigraphy study, the researchers, using FOSR-based analyses in a different sample of 59 participants, found increases in mean activity in afternoon hours and differences in variability, including lower variability in the afternoon, among amyloid-positive participants.

The scientists don’t know why amyloid buildup would trigger differences in activity patterns during these particular times of day. They note that there is a well-known phenomenon among individuals with Alzheimer’s disease called “sundowning,” in which agitation increases in the afternoon and early evening.

“It’s conceivable that the higher afternoon activity we observed is a signal of ‘preclinical sundowning,’” Spira says. “At the same time, it’s important to note that these findings represent averages among a small sample of older people over a short period of time. We can’t predict whether an individual will develop amyloid plaques based on the timing of their activity. So, it would be premature for older people to be concerned because their fitness trackers say they are particularly active in the afternoon, for example.”

He and his colleagues plan to do larger studies of this kind. They also hope to do longer-term studies to see if daily activity-pattern changes are associated not only with brain amyloid but also with actual cognitive decline.

Reference:

Adam P Spira, Fangyu Liu, Vadim Zipunnikov, Murat Bilgel, Jill A Rabinowitz, Yang An, Junrui Di, Jiawei Bai, Sarah K Wanigatunga, Mark N Wu, Brendan P Lucey, Jennifer A Schrack, Amal A Wanigatunga, Paul B Rosenberg, Eleanor M Simonsick, Keenan A Walker, Luigi Ferrucci, Susan M Resnick. Evaluating a novel 24-hour rest/activity rhythm marker of preclinical β-amyloid deposition. SLEEP, 2024; DOI: 10.1093/sleep/zsae037.

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Vitamin D Supplementation Reduces CRP Levels in Postmenopausal Women: Study

Vitamin D supplementation has been suggested to have potential benefits in reducing inflammation and blood pressure, particularly in postmenopausal women. However, the evidence from randomized controlled trials (RCTs) on the relationship between vitamin D supplementation and inflammatory markers such as C-reactive protein (CRP), as well as blood pressure, remains inconclusive. A recent systematic review and meta-analysis aimed to provide more robust evidence on the effects of vitamin D supplementation on CRP, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in postmenopausal women.

Previous observational studies have indicated an inverse relationship between vitamin D supplementation and CRP levels, suggesting a potential anti-inflammatory effect. However, RCTs have not consistently confirmed this association. This study was published in the Journal of the Academy of Nutrition and Dietetics by Jiang Q. and colleagues.

A systematic search of four databases (PubMed, Web of Science, Embase, and Scopus) was conducted to identify relevant RCTs published in international scientific journals up to January 2023. Changes in CRP, SBP, and DBP from baseline were compared between postmenopausal women who received vitamin D supplementation and those who did not (controls). The meta-analysis utilized the random-effects model to compute overall effect sizes, summarized as mean difference (MD) with 95% confidence intervals (CIs). Heterogeneity among studies was assessed using Cochrane’s Q test and I² statistic, while publication bias was evaluated using funnel plots and Egger’s test.

Key Findings:

  • Seven studies were included in the meta-analysis, comprising 6 arms each for CRP, SBP, and DBP.

  • Vitamin D supplementation significantly reduced CRP concentrations in postmenopausal women (MD = -0.65 mg/L; 95% CI -0.93 to -0.37 mg/L; P < .001).

  • Studies with a duration of more than 3 months and those involving doses of ≤1,000 IU/d showed greater reductions in CRP levels after vitamin D supplementation.

  • However, vitamin D supplementation did not significantly reduce SBP (MD = -1.06 mm Hg; 95% CI -2.43 to 0.30 mm Hg; P = .127) or DBP (MD = 0.003 mm Hg; 95% CI -0.86 to 0.86 mm Hg; P = .994) compared with control groups.

This meta-analysis suggests that vitamin D supplementation is associated with reduced CRP concentrations in postmenopausal women. However, no significant effects were observed on systolic or diastolic blood pressure levels. These findings provide valuable insights into the potential anti-inflammatory effects of vitamin D supplementation in this population. Further research is needed to elucidate the mechanisms underlying these effects and to explore the clinical implications for cardiovascular health in postmenopausal women.

Reference:

Jiang, Q., Prabahar, K., Saleh, S. A. K., Adly, H. M., Velu, P., Adi, A. R., Baradwan, S., Hajkhalaf, M. I., Baredwan, A., Gari, F., & Kord-Varkaneh, H. The effects of vitamin D supplementation on C-reactive protein and systolic and diastolic blood pressure in postmenopausal women: A meta-analysis and systematic review of randomized controlled trials. Journal of the Academy of Nutrition and Dietetics,2024;124(3):387-396.e5. https://doi.org/10.1016/j.jand.2023.10.013

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Tezepelumab novel therapeutic approach in uncontrolled severe non-type 2 asthma, case study suggests

Japan: A recent case study published in Respirology Case Reports has shown that Tezepelumab could serve as a novel therapy for patients with uncontrolled severe non-type 2 asthma despite having bronchial thermoplasty (BT) and prior treatment with biologics.

The data resulted from a new case report concerning an 80-year-old female with non-type 2 asthma, which had progressively gotten worse and had been diagnosed 11 years prior.

“This is the first case of a patient who did not respond to sequential bronchial thermoplasty, dupilumab, benralizumab, and mepolizumab but presented with good clinical response to tezepelumab. Therefore, tezepelumab may be useful for patients with non-type 2 asthma,” the investigators wrote.

Severe asthma affects about 5%–10% of patients with asthma. Tezepelumab is a human IgG2 monoclonal antibody characterized by its inhibition of thymic stromal lymphopoietin (TSLP). Tezepelumab can be effective in patients with poorly controlled moderate to severe asthma regardless of phenotype (type 2 or non-type 2). Yoshiro Kai, Minami-Nara General Medical Center, Yoshino-gun, Japan, and colleagues describe a case of non-type 2 asthma that progressively worsened over the years. Non-type 2 severe asthma developed during tezepelumab treatment after failed treatment with BT, dupilumab, benralizumab, and mepolizumab.

The case is of an 80-year-old woman, labeled as a ‘never-smoker’ and was diagnosed with asthma 11 years ago. The patient was shown not to have comorbid eosinophilic chronic rhinosinusitis and was also sensitive to receiving aspirin.

She experienced repeated exacerbations needing treatment with systemic corticosteroids despite therapy with medications including high-dose inhaled corticosteroids/long-acting beta-agonists plus long-acting muscarinic antagonists. The patient presented with non-eosinophilic asthma.

The patient was initially treated with bronchial thermoplasty, which was only effective for one year. Treatment with bronchial thermoplasty, dupilumab, benralizumab, and mepolizumab was ineffective. The fourth treatment, which included tezepelumab, was initiated.

There was a significant improvement in the patient’s quality of life and symptoms.

The research team noted that eosinophils are an essential part of asthma pathogenesis, adding that dupilumab, mepolizumab, and benralizumab are considered to be useful for Th2-severe asthma treatment. However, due to low eosinophil counts and FeNO levels, the team added that ineffective suppression of IL-13 and IL-5 may have occurred in this case.

In conclusion, Tezepelumab treatment might be a novel therapeutic approach in patients with uncontrolled severe non-type 2 asthma despite BT and previous biologic treatments with dupilumab, benralizumab, and mepolizumab.

“Nevertheless, there is a need to perform further studies evaluating the efficacy and safety of tezepelumab against uncontrolled severe non-type 2 asthma,” the research team concluded.

Reference:

Kai Y, Suzuki K, Kataoka R, Sato I, Tamaki S, Muro S. Efficacy of tezepelumab against uncontrolled severe non-type 2 asthma refractory to bronchial thermoplasty, benralizumab, dupilumab, and mepolizumab. Respirol Case Rep. 2024 Feb 27;12(3):e01311. doi: 10.1002/rcr2.1311. PMID: 38420113; PMCID: PMC10898956.

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Combined Treatment Method may Improve Survival in Anaplastic Thyroid Cancer Patients with Metastasis: Study

Anaplastic thyroid cancer (ATC) is a rare and aggressive malignancy which poses significant challenges in treatment and prognosis, specially in the cases with distant metastasis (DM). However, a recent study by Hongen Guo and team indicate that a combination of treatment strategies could enhance the survival rates for patients with this disease. The key findings of this study were published in the recent edition of BMC Surgery.

The study was based on a retrospective analysis of data from the Surveillance, Epidemiology and End Results (SEER) database that focused on anaplastic thyroid cancer patients with distant metastasis at the time of diagnosis. The results from the analysis included a total of 315 anaplastic thyroid cancer patients with distant metastasis and highlighted the key factors influencing survival. Surgical intervention targeting the primary tumor, along with radiotherapy, chemotherapy and the presence of lung metastasis was found to be the significant determinants of prognosis.

The patients who underwent a combination of treatment modalities like the surgery paired with chemotherapy or surgery combined with chemoradiation, expressed markedly improved survival outcomes when compared to the individuals who received only a single form of therapy.

These findings underscore the potential benefits of adopting a multifaceted approach to treating anaplastic thyroid cancer, particularly in cases where the distant metastasis is present. While the results offer promising insights into enhancing treatment efficacy, the outcomes emphasized the need for larger sample cohorts to validate these findings comprehensively.

The outcomes of this research signifies a major step forward in the fight against anaplastic thyroid cancer that offers hope for enhanced treatment strategies and improved survival rates for patients with this rare and aggressive malignancy.

Reference:

Guo, H., & Lin, H. (2024). The value of multimodal treatment in anaplastic thyroid cancer patients with distant metastasis. In BMC Surgery (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12893-024-02375-6

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New guidelines on management of acute pancreatitis released by American College of Gastroenterology

USA: The American College of Gastroenterology has released a new guideline on the management of acute pancreatitis (AP). The guidelines underscored the importance of early management to prevent complications such as organ failure and pancreatic necrosis in patients with acute pancreatitis. 

Acute pancreatitis is an acute inflammation of the pancreas. It is one of the most common diseases of the gastrointestinal tract that leads to hospital admission. AP is heterogeneous, progressing differently among patients, and is often unpredictable. Early management is important to identify and treat AP patients to prevent complications.

Biliary pancreatitis patients typically require surgery to prevent recurrent disease and may require early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in AP treatment; the safety of early refeeding and the importance of preventing AP complications are addressed.

The guideline, published in the American Journal of Gastroenterology, provides an evidence-based practical approach to managing patients with AP.

Following are the recommendations for the management of acute pancreatitis

Etiology of acute pancreatitis

  • Transabdominal ultrasound is suggested in patients with AP to evaluate for biliary pancreatitis and a repeat US if the initial examination is inconclusive.
  • In patients with idiopathic AP (IAP), additional diagnostic evaluation with repeat abdominal ultrasound, MRI, and/or endoscopic ultrasound (EUS) is recommended.

Initial management

  • Moderately aggressive fluid resuscitation is suggested for patients with AP. Additional boluses will be needed if there is evidence of hypovolemia.
  • Lactated Ringer solution use is suggested over normal saline for intravenous resuscitation in AP.

Endoscopic retrograde cholangiopancreatography (ERCP) in AP

  • Medical therapy is suggested over early (within the first 72 hours) ERCP in acute biliary pancreatitis without cholangitis.

Preventing post-ERCP pancreatitis (PEP)

  • Rectal indomethacin is recommended to prevent post-ERCP pancreatitis in individuals considered to be at high risk of PEP.
  • Placement of a pancreatic duct stent is suggested in patients at high risk for PEP who are receiving rectal indomethacin.

The role of antibiotics in AP

  • The researchers suggest against prophylactic antibiotics in patients with severe AP.
  • The researchers suggest against fine-needle aspiration (FNA) in patients with suspected infected pancreatic necrosis.

Nutrition in AP

  • In patients with mild AP, early oral feeding (within 24–48 hours) is suggested as tolerated by the patient compared with the traditional nothing-by-mouth approach.
  • In patients with mild AP, initial oral feeding is suggested with a low-fat solid diet rather than a stepwise liquid-to-solid approach.

“Regardless of the method, it must be remembered that many patients with sterile necrosis, and select patients with infected necrosis, seem to improve and remain asymptomatic, and no intervention may be necessary,” Santhi Swaroop Vege, Mayo Clinic, Rochester, Minnesota, USA, and colleagues wrote.

They added, “Therefore, the management of patients with necrosis is very individualized, requiring consideration of both the clinical appearance of patients and the expertise available at the institution.”

“Referral to centers of expertise is very important because delaying intervention with maximal supportive care and using a minimally invasive approach have both shown to be of benefit in reducing mortality and morbidity in patients with acute necrotizing pancreatitis,” they concluded.

Reference:

Tenner, Scott MD, MPH, JD, FACG1; Vege, Santhi Swaroop MD, MACG2; Sheth, Sunil G. MD3; Sauer, Bryan MD, MSci, FACG4; Yang, Allison MD, MPH5; Conwell, Darwin L. MD, MSc, FACG6; Yadlapati, Rena H. MD, MHS, FACG7; Gardner, Timothy B. MD, FACG8. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. The American Journal of Gastroenterology 119(3):p 419-437, March 2024. | DOI: 10.14309/ajg.0000000000002645

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Study Decodes DEET Insect Repellents for Child Safety in the Insect-Prone Wilderness

In the realm of insect repellents, N, N-diethyl-meta-toluamide (DEET) has long been hailed as the ‘gold standard’ since the 1950s, forming a cornerstone of most insect repellent products available today. However, the safety of DEET, especially in protecting children from arthropod bites, has become a subject of heated debate due to conflicting scientific data and a maze of information in the media. The study was published in the journal “Pediatric Dermatology.”

Despite its extensive use, concerns surrounding the safety of DEET insect repellents for children are primarily rooted in a handful of fatal incidents. These tragic occurrences are often linked to accidental overdoses or the misuse of insect repellents, where users neglect warnings on product labels. It is crucial to underline that when used as directed, DEET insect repellents boast an excellent safety record, with minimal reported side effects.

Also Read: Biological effectiveness of long-lasting insecticidal malaria nets may be short-lived: BMJ

In an effort to shed light on this ongoing debate, a comprehensive review aims to distill the existing literature on the safety outcomes associated with DEET insect repellent use in children. This review seeks to provide clear and evidence-based recommendations for parents and caregivers grappling with decisions about protecting their children from arthropod bites. The safety record of DEET insect repellents, when used properly, remains commendable. Accusations of harm often arise from misuse, highlighting the importance of following guidelines provided by manufacturers.

Proper application, adhering to labeled instructions, ensures an effective yet safe shield against insect bites for children. Beyond DEET, the review explores alternative options that have gained approval from the Environmental Protection Agency (EPA) or are derived from natural sources. These alternatives, boasting low toxicity levels, offer a compelling choice for those seeking effective protection without the perceived risks associated with synthetic insect repellents. While the debate continues, it is essential for parents and caregivers to be well-informed. Understanding the nuances of insect repellent safety, particularly in the context of children, empowers individuals to make choices that align with their priorities for protection and well-being.

Also Read: Researchers discover demodicidosis as under-recognized cause of facial hyperpigmentation

In conclusion, the review serves as a beacon in the sea of information, guiding parents through the complexities of insect repellent choices. By providing a nuanced understanding of the safety profile of DEET and presenting viable alternatives, the review equips caregivers with the knowledge needed to make informed decisions in safeguarding their children against the persistent threat of arthropod bites.

Further reading: An updated review on the safety of N, N-diethyl-meta-toluamide insect repellent use in children and the efficacy of natural alternatives. Doi:  https://doi.org/10.1111/pde.15531

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IMIDs may not significantly increase risk of Preterm birth and Low birthweight, finds study

IMIDs may not significantly increase the risk of Preterm Birth and Low birthweight suggests a new study published in the eClinical Medicine.

Immune-mediated inflammatory diseases (IMIDs) are likely to complicate maternal health. However, literature on patients with IMIDs undergoing pregnancy is scarce and often overlooks the presence of comorbidities. We aimed to evaluate the impact of IMIDs on adverse pregnancy outcomes after assessing and addressing any discrepancies in the distribution of covariates associated with adverse pregnancy outcomes between patients with and without IMIDs.They conducted a retrospective cohort study using data from an integrated U.S. community healthcare system that provides care across Alaska, California, Montana, Oregon, New Mexico, Texas, and Washington. We used a database containing all structured data from electronic health records (EHRs) and analyzed the cohort of pregnant people who had live births from January 1, 2013, through December 31, 2022. We investigated 12 selected IMIDs: psoriasis, inflammatory bowel disease, rheumatoid arthritis, spondyloarthritis, multiple sclerosis, systemic lupus erythematosus, psoriatic arthritis, antiphospholipid syndrome, Sjögren’s syndrome, vasculitides, sarcoidosis, and systemic sclerosis. We characterized patients with IMIDs before pregnancy (IMIDs group) based on pregnancy/maternal characteristics, comorbidities, and pre-pregnancy/prenatal immunomodulatory medications (IMMs) prescription patterns.

The 1:1 propensity score matched the IMIDs cohort with people who had no IMID diagnoses before pregnancy (non-IMIDs cohort). Outcome measures were preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), and caesarean section. Findings: The analytic cohort had 365,075 people, of which 5784 were in the IMIDs group and 359,291 were in the non-IMIDs group. The prevalence rate of pregnancy of at least 20 weeks duration in people with a previous IMID diagnosis has doubled in the past ten years. 17% of the IMIDs group had at least one prenatal IMM prescription. Depending on the type of IMM, 48%–70% of the patients taking IMMs before pregnancy continued them throughout pregnancy. Overall, patients with one or more of these 12 IMIDs had increased risk of PTB (Relative risk (RR) = 1.1 [1.0, 1.3]; p = 0.08), LBW (RR = 1.2 [1.0, 1.4]; p = 0.02), SGA (RR = 1.1 [1.0, 1.2]; p = 0.03), and caesarean section (RR = 1.1 [1.1, 1.2], p < 0.0001) compared to a matched cohort of people without IMIDs.

When adjusted for comorbidities, patients with rheumatoid arthritis (PTB RR = 1.2, p = 0.5; LBW RR = 1.1, p = 0.6) and inflammatory bowel disease (PTB RR = 1.2, p = 0.3; LBW RR = 1.0, p = 0.8) did not have significantly increased risk for PTB and LBW. For patients who have been pregnant for 20 weeks or more, the association between IMIDs and adverse pregnancy outcomes depends on both the nature of the IMID and the presence of comorbidities. Because this study was limited to pregnancies resulting in live births, results must be interpreted together with other studies on early pregnancy loss and stillbirth in patients with IMIDs.

Reference:

Maternal-fetal outcomes in patients with immune-mediated inflammatory diseases, with consideration of comorbidities: a retrospective cohort study in a large U.S. healthcare system. Yeon Mi Hwang, Qi Wei, Samantha N. Piekos, Bhargav Vemuri, Sevda Molani, Philip Mease et al. Published:February 01, 2024DOI:https://doi.org/10.1016/j.eclinm.2024.102435

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