Delhi Army Hospital performs high-risk transcatheter lifesaving cardiac procedure on 8-year-old Baramullah boy

New Delhi: An eight-year-old boy from Jammu and Kashmir’s Baramullah has received a new lease of life after undergoing a challenging life-saving cardiac procedure at an Army hospital here, officials said on Tuesday. 

The pediatric cardiology team of the Armed Forces Medical Services (AFMS), “In an extraordinary medical achievement, successfully performed a high-risk transcatheter (non-surgical) lifesaving cardiac procedure” at the Army Hospital (Research & Referral) in Delhi Cantonment, the defence ministry said in a statement.

Also Read:Woman Power: Army Doctor Col Sunita, takes charge of Armed Forces Transfusion Centre, Delhi

The procedure was performed on “An eight-year-old civilian boy from Baramullah, Jammu and Kashmir, who had a critical narrowing of aorta (blood channel supplying pure blood to all the parts of the body) resulting in compromised blood supply to few vital organs of the body as well as reduced function of heart”.

This complex procedure was done through a small nick in the groin and involved implantation of a large stent, it said.

It was an “extremely life-threatening” complicated procedure. However, it went off uneventfully and the child has been discharged in just three days post-procedure without even a scar on the body, the statement said. 

Under ‘Operation Sadbhavna’ in Jammu and Kashmir, the boy was brought to this centre by Indian Army’s Dagger Division, as his family was incapable of affording his treatment, it said. 

“With the collaborative efforts of Army Hospital (R&R), New Delhi, Chinaar Corps/Dagger Division, J&K and Indrani Balan Foundation, Pune, the boy will now lead to an absolutely normal life in future,” the ministry said.

The expertise of performing such a complex procedure is available only at few centres in the country, including Army Hospital (R&R) in Delhi, it added. 

Medical Dialogues team had earlier reported that in an extraordinary medical achievement, doctors in the Department of Hematology & Stem Cell Transplantation at the Army Hospital R&R in Delhi Cantt. have for the first time successfully conducted a life-saving Bone Marrow Transplant (commonly known as BMT) for a child diagnosed with a rare primary immunodeficiency disorder. 

Also Read:Army Hospital in Delhi successfully conducts life-saving Bone Marrow Transplant in a child

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Initial conservative strategy more appropriate for patients with acute NSTEMI and high levels of frailty: JAMA

Spain: A secondary analysis of a randomized clinical trial (RCT) of 167 patients with frailty and non-ST-segment elevation myocardial infarction (NSTEMI) showed an early harm followed by later benefit with an initial invasive strategy, resulting in a neutral effect on survival at 4 years.

“A routine invasive strategy did not reduce the number of days alive at a median follow-up of 1113 days versus a conservative strategy,” the researchers reported in JAMA Network Open. Invasive treatment was linked with shorter survival within the first year but more prolonged survival after the first year.

The MOSCA-FRAIL RCT compared invasive and conservative treatment strategies in patients with frailty with NSTEMI. It revealed no differences in the number of days alive and out of the hospital at one year. Juan Sanchis, CIBERCV, Valencia, Spain, and colleagues sought to assess the outcomes of the MOSCA-FRAIL trial during extended follow-up.

The MOSCA-FRAIL trial was conducted at 13 hospitals in Spain between 2017 and 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Follow-up in the preplanned secondary analysis extended to January 31, 2023.

Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Among the 167 included patients in the analysis, the mean age was 86 years; 52.7% were women.

The study’s primary endpoint was the difference in restricted mean survival time (RMST). Secondary endpoints were readmissions for any cause, considering recurrent readmissions.

The researchers reported the following findings:

  • A total of 93 deaths and 367 readmissions accrued.
  • The RMST for all-cause death over the entire follow-up was 3.13 years in the invasive and 3.06 years in the conservative treatment groups.
  • The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 days).
  • Patients under invasive treatment tended to have shorter survival in the first year (−28 days), which improved after the first year (192 days).
  • Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58).
  • Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4.
  • There were no differences for the secondary endpoints.

In conclusion, an invasive treatment strategy failed to improve outcomes at a median follow-up of 1113 days. However, the researchers observed a differential distribution of deaths, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior.

“Therefore, an initial conservative strategy may be more suitable for patients with NSTEMI and high levels of frailty,” the researchers wrote. “These findings provide valuable insights for clinical decision-making in this vulnerable patient population.”

Reference:

Sanchis J, Bueno H, García-Blas S, et al. Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(3):e240809. doi:10.1001/jamanetworkopen.2024.0809

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8-year-old Yemeni boy undergoes rare thyroid cancer surgery at Jaslok Hospital

Mumbai: In a remarkable medical achievement, Jaslok Hospital & Research Centre recently provided comprehensive and successful treatment to an 8-year-old child from Yemen diagnosed with Papillary Thyroid Cancer. 

The child arrived at the facility on 2nd Jan 2024 with a 4×4 cm swelling in the front and left side of the neck that he had for three months, a condition initially suspected to be a common lymphatic swelling.

Usually, such neck swellings in young children are lymphatic swellings like cystic hygroma or branchial cysts, but in this child, it was a much more serious diagnosis. However, thorough investigations conducted in Yemen revealed the unexpected diagnosis of thyroid cancer.

Also Read:Jaslok Hospital doctors perform Automated Implantable Cardioverter Defibrillator implantation to treat rare heart disease

Dr. Mehul Bhansali, Director of Surgical Oncology, was involved in the care of this patient along with Dr. Fazal Nabi, Director of Paediatrics. At the hospital, they repeated the ultrasound of the neck and biopsy of the lesion as the diagnosis of Thyroid Cancer at this young age was very rare so we needed an in-house confirmation by Onco-pathologist Dr. Shubhanda Kane.

Having thyroid cancer in such young patients can sometimes be associated with many other medical problems like diseases of the adrenal glands, pancreatic pathology, or parathyroid gland pathology. Hence, the patient was evaluated for any such associated pathologies via a series of blood tests, all of which were found to be normal. A PET CT scan was also conducted to rule out any distant spread in the body.

All these investigations were available in-house at Jaslok Hospital, and the entire preoperative workup and diagnostic evaluation of the patient were done in a matter of days. The diagnosis was explained to the patient’s parents, and with informed consent, the medical team proceeded with major thyroid surgery. The surgery was challenging in such a small boy due to his age and small neck size, posing a higher risk of injury to vital neck structures like the larynx, recurrent nerve and parathyroids. The surgery was successfully performed with by Dr. Mehul Bhansali, Dr Snehal Bhange and their team of doctors on 9th January, 2024.

Postoperatively, the patient was well-managed by the Paediatric ICU team and discharged on the third day after surgery. Dr Fazal Nabi, speaking about the care mentioned “8 years old boy presented with complaint of Swelling in anterior side of neck for 3 months. Swelling gradually increased in size.

There was no pain or any other constitutional symptoms. Only accompanying symptom was presence of enlarged Right cervical Lymph node. Investigations were done which showed presence of Papillary carcinoma of Thyroid which was later confirmed on Biopsy and PET Scan showed enlarged cervical lymph node and thyroid swelling.

He was operated for total thyroidectomy. Post operative serum calcium levels were normal on Day 0. He developed Tetany on Post Operative Day 1 and was treated with IV calcium gluconate along with Vitamin D and Magnesium. He didn’t have other episode of tetany and recovered well with intensive post operative care. He was discharged on oral calcium and vitamin D. Papillary carcinoma of thyroid in children is rare with an incidence of 0.54 per 100000 children and requires intensive management of calcium and vitamin D levels in the body for optimum outcomes.”

The final histopathology report from the hospital confirmed papillary thyroid cancer. He was discharged on 15th January, 2024. The patient will now need further Radioactive Iodine ablation to complete his treatment, which will be carried out by the Nuclear Medicine department following established protocols.

Speaking about challenges in the surgery of such a small child Dr Mehul Bhansali, Director of Surgical Oncology, mentioned “The technical difficulties in handling delicate vital structures in the neck of a child with no intraoperative complications was possible only due to high quality training and expertise of all the surgeons. Smooth post- operative recovery was the joint effort of the Paediatric team and dedicated round the clock nursing care. He emphasized on the hospital’s commitment to delivering the highest standard of care to all patients.”

Mr. Samad Zaid, father of the child mentioned “Mazen is doing extremely well and I am so delighted to see him back to his normal life.”

Jaslok Hospital takes pride in its multidisciplinary approach, cutting-edge facilities, and the collaborative expertise of its medical professionals, which collectively contribute to the successful management of complex cases. The hospital remains committed to delivering world-class healthcare with compassion and innovation.

Also Read:Jaslok Hospital doctors treat 48-year-old woman with rare Ewing’s sarcoma of right breast

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Metformin Shows Consistent Benefits Across Renal Functions in Type 2 Diabetes Patients

In a recent observational study spanning three tertiary hospitals, researchers have uncovered compelling evidence supporting the widespread efficacy of metformin, the primary treatment for type 2 diabetes mellitus (T2DM). The study, which focused on patients with preserved renal function, aimed to bridge existing gaps in understanding the impact of metformin on various renal conditions. The study concluded that Metformin use in T2DM patients across various renal functions consistently correlates with a decreased risk of overt diabetic nephropathy (DN), major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE).

The study results were published in the journal Scientific Reports.

Also Read: Evergreen Talk Series: Combination of Linagliptin and Dapagliflozin in T2DM with multiple episodes of hypoglycemia

Metformin, renowned as the cornerstone treatment for type 2 diabetes mellitus (T2DM), has long been hailed for its efficacy in enhancing clinical outcomes among individuals with maintained renal function. However, a notable knowledge gap persists regarding the extent of metformin’s effectiveness across diverse renal functions. Hence, researchers conducted a retrospective, multicenter study by utilizing data from three tertiary hospitals’ databases, drawing on the medical records of patients with T2DM.The metformin cohort comprised individuals who had been prescribed metformin during run-in periods and received at least one additional prescription, while the control cohort included those prescribed oral hypoglycemic agents other than metformin, with no subsequent metformin prescriptions during the observation period.For patients without diabetic nephropathy (DN), the study investigated outcomes such as events of DN, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE). Following meticulous 1:1 propensity matching, 1994 individuals were selected for both the metformin and control cohorts among T2DM patients without baseline DN.

Findings:

  • The study’s findings revealed intriguing insights into metformin’s impact on clinical outcomes.
  • While the incidence rate ratio (IRR) for DN events showed no significant difference between the cohorts (IRR 1.06, 95% CI 0.96–1.17), metformin emerged as a potent protective factor against major adverse cardiovascular events (MACE) with an IRR of 0.76 (0.64–0.92).
  • Moreover, metformin showcased remarkable efficacy in reducing major adverse kidney events (MAKE) with an IRR of 0.45 (0.33–0.62).
  • Delving deeper into the data, the study explored outcomes based on renal function subgroups, including CKD 3A, 3B, and 4.In CKD 3A, metformin demonstrated significant benefits with an IRR of 0.70 (0.57–0.87) for MACE and 0.39 (0.35–0.43) for MAKE.
  • Similarly, in CKD 3B, the IRRs were 0.83 (0.74–0.93) for MACE and 0.44 (0.40–0.48) for MAKE.
  • In CKD 4, metformin continued to exhibit positive effects, with IRRs of 0.71 (0.60–0.85) for MACE and 0.45 (0.39–0.51) for MAKE.
Also Read: Add on Metformin can offset weight gain due to medicines for bipolar disorder

The study’s lead researcher emphasized that the findings suggest metformin’s consistent correlation with a reduced risk of overt DN, MACE, and MAKE across various renal functions in T2DM patients. However, it’s crucial to note that this study is observational, and further research, including randomized controlled trials, is essential to validate these promising results. As the medical community eagerly awaits further research, these findings shed light on the potential multifaceted benefits of metformin, offering hope for improved outcomes in T2DM patients, particularly those with varying levels of renal function.

Further reading: Impact of metformin on cardiovascular and kidney outcome based on kidney function status in type 2 diabetic patients: a multicentric, retrospective cohort study. https://doi.org/10.1038/s41598-024-52078-4

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Schizophrenia may increase risk of cardioembolic stroke, finds JAHA study

A recent study looked into the intricate relationship between schizophrenia and stroke by uncovering the potential links between the mental disorder and specific stroke subtypes. While previous studies hinted at a connection between schizophrenia and stroke, this investigation was marked to be the first to explore stroke subtypes in detail. The key findings were published in the recent edition of the Journal of the American Heart Association.

This study employed two-sample Mendelian randomization analyses and focused on unraveling potential causal associations between schizophrenia and various stroke outcomes, including ischemic stroke, large-artery stroke, small-vessel stroke, cardioembolic stroke and intracerebral hemorrhage.

The findings revealed compelling associations between schizophrenia and two specific stroke subtypes the cardioembolic stroke and intracerebral hemorrhage. After utilizing the inverse variance weighting method, Shinya Nakada and team identified a significant association between schizophrenia and cardioembolic stroke (odds ratio [OR] 1.070 [95% CI, 1.023–1.119]) that suggests a potential causal relationship. The association with intracerebral hemorrhage (OR 1.089 [95% CI, 1.005–1.180]) was observed amidst less robust evidence.

Also, further analyses employed various Mendelian randomization methods that corroborated the link with cardioembolic stroke by underlining the importance of these findings. The evidence for an association with intracerebral hemorrhage was less conclusive across different methodologies.

The implications of this study suggests that individuals with schizophrenia underwent an increased risk of cardioembolic stroke that necessitates careful cardiac evaluation and monitoring within this population. By recognizing and addressing this potential risk factor, the healthcare professionals could potentially reduce the burden of stroke among individuals with schizophrenia. This comprehensive research not only advances the existing understanding of schizophrenia and stroke but additionally highlights the importance of interdisciplinary approaches in healthcare.

Reference:

Nakada, S., Ho, F. K., Celis‐Morales, C., & Pell, J. P. (2024). Schizophrenia and Types of Stroke: A Mendelian Randomization Study. In Journal of the American Heart Association. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/jaha.123.032011

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Handheld ultrasonographic devices with clinical examination may help diagnose pulmonary and cardiac diseases: JAMA

In sub-Saharan Africa, agreement between clinicians using a handheld ultrasonographic device and expert sonographers using a high-end ultrasonographic machine regarding lung ultrasonography findings has yet to be studied.

According to an Original Investigation on Imaging published in JAMA Network Open, researchers mentioned that handheld ultrasonographic devices used in addition to clinical examination may support clinicians in diagnosing cardiac and pulmonary diseases in rural sub-Saharan Africa.
The study’s objective was to evaluate the agreement between primary care clinicians who had undergone training in lung ultrasonography, board-certified expert sonographers, and senior physicians regarding ultrasonographic findings and diagnoses. The study was conducted in a rural Tanzanian referral centre from February 1, 2022, to April 30, 2023. The participants were five or older with respiratory symptoms and at least two distinct respiratory signs. Participants underwent a clinical examination, lung ultrasonography by a clinician, lung ultrasonography by an expert sonographer, and chest radiography by a senior physician.
The clinicians received two hours of instruction and three two-hour clinical training sessions on handheld lung ultrasonographic devices, while the expert sonographers were board-certified. The primary outcomes measured were the percentage agreement and Cohen κ coefficient for sonographic findings and diagnoses between the different groups.
Key findings from the study are:
• 438 participants of 54 years, including 51 %, were included in the study.
• The median percentage agreement of ultrasonographic findings between clinicians and expert sonographers was 93%, κ ranging from −0.003 to 0.83.
• Median (range) agreement of diagnoses between clinicians and expert sonographers was 90%, with κ ranging from −0.002 to 0.76.
• Between clinicians and senior physicians, the median (range) agreement of diagnoses was 89%. κ ranged from −0.008 to 0.76.
• Between clinicians and senior physicians, diagnosis agreements for heart failure, definite/probable tuberculosis, and viral and bacterial pneumonia were 85%, 78%,50% and 56% (κ, 0.06) for bacterial pneumonia with κ values of 0.69, 0.57, 0.002 and 0.06 respectively.
This study’s findings indicate that handheld ultrasonographic devices, when used alongside clinicians trained in lung ultrasonography, history, and physical examination, can help identify ultrasonographic findings and determine the cause of a respiratory issue.
Reference:
Katende A et al. Use of a Handheld Ultrasonographic Device to Identify Heart Failure and Pulmonary Disease in Rural Africa. JAMA Netw Open. 2024;7(2):e240577. doi:10.1001/jamanetworkopen.2024.0577

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Novel insecticide paint may help curb outbreaks of Malaria, Zika and dengue fever: Study

Spain: A recent study published in Frontiers in Tropical Diseases has suggested insecticide paints to be an effective innovation strategy for mosquito control.

“The strategy could be implemented as a reinforcement of the measures carried out by the vector control program in the city of Praia and throughout the country,” the researchers wrote. 

Malaria and other illnesses caused by parasites, viruses, and bacteria transmitted by organisms that spread infectious pathogens account for more than 17% of all infectious diseases worldwide. These vector-borne diseases, typically transmitted by insects like mosquitoes, flies, and ticks, disproportionally affect the poorest populations in tropical and subtropical regions.

In Cabo Verde, an island nation off west Africa, vector-borne disease has been prevalent for centuries, in part due to the island’s geographical location and climate. Now, researchers in Cabo Verde and Spain set out to test the efficacy of three insecticide paint formulations to reinforce the existing national program aiming to minimize the occurrence of disease outbreaks. 

“Here we show that VESTA insecticide paint is effective at killing Aedes aegypti, the yellow fever mosquito, in the city of Praia for at least one year,” said lead author Dr Lara Ferrero Gómez, who coordinates a research group on tropical diseases at the Jean Piaget University of Cabo Verde. “We also found it has good acceptance in the population, with 98% confirming the decrease in mosquitoes in their residences after paint application.”

Mosquito control for up to a year

In a large-scale field trial, trained volunteers painted 228 houses in two Praia neighborhoods that are particularly vulnerable to diseases transmitted by mosquitoes. This is due to insufficient drainage which leads to flooding in the rainy season and poor wastewater management. Additionally, many residences in Cabo Verde store water due to insufficient and disrupted water supply, and water storage is often unsafe.

After one, three, six, and 12 months, WHO cone bioassays were conducted at two randomly selected houses in each neighborhood. “Bioassays record the mortality of A. aegypti mosquitoes after exposing them for half an hour to the insecticidal paint. This allows us to directly evaluate the effectiveness of the insecticidal paint,” Ferrero Gómez explained.

All three insecticide paint mixtures lead to complete mortality of A. aegypti mosquitoes one month after the houses were painted. Three months after painting, all formulations still exceeded the WHO efficiency threshold, which lies at 80%. At month six, two formulations fell below this threshold. The VESTA formulation, however, also met WHO requirements at months six and 12. “The paint works by releasing very small quantities of insecticide over a long period, which makes it more sustainable and eco-friendlier,” Ferrero Gómez pointed out.

The researchers did not register any serious effects of the paint on residents’ health. Adverse effects reported by few residents included mild eye or nose irritation (10%) and headache (4%).

Malaria free – what’s next?

At the beginning of the year, Cabo Verde was the third country in Africa to be declared free of Malaria by the WHO. The challenge to stop its reoccurrence, however, remains. The researchers said that insecticidal paint is also a promising strategy to strengthen the prevention and control of malaria cases at a household level since insecticide paint is effective for any type of vector disease transmitted by mosquitos, not just zika and dengue fever.

While the researchers face certain limitations, such as the need to meticulously apply the paint in two layers to ensure it does not lose its effectiveness, the TINTAEDES project is expected to extend to more locations across Praia, which is a hotspot for vector-borne diseases, as well as across all of Cabo Verde.

Reference:

Lara Ferrero Gómez, Hélio D. Ribeiro Rocha, Ignacio Gil Torró, Irene Serafín Pérez, Deinilson Conselheiro Mendes, Keily L. Fonseca Silva, Davidson D. Sousa Rocha Monteiro, Jailson P. Tavares Dos Reis, Silvânia Veiga Leal, Mendez, Basilio Valladares Hernández, Insecticide paints: a new community strategy for controlling dengue and zika mosquito vectors in Cabo Verde, Frontiers in Tropical Diseases, https://doi.org/10.3389/fitd.2024.1321687.

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New research sheds light on mycophenolate and azathioprine efficacy in interstitial lung disease

Italy: A systematic review and meta-analysis published in BMJ Open Respiratory Research assess whether the administration of mycophenolate mofetil (MMF) or azathioprine (AZA) in interstitial lung disease (ILD) was associated with changes in pulmonary function and gas transfer.

The researchers reported an unclear benefit of MMF on interstitial lung disease. They found no significant difference in outcome compared with placebo or standard of care.

“We observed a minor increase in percent predicted forced vital capacity and diffusion lung capacity of carbon monoxide from baseline in MMF. Studies on AZA were limited,” Francesco Lombardi, Pulmonary Medicine, Policlinico Universitario Agostino Gemelli, Roma, Italy, and colleagues wrote.

Mycophenolate mofetil and azathioprine are two immunomodulatory drugs used for treating connective tissue disease, with both drugs having mechanisms that target lymphocytes. They are being increasingly used to treat ILD, but the evidence is limited for the efficacy of AZA or MMF in improving outcomes. Therefore, Dr. Lombardi and colleagues sought to evaluate the MMF or AZA efficacy on pulmonary function in ILD.

The population included any interstitial lung disease diagnosis, interventions included AZA or MMF treatment, and the outcome was delta change from baseline in percent gas transfer (diffusion lung capacity of carbon monoxide, %DLco) and predicted forced vital capacity (%FVC). The study’s primary endpoint compared outcomes relative to the placebo comparator; the secondary endpoint evaluated outcomes in treated groups only.

Prospective observational studies and randomized controlled trials (RCTs) were included. No language restrictions were applied. Studies with high-dose concomitant steroids and retrospective studies were excluded.

A systematic search of online databases was conducted on May 9. Meta-analyses were specified according to drug and outcome with random effects, I2 evaluated heterogeneity, and Grading of Recommendations, Assessment, Development, and Evaluation evaluated certainty of evidence.

Primary endpoint analysis was restricted to RCT design, secondary endpoint included subgroup analysis according to prospective observational or RCT design.

Following were the key findings:

  • Out of 2831 publications screened, 12 were suitable for quantitative synthesis.
  • Three MMF RCTs were included with no significant effect on the primary endpoints (%FVC 2.94; %DLco −2.03).
  • An overall 2.03% change from baseline in %FVC was observed in MMF, and the RCT subgroup summary estimated a 4.42% change from baseline in %DLCO.
  • AZA studies were limited.
  • All estimates were considered very low-certainty evidence.

In conclusion, there were limited RCTs of AZA or MMF, and their benefit on interstitial lung disease was of very low certainty. MMF may support the preservation of pulmonary function, but the confidence in the effect was weak.

“To support high certainty evidence, RCTs should be designed to directly assess the efficacy of mycophenolate mofetil in ILD,” the researchers wrote.

Reference:

Lombardi F, Stewart I, Fabbri L REMAP-ILD Consortium, et alMycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysisBMJ Open Respiratory Research 2024;11:e002163. doi: 10.1136/bmjresp-2023-002163

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Betamethasone not effective for at risk for preterm delivery to reduce treatment of neonatal respiratory distress

Betamethasone administered in the late preterm period to those at risk for preterm delivery did not reduce the need for treatment of neonatal respiratory distress suggests a new study published in the Obstetrics & Gynecology.

A study was done to evaluate the efficacy of antenatal corticosteroids in reducing neonatal respiratory complications when administered to those at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. This was a single-centre, triple-blind, randomized, placebo-controlled trial in southern India enrolling pregnant participants at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. Computer-generated block randomization was used with participants randomized to either one course of intramuscular betamethasone or placebo. The primary outcome was a composite of treatment for respiratory distress in the neonate, defined as the need for oxygen or continuous positive airway pressure or mechanical ventilation for at least 2 hours in the first 72 hours of life. Neonatal secondary outcomes were transient tachypnea of the newborn, respiratory distress syndrome, necrotizing enterocolitis, sepsis, hyperbilirubinemia, hypoglycemia, stillbirth, and early neonatal death; maternal secondary outcomes were chorioamnionitis, postpartum haemorrhage, puerperal fever, and length of hospitalization. All analyses were based on intention to treat.

A sample size of 1,200 was planned with 80% power to detect a 30% reduction in rates of respiratory distress. After a planned interim analysis, enrollment was stopped for futility. RESULTS: From March 2020 to August 2022, 847 participants were recruited, with 423 participants randomized to betamethasone and 424 participants randomized to placebo. There were 22 individuals lost to follow-up. There was no statistically significant difference in the primary outcome (betamethasone 4.9% vs placebo 4.8%, relative risk 1.03, 95% CI, 0.57–1.84, number needed to treat 786). There were no statistically significant differences in secondary neonatal or maternal outcomes. Betamethasone administered in the late preterm period to those at risk for preterm delivery did not reduce the need for treatment of neonatal respiratory distress.

Reference:

Yenuberi, Hilda MD; Ross, Benjamin DM; Sasmita Tirkey, Richa MS; Benjamin, Santosh Joseph MS; Rathore, Swati MS; Karuppusami, Reka MSc; Lal, Aadarsh MSc; Thomas, Niranjan MD, FRACP; Mathew, Jiji Elizabeth MS. Late Preterm Antenatal Steroids for Reduction of Neonatal Respiratory Complications: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000005520, February 8, 2024. | DOI: 10.1097/AOG.0000000000005520

Keywords:

Yenuberi, Hilda MD; Ross, Benjamin DM; Sasmita Tirkey, Richa MS; Benjamin, Santosh Joseph MS; Rathore, Swati MS; Karuppusami, Reka MSc; Lal, Aadarsh MSc; Thomas, Niranjan MD, FRACP; Mathew, Jiji Elizabeth MS, Obstetrics & Gynecology, preterm, Antenatal, Steroids, Reduction, Neonatal Respiratory Complications

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Treatment of H. pylori infection may reduce risk of colorectal cancer and associated mortality: Study

Although H. pylori infection does not itself cause illness but, chronic infection is associated with long-lasting inflammation in the stomach, which can cause complications like atrophic gastritis and stomach cancer.

According to a study published in the Journal of Clinical Oncology, H. pylori-positive individuals may exhibit a small yet statistically significant increase in the incidence and mortality rates of colorectal cancer (CRC). Untreated individuals, especially those with active infections, seem at the most significant risk.
Helicobacter pylori is the most common cause of infection-associated cancer worldwide. This study evaluated the impact of H. pylori infection and treatment on CRC incidence and mortality.
The study included patients in the US who completed H. pylori testing between 1999 and 2018. They conducted a retrospective cohort analysis among adults within the Veterans Health Administration who completed testing for H. pylori. The primary exposures were H. pylori test results (positive/negative) and treatment (untreated/treated) among H. pylori-positive individuals. The primary outcomes were CRC incidence and mortality. Follow-up started at the first H. pylori testing and continued until the earliest incident or fatal CRC, non-CRC death, or December 31, 2019.
Key findings of the study are:
  • 25.2 % of individuals among 812,736 tested positive for H. pylori.
  • Being H. pylori–positive versus H. pylori–negative was associated with higher CRC incidence and mortality.
  • H. pylori treatment versus no treatment was associated with lower CRC incidence and mortality through 15-year follow-up.
  • Being H. pylori–positive versus H. pylori–negative was associated with an 18 % and 12% higher incident and fatal CRC risk, respectively. The aHR was 1.18 and 1.12, respectively.
  • Individuals with untreated versus treated H. pylori infection had 23% and 40% higher incident and fatal CRC risk, respectively, with aHR of 1.23 and 1.40.
  • The results were more pronounced in the analysis restricted to individuals with nonserologic testing.
Concluding further, they said that H. pylori infection is linked to a higher incidence and mortality rate for colorectal cancer (CRC), particularly in those with active infections and who are untreated. The association is small but significant, they added.
Reference:
Shailja C. Shah et al. Impact of Helicobacter pylori Infection and Treatment on Colorectal Cancer in a Large, Nationwide Cohort. JCO 0, JCO.23.00703
DOI:10.1200/JCO.23.00703

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