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A study was done to evaluate the presence of sleep disorders, obesity and anxiety associated with cavitated carious lesions in children aged 8 to 10 years. A cross-sectional study was carried out in the Northeast of Brazil. The sample was comprised of 793 schoolchildren randomly selected from public and private schools. Calibrated examiners (Kappa >0.80) performed the clinical examination of dental caries using the International Caries Detection and Assessment System and applied the Revised Children’s Manifest Anxiety Scale and the Sleep Disturbance Scale for Children questionnaires. The anthropometric variables evaluated were weight and height. Negative binomial regressions (α ≤ 0.05) were performed. A Directed Acyclic Graph was prepared using DAGitty software (version 3.0), to select the co-variables for the statistical fits. Results: The prevalence of tooth decay was 52.8%. The mean number of tooth surfaces with cavitated caries was 2.2(2.8), 58.9% of the schoolchildren had some type of sleep disorder, while 20.2% were anxious and 29.1% were obese. Sleep disturbance (RR = 1.38; 95% CI: 1.05–1.83), general anxiety (RR = 1.71; 95% CI: 1.32–2.21), obesity (RR = 1.48; 95% CI: 1.17–1.86) were associated with dental caries in the final model. The presence of carious lesions was higher in children with sleep disorders, anxiety, obesity, and those who experienced dry mouth.

Reference:

de Lima LCM, Bernardino VMM, Leal TR, Granja GL, Paiva SM, Granville-Garcia AF. Sleep disorders, anxiety and obesity associated with untreated dental caries in children eight to ten years of age. J Public Health Dent. 2024. https://doi.org/10.1111/jphd.12595

Keywords:

Children, sleep disorders, anxiety, obesity, dry mouth, dental caries, Journal of Public Health Dentistry, de Lima LCM, Bernardino VMM, Leal TR, Granja GL, Paiva SM, Granville-Garcia AF

Wei Li, Sichuan University, Chengdu, China, and colleagues reported outcomes in three pemphigus vulgaris patients who experienced a relapse after rituximab therapy and received treatment of ofatumumab subcutaneous injections (at baseline and week 2) combined with low-dose glucocorticoids. Overall, two patients achieved lesion clearance, and one patient showed significant improvement. No serious adverse events were reported.

Pemphigus is a rare group of autoimmune diseases that causes blisters on the mucous membranes and skin throughout the body. It can affect the nose, mouth, eyes, throat, and genitals. The most common type of pemphigus is Pemphigus vulgaris.

The therapeutic strategy for pemphigus vulgaris treatment still needs optimization because of the multiple deficiencies of rituximab and glucocorticoid. A recent retrospective study revealed that the recurrence rate of PV after a single-cycle infusion of rituximab was 63%. Ofatumumab is a subcutaneous anti-CD20 monoclonal antibody administered subcutaneously and provides a possible alternative option.

In the study, three patients experienced a relapse of pemphigus vulgaris after clinical remission induced by rituximab. They received an ofatumumab (20 mg) subcutaneous injection twice (2 weeks apart) in combination with a prednisone dose adjusted according to their disease severity and weight, with written informed consent.

The following were the key findings of the study:

• Over the 24-week observation, two of three patients achieved lesion clear-up under prednisone (0.2 mg/kg per day), and the other patient’s pemphigus disease area index dropped from 39 to 3 with prednisone (15 mg/day).
• The anti-desmoglein antibody levels and CD19+B cell counts declined compared to those at baseline.
• There were no severe adverse events within the 24-week follow-up.

“In summary, we propose a protocol of ofatumumab for patients with refractory pemphigus vulgaris and report positive treatment outcomes of three patients who received this regimen,” the researchers concluded.

Reference:

Zhang, X., Xiao, Y., Li, X., Wang, J., Zhou, X., Zhou, Y., Wang, M., Li, W., & Wang, Y. Ofatumumab subcutaneous injection successfully treated patients with pemphigus vulgaris relapse post rituximab. The Journal of Dermatology. https://doi.org/10.1111/1346-8138.17108

In 2016, the LAI developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for preventing atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of several risk factors and subclinical atherosclerosis in predicting ASCVD risk necessitated updating the risk algorithm and treatment goals.

“Indians have a high prevalence of coronary artery disease associated with high mortality and morbidity as compared to the Western population despite basal LDL-C of approximately 10mg lower than the Western population.” 

“This recently updated expert recommendation includes NAFLD, Metabolic syndrome in the high-risk atherosclerotic cardiovascular disease (ASCVD) group, air pollution, and fasting Triglyceride> 150mg as risk modifiers and ASCVD risk groups based on blood LDL-C and Non-HDL-C levels.”

For developing the guideline, the LAI core committee held twenty-one meetings and webinars from 2022 to 2023 with experts across India. They critically reviewed the latest evidence regarding the ASCVD risk prediction strategies and the benefits and modalities for intensive lipid lowering. Consensus Statement IV was commissioned based on the expert consensus and extensive review of published data.

Under the new guidelines, patients have been categorized into different risk groups.

The guidelines suggest that individuals with metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) should aim for LDL cholesterol levels below 70mg/dL.

A new category called ‘Extreme Risk Group Category C’ has been introduced for a small number of patients who continue to experience chest pain despite all available treatments. For individuals in this category, LDL cholesterol levels should ideally range between 10-15 mg/dL.

LAI has been recommending regular lipid profile screenings from the age of 20 and the age of two for those with a family history of high cholesterol or premature coronary heart disease in men under 55 years and women under 65 years.

According to the guidelines, lipid profile screenings should commence at the age of two, or as early as possible if not feasible, in cases of adopted children or families with elevated lipoprotein (a).

The new guidelines also recommend including lipoprotein (a) assessment in lipid profile tests for initial screening, as it is highly prevalent among 25 per cent of Indians.

In the  guideline particular emphasis (of the guideline) is on the importance of looking at subclinical atherosclerosis to reduce cardiovascular events. Management strategies to treat those few patients (Extreme risk group C) who continue to suffer CV events despite all possible measures, even at an achieved LDL-C level of 30mg/dl.

“These recommendations are ideal for managing dyslipidemia in the Indian population,” he said.

The document further states, “The young age of onset and more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands the early institution of aggressive preventive measures to protect the young population before the development of ASCVD events.”

“The low cost and wide availability of statins in India enable the implementation of effective LDL-C lowering therapy in individuals at high risk of ASCVD. Subjects with evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions.”

“This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The purpose of these updated recommendations is to modernize dyslipidemia management in Indian patients to reduce the epidemic of atherosclerotic cardiovascular disease among Indians in Asia and worldwide”.

Reference:

Puri, R., Bansal, M., Mehta, V., Duell, P. B., Wong, N. D., Iyengar, S., Kalra, D., Nair, D. R., Nanda, N. C., Narula, J., Deedwania, P., Yusuf, J., Dalal, J. J., Shetty, S., Vijan, V. M., Agarwala, R., Kumar, S., Vijay, K., Khan, A., . . . Mohan, J. (2024). Lipid Association of India 2023 update on cardiovascular risk assessment and lipid management in Indian patients: Consensus statement IV. Journal of Clinical Lipidology. https://doi.org/10.1016/j.jacl.2024.01.006

The researchers revealed favourable effects of dorzagliatin in hypoglycemic control and effectively reduced the glycated haemoglobin (HbA1c), fasting blood glucose (FBG), and 2h postprandial blood glucose levels in T2D patients. Dorzagliatin stimulated insulin secretion during the initial phase and exerted a hypoglycemic effect.

The study stated that the incidence of adverse events, such as elevated cardiovascular risk and blood lipids, warrants further investigations through long-term clinical trials.

New drugs have emerged in recent years for treating type 2 diabetes, encompassing SGLT2 inhibitors (sodium-dependent glucose transporters 2 inhibitors), GLP-1 agonists (glucagon-like peptide 1 receptor agonist), DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors), etc. They are frequently administered as adjunct treatments when metformin monotherapy is ineffective. However, at present, the glycemic control rate among T2DM patients remains suboptimal, indicating unfavourable long-term prognostic outcomes and a higher risk of complications. Therefore, it is necessary to enhance the health education of type 2 diabetes. Moreover, there is an urgent need to pioneer more safe, effective, and convenient hypoglycemic drugs.

Dorzagliatin is a newly developed glucokinase activator that reportedly exerted superior hypoglycemic effects and fewer occurrences of adverse reactions in previous studies and is presently recognized as a promising therapeutic drug. Considering this, Wu Yuqian, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China, and colleagues aimed to evaluate the safety and efficacy of dorzagliatin for treating type 2 diabetes.

For this purpose, the researchers systematically searched seven databases from 2016 to 2023. RCTs comparing dorzagliatin with a placebo for T2D were applicable for containing this study. The relevant data was extracted, and a meta-analysis was implemented using RevMan 5.4 software.

The meta-analysis included three studies comprising 1332 patients. HbA1c levels were used as the major indicator of efficacy, 2h postprandial blood glucose, FBG, Homa-β, and Homa-IR were the Secondary outcome measures.

The researchers reported the following findings:

• Dorzagliatin significantly reduced blood glucose levels and enhanced insulin resistance compared with the placebo group.
• In terms of safety, no serious adverse events occurred.
• Lipid-related indicators, especially triglyceride levels, and the incidence of hypoglycemia were higher in patients in the dorzagliatin group compared with those in the control group, but the increase from baseline was mild.

In conclusion, compelling evidence underscores dorzagliatin benefits in lowering the levels of 2h-PFG, FBG, and HbA1c, as well as promoting insulin secretion and attenuating insulin resistance.

Moreover, dorzagliatin administration did not elevate the incidence of hypoglycemia, proteinuria, upper respiratory tract infection, fluctuations in liver enzyme levels, and other serious adverse events.

“These favourable outcomes conjointly position dorzagliatin as a promising novel hypoglycemic drug,” the researchers concluded.

Reference:

Wu, Yuqian MDa,*; Wang, Kai MDb; Su, Jingyang MDc; Liu, Xin MDd. Efficacy and safety of dorzagliatin, a novel glucokinase activators, in the treatment of T2DM: A meta-analysis of randomized controlled trials. Medicine 103(8):p e36916, February 23, 2024. | DOI: 10.1097/MD.0000000000036916