Exposure to UV radiations of sun may have positive effect on fertility in women aged 30-40

A research team from Tel Aviv University and the Sheba Medical Center at Tel Hashomer conducted investigation of seasonal fluctuations in AMH (anti-Müllerian hormone) levels. Their pioneering study revealed that during the summer, women of late reproductive age-between the ages of 30 and 40-experience increased secretion of the hormone from their ovaries. This phenomenon is suggested to be attributed to heightened exposure to ultraviolet (UV) radiation from the sun. The groundbreaking research was led by Prof. Carmit Levy of the Department of Human Genetics and Biochemistry, in a team effort of Ph.D. student Roma Parikh and Prof. Yftach Gepner of the School of Public Health, all from the Faculty of Medicineat Tel Aviv University and Dr. Ruth Percik from the Institute of Endocrinology at Sheba Medical Center. The results of the study were published in the journal Steroids.

“The ovaries secrete the anti-Müllerian hormone, and its level in the bloodstream is linked to ovarian function,” explains Dr. Percik. “While the hormone level is specific to an individual woman at a given point in time and does not provide a definitive assessment of the status of her fertility, evaluating its value, trend, and comparison to the age group is the best indicator of fertility that we have. For this reason, every woman who wants to get pregnant, or is trying to, is sent for an AMH test. In Israel, all of these tests are directed to the central laboratory in Sheba. Our research group investigated the seasonal variability of the AMH tests in order to gauge how the ovaries respond to UV radiation.”

The researchers compared the AMH results of 2,235 Israeli women to the recorded levels of UV radiation. For younger women, aged 20-29, no statistical relationship was found between UV exposure and AMH level. On the other hand, among older fertile women, aged 30 to 40, a statistically significant seasonal pattern emerged: These women, whose egg reserves are in decline, responded positively to sun exposure.

“Based on our prior studies, we can affirm that sun exposure increases metabolism, sexual appetite and behavior, and, at least in animal models, enlarges the ovaries and extends the estrus period,” explains Prof. Levy. “This is a preliminary, pioneering human epidemiological study, and we need to be cautious about inferring a causal relationship between fertility in women and exposure to UV radiation. Humans are not the same as mice. However, we are also animals, our hairless nature makes us even more sensitive to solar radiation. Our research suggests that the female reproductive system is indeed more fertile in the summer, but we still have no information on the mechanism or actual success rates.”

Particularly interesting is the absence of this effect among younger women in their 20s. According to Dr. Percik, this may be attributed to the ample egg reserve found in young women. “Based on my interpretation of the findings, women at the onset of their reproductive age are less in need of signals from the sun, which affect hormonal pathways that have not yet been sufficiently studied. They are less impacted or dependent on the forces of nature in the context of fertility. In contrast, older ovaries need optimal environmental factors in order to function. In fact, this effect was even more pronounced among women aged 35 and older. Of course, there are caveats: Exposure to the sun’s UV radiation should always be done in moderation, and further research is required in order to determine whether such exposure actually helps fertility, and how much exposure is needed.”

Reference:

Roma Parikh, Shivang Parikh, Rina Hemi, Nadav Elkoshi, Yftach Gepner, Carmit Levy, Ruth Percik, Seasonal AMH variability implies a positive effect of UV exposure on the deterioration of ovarian follicles, Steroids, https://doi.org/10.1016/j.steroids.2023.109307.

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Vitamin D Deficiency Linked to Higher Risk of Oral Candidiasis in HIV Patients, finds study

In a groundbreaking case-control study, researchers have
unveiled a compelling association between vitamin D deficiency and the
prevalence of oral candidiasis in individuals living with human
immunodeficiency virus (HIV). Oral candidiasis, a common opportunistic
infection in HIV patients, has long been a concern, and this study sheds new
light on the role of vitamin D levels in its occurrence.


The study results were published in the journal BMC Infectious
diseases.

Also Read: High prevalence and persistence of vitamin D deficiency revealed over time in patients with acute MI: Study

Oral candidiasis, a prevalent opportunistic
infection affecting individuals with human immunodeficiency virus (HIV), is now
under the spotlight as a new study reveals a potential connection with vitamin
D deficiency. Hence researchers conducted a study on a cohort of 206 individuals, including 104
cases diagnosed with oral candidiasis and 102 age- and sex-matched controls
without the condition, to investigate the link between vitamin D levels and the
incidence of oral candidiasis in HIV-infected patients.


Findings:

  • The findings are striking.

  • Patients with oral candidiasis exhibited markedly lower levels
    of 25-OH vitamin D3 compared to their counterparts without the infection.

  • Furthermore, CD4 counts, a key indicator of immune function,
    were significantly lower in the group with oral candidiasis, suggesting a
    potential link between immune status and the occurrence of this opportunistic
    infection.


  • Viral load, another critical parameter in HIV management, was
    notably higher in patients with oral candidiasis, emphasizing the complex
    interplay between viral activity and the development of opportunistic
    infections.

  • The researchers employed multivariate logistic regression
    analysis to explore various factors influencing the risk of oral candidiasis.

  • Educational status, current Highly Active Antiretroviral Therapy
    (HAART), history of oral candidiasis, CD4 count, viral load, and vitamin D
    level emerged as significant factors associated with the likelihood of
    developing oral candidiasis.


  • Notably, the study found a staggering association between
    hypovitaminosis D and an increased risk of oral candidiasis in HIV patients.
Also Read: Higher Vitamin D Levels prior to Methotrexate initiation may Lower Mortality in RA, study finds

Individuals with lower vitamin D levels were found to be at a significantly
higher risk of developing oral candidiasis compared to those with sufficient
vitamin D levels.

The implications of this research are substantial. Given the
prevalence of vitamin D deficiency among individuals living with HIV,
especially those grappling with oral candidiasis, the study suggests that
vitamin D supplementation could play a pivotal role in improving oral health
and preventing the onset of this opportunistic infection.

This groundbreaking research not only deepens our understanding
of the intricate connections between vitamin D, immune function, and
opportunistic infections in HIV patients but also opens avenues for potential
interventions to enhance the overall well-being of individuals living with HIV.

Further reading: Tehrani, S., Abbasian, L., Dehghan Manshadi, S.A. et al. Vitamin D deficiency and oral candidiasis in patients with HIV infection: A case‒control study. BMC Infect Dis 24, 217 (2024). Doi: https://doi.org/10.1186/s12879-024-09065-x

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Asymptomatic Bradyarrhythmias may not require any treatment, needless pacemaker therapy: JAMA

A groundbreaking post hoc analysis of the Implantable Loop
Recorder Detection of Atrial Fibrillation (AF) to Prevent Stroke (LOOP) trial
has unearthed a previously underestimated prevalence of bradyarrhythmias in
individuals aged 70 and above with cardiovascular risk factors. The study
concluded that one in five individuals over 70
years old with cardiovascular risk factors may have bradyarrhythmias when
subjected to long-term continuous monitoring for AF.

The study results were published in the journal
JAMA Cardiology.

Also Read: Low Serum Albumin Levels Related to Increased Risks Post Cardiac Surgery

Growing attention is directed towards heart rhythm monitoring
and technologies aimed at identifying subclinical atrial fibrillation (AF),
potentially resulting in the inadvertent discovery of bradyarrhythmias. Hence,
researchers conducted a Post Hoc analysis of the LOOP randomized trial to investigate
the impact of long-term continuous monitoring for atrial fibrillation (AF)
using an implantable loop recorder (ILR) compared to standard care across four
sites in Denmark.


Between January 2014 and May 2016, the trial enrolled 6004
participants, all aged 70 or older, with conditions such as hypertension,
diabetes, heart failure, or prior stroke. The focus was on evaluating
bradyarrhythmia diagnoses, pacemaker implantations, syncope events, and sudden
cardiovascular deaths over a median follow-up period of 65 months.


Findings:


  • Intriguingly, the ILR screening group, comprising 1501
    participants, exhibited a staggering 6.21-fold increase in bradyarrhythmia
    diagnoses compared to the control group (4503 participants), where only 3.8%
    received such a diagnosis.

  • Significantly, a large proportion of bradyarrhythmia cases in
    the ILR group (79.8%) were asymptomatic, highlighting the potential value of
    continuous monitoring in capturing silent cardiac irregularities.


  • The most prevalent types of bradyarrhythmias identified were
    sinus node dysfunction and high-grade atrioventricular block.

    Age, male gender, and a history of prior syncope were identified
    as risk factors associated with bradyarrhythmias.


  • Notably, the ILR screening group experienced a noteworthy
    increase in pacemaker implantations (4.5%) compared to the control group
    (2.9%).

  • However, there was no discernible difference in the occurrence
    of syncope or sudden cardiovascular death between the two groups.


  • Bradyarrhythmias, identified through continuous monitoring, were
    found to be correlated with subsequent syncope, cardiovascular death, and
    all-cause mortality.

  • Crucially, the impact of bradyarrhythmia on these outcomes
    remained consistent across both the ILR and control groups.
Also Read: Automatic mechanical ventilation feasible and comparable to manual ventilation method during CPR: Study


In conclusion, this study suggests that more than one in five
individuals over 70 years old with cardiovascular risk factors may have
bradyarrhythmias when subjected to long-term continuous monitoring for AF. The
utilization of ILR screening significantly heightened the detection of
bradyarrhythmias and led to more pacemaker implantations compared to standard
care. While shedding light on this hidden aspect of cardiac health, the study
underscores the need for comprehensive heart rhythm monitoring, offering
invaluable insights for diagnostic and therapeutic considerations in managing
cardiovascular health in the elderly.

Further reading: Diederichsen SZ, Xing LY, Frodi DM, et al. Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care: Post Hoc Analysis of the LOOP Randomized Clinical Trial. JAMA Cardiol. 2023;8(4):326–334. doi:10.1001/jamacardio.2022.5526

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Incorporating ibuprofen/arginine gel in bleaching protocols reduces risk and intensity of tooth sensitivity: Study

Brazil: The use of experimental desensitizing gel containing arginine and ibuprofen effectively lowers the risk and intensity of tooth sensitivity (TS) without compromising the bleaching efficacy, a recent randomized, triple-blind controlled trial published in the Journal of Dentistry has revealed.

“Clinicians may consider incorporation of desensitizing agents, such as the ibuprofen/arginine gel, into their bleaching protocols to enhance patient comfort and satisfaction,” the researchers suggest.

Tooth bleaching is one of the most common cosmetic procedures patients seek due to dissatisfaction with colour and tooth appearance. Despite the success of dental bleaching procedures, adverse effects such as bleaching-induced tooth sensitivity (TS) and gingival irritation are commonly observed. Among these, bleaching-induced TS is the most prevalent.

The application of anti-inflammatories as topical desensitizers before dental bleaching is an approach to lower bleaching-induced tooth sensitivity. Giovana Mongruel Gomes, University of Ponta Grossa Ponta Grossa, Paraná, Brazil, and colleagues compared the intensity and risk of TS and the colour change resulting from in-office dental bleaching after using an experimental desensitizing gel containing arginine and ibuprofen.

The trial included sixty-two participants with upper canine shades A2 or darker. They were randomly assigned to either the ibuprofen-arginine desensitizing group or the placebo group. The desensitizing gel was applied for 15 min before in-office bleaching with 35 % hydrogen peroxide gel for 50 min (2 sessions).

The researchers used visual (0–10) and numeric rating (0–5) scales to assess the absolute risk and intensity of TSt, and group comparisons were made using the Wilcoxon test, McNemar test, and paired Student t-test. The colour change was assessed using Vita Bleachedguide (ΔSGU), Vita Classical, and Vita EasyShade (ΔEab, ΔE00, and ΔWID) before and one month after the bleaching procedure. A paired t-test was used to perform group comparisons for colour change.

The study led to the following findings:

  • The odds ratio for TS was 0.14, meaning lower odds of TS for the desensitizing gel.
  • A lower intensity of TS was also observed for the experimental group up to 48 h after bleaching.
  • All colour evaluation tools demonstrated effective and similar whitening for both groups.

The findings showed that the topical application of ibuprofen in combination with arginine has demonstrated the ability to reduce the intensity and risk of tooth sensitivity while preserving the efficacy of the bleaching process.

“The topical application of ibuprofen/arginine on the in-office bleaching reduced risk and intensity of bleaching-induced tooth sensitivity,” the researchers wrote.

Reference:

Hortkoff, D., Da Silva, K. L., Farago, P. V., Gomes, J. C., Reis, A., & Gomes, G. M. (2024). Effect of topical application of ibuprofen/arginine on the in-office bleaching-induced tooth sensitivity: A randomized, triple-blind controlled trial. Journal of Dentistry, 142, 104875. https://doi.org/10.1016/j.jdent.2024.104875

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Researchers report first documented case of loperamide misuse linked with acute pancreatitis

USA: A recent article published in Annals of Internal Medicine: Clinical Cases reports the first documented case of loperamide misuse associated with acute pancreatitis.

Given loperamide’s mu agonism, Christopher A. Bouvette, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, and colleagues suspected that supratherapeutic doses induce sphincter of Oddi dysfunction and predispose to pancreatitis.

Loperamide was originally listed as a Schedule II drug in 1977, since then, loperamide has been deregulated and became nonprescription in 1988. Loperamide misuse has mirrored the progression of America’s opioid epidemic, most frequently presenting with cardiac complications.

Epidemiologic studies have shown increasing reports of loperamide misuse for euphoria or as a methadone equal. Misuse dysregulates cardiac myocytes and is often manifested by ventricular dysrhythmias.

The case concerns a 32-year-old man with an extensive history of gastric and duodenal ulcers presented to an outside facility with a 4-month history of fluctuating abdominal pain. Six years previously, the patient had multiple emergent laparotomies and antrectomy with Roux-en-Y gastrojejunostomy for penetrating duodenal ulcers related to nonsteroidal anti-inflammatory drug use.

Initially, he attributed current pain to his previous operations and dyspepsia, although 72 hours of 10/10 abdominal pain, weakness, and fatigue ultimately prompted presentation. He did not report recent abdominal trauma or instrumentation. His only active medication was scheduled omeprazole and as-needed acetaminophen. He reported no active alcohol, illicit drug use, or tobacco.

On arrival, the patient was normotensive and afebrile, and heart rates ranged from 45 to 55 beats/min. An electrocardiogram revealed transient episodes of asymptomatic bradycardia with a corrected QT interval of 577 milliseconds. Physical examination included midline abdominal wall surgical scars.

An abdominal/pelvic computed tomography scan revealed severe obstipation, acute pancreatitis, loculated peripancreatic/perigastric/left retroperitoneal fluid collections, and severe compression of the splenic vein with splenomegaly. The patient received supportive care for pancreatitis, including opioid analgesia and intravenous fluids.

There was a clinical improvement in the patient after endoscopic retrograde pancreatography. Autoimmune pancreatitis panel (IgG4) and genetic panel (CFTR, SPINK1, PRSS1, and CTRC) were sent and returned within normal limits. Upon further discussion with the patient, he disclosed taking up to 150 loperamide, 2 mg tablets, daily for the last 6 months.

It was suspected that these longstanding supratherapeutic loperamide doses may have led to sphincter Oddi dysfunction with resulting pancreatitis. Following stabilization, the patient was discharged to an inpatient substance misuse rehabilitation centre.

“We aim to provide an interesting hypothesis for this patient’s presentation,” the researchers wrote. “We hope to provide a heightened awareness of potential patterns of misuse.”

“Furthermore, in patients with a clinical picture of opioid misuse, evidence of ventricular dysregulation, and now perhaps pancreatitis, providers may have heightened suspicion for loperamide misuse,” they concluded.

Reference:

DOI: https://doi.org/10.7326/aimcc.2023.0874

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Parental smoking and childhood obesity link transcends socio-economic boundaries, reveals study

A study into parental smoking and childhood obesity has challenged previous notions by revealing that the links between the two are not confined to a specific socio-economic group.

The data shows a strong correlation between parents who smoke and their children’s consumption of high calorie unhealthy foods and drinks, across social classes.

Using longitudinal data on 5,000 Australian children collected over a 10-year period, the research found those living with parents who smoke, on average, eat less healthy, higher calorie food such as fruit juice, sausages, fries, snacks, full fat milk products, and soft drinks.

Lead researcher Dr Preety Srivastava said the findings are a reminder that obesity-which continues to be a leading public health concern globally-is an issue across all classes and social groups.

“Australia has one of the highest rates of childhood obesity among rich nations, with data indicating one in four Australian children are overweight or obese in 2017-18,” she said.

Poor taste leads to poor food choices

Preety Srivastava said it was important to understand that parental smoking had a greater potential impact than just the risks of passive smoke exposure. Another significant way that smoking affects children’s health is through parents’ role in modelling dietary behaviours to their kids.

“Previous studies show that compared to non-smokers, smokers have a higher preference for high energy and high fat foods due to the loss of taste sensitivity caused by nicotine and other chemicals found in cigarettes.

“In households where either or both parents smoke, children are exposed to more of these ‘high flavour’ foods possibly due to the altered taste preference of their parents.”

Smoking doesn’t discriminate

Although the bulk of evidence shows that low-socioeconomic families experience higher risks of obesity and smoking than other groups, the research found the link between parental smoking and childhood obesity to be prevalent across socio-economic classes.

“We separated the data into three socio-economic groups – lower, middle and upper – and found that all three equally demonstrated the link between parents who smoke and obesity in children.

“We did, however, find that mothers smoking behaviour could have a significantly greater negative impact on childhood obesity than fathers smoking behaviour.

“As they’re often the primary caregivers of their children and handle household tasks such the food shopping and cooking, it is possible that mothers who smoke have a more significant influence on their children’s diet.”

Breaking the chain

The implications of these findings are far-reaching and emphasise the need for targeted public health interventions to curb parental smoking and promoting healthier diets for children.

“Our findings underscore the need for tobacco control measures that help parents quit smoking or reduce their tobacco use as doing so can have positive spillover effects on family health behaviours, including dietary choices and physical activity.

“Obesity can have negative emotional and social impacts on children, such as low self-esteem and increased rates of being bullied and socially excluded with further adverse consequences on academic performance and long-term employment opportunities.

“It is important policymakers, healthcare professionals, educators and parents collaborate to address the root causes of childhood obesity.” 

Reference:

Srivastava, P., Trinh, TA., Hallam, K.T. et al. The links between parental smoking and childhood obesity: data of the longitudinal study of Australian children. BMC Public Health 24, 68 (2024). https://doi.org/10.1186/s12889-023-17399-5.

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Risk-reducing mastectomy may lower breast cancer mortality, finds study

A study co-led by Professor Kelly Metcalfe of the Lawrence Bloomberg Faculty of Nursing, and researchers at the Familial Breast Cancer Research Unit at Women’s College Hospital, finds risk-reducing mastectomies (RRM) in women with a BRCA1 or BRCA2 genetic variant, significantly reduces the risk of being diagnosed with breast cancer and lowers the probability of death.

The study, published in the British Journal of Cancer, examined how RRM affects the rate of death of women with a pathogenic variant but no cancer diagnosis. To date, there has been only one other study published by researchers in the Netherlands that examines the impact of RRM on mortality and quantifies the benefits associated for women.

“The decision to have a risk reducing mastectomy is often difficult for a woman to make, and the more evidence we are able to provide them with when they are making that decision, the more informed their care plan will be,” says Metcalfe who is also a Senior Scientist with Women’s College Research Institute.

Women who have an inherited BRCA1 or BRCA2 variant, have an 80 per cent risk of developing breast cancer over the course of their lifetime. Research has shown that an RRM reduces the risk of breast cancer by 90 per cent, and in Canada, 30 per cent of women with a pathogenic variant opt for this surgery. It is, Metcalfe says, one of the most effective ways of preventing breast cancer in women with this risk profile.

Through a pseudo-randomized trial, Metcalfe, and her team, followed over 1600 participants from a registry of women with a pathogenic BRCA 1/2 variant from nine different countries over the course of six years, with half of the women having a risk-reducing mastectomy.

At the end of the trial, there were 20 incident breast cancers and two deaths in the group who opted for a RRM, and 100 incident breast cancers and seven deaths in the control group. RRM reduced the risk of breast cancer by 80 per cent, and the probability of dying of breast cancer 15 years after risk-reducing mastectomy was less than one per cent.

“Although there wasn’t a significant difference in deaths between the two groups in this study, we know that a risk reducing mastectomy significantly reduces the risk of ever developing breast cancer,” says Metcalfe.

Metcalfe points out that following these participants for an extended period would generate more evidence to assess the true mortality risk with precision and highlight the benefits associated with this type of surgery.

“Right now, we have good screening in place for breast cancer, including breast MRI, so surgery is only offered as an option, not a recommendation,” says Metcalfe. “But with more studies being conducted to assess women’s trajectory and risk factors following RRM, we will know whether these guidelines need to be changed in the future.”

Reference:

Metcalfe, K., Huzarski, T., Gronwald, J. et al. Risk-reducing mastectomy and breast cancer mortality in women with a BRCA1 or BRCA2 pathogenic variant: an international analysis. Br J Cancer 130, 269–274 (2024). https://doi.org/10.1038/s41416-023-02503-8.

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Extracorporeal Shockwave Therapy may improve symptoms among male patients with chronic pelvic pain syndrome: Study

Chronic pelvic pain syndrome (CPPS) type III refers to unexplained chronic pelvic pain in men, often accompanied by irritative voiding symptoms and pain in the groin, genitalia, or perineum, without the presence of pyuria or bacteriuria.

According to a Research Article published in Prostate International, researchers concluded that Introducing extracorporeal shockwave therapy (ESWT) as a treatment option for male patients with Chronic pelvic pain syndrome (CPPS) has proven effective in improving both their pain levels and overall quality of life. ESWT is a valuable addition to the existing treatment options for CPPS, demonstrating both safety and efficacy in clinical practice.
CPPS is a challenging condition that often necessitates multidisciplinary treatment. One of the treatment options is extracorporeal shockwave therapy (ESWT), but its effectiveness in CPPS is still debated. This study assessed ESWT’s safety and efficacy in male CPPS patients undergoing perineal treatment.
ESWT was administered to the perineum weekly for up to eight weeks. Evaluations were conducted using the International Index for Erectile Function, International Prostate Symptom Score, King’s Health Questionnaire, National Institutes of Health – Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT phenotype system. These assessments were performed before and after treatment and at regular intervals during follow-up appointments up to 20 weeks.
Key findings from the study are:
  • Fourteen patients aged between 21 and 85 years were recruited.
  • Thirteen patients completed the study.
  • Researchers reported improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King’s Health Questionnaire, and National Institutes of Health – Chronic Prostatitis Symptom Index scores.
  • There was an improvement in the erectile function domain of the International Index for Erectile Function.
  • Lower urinary tract symptoms improved as assessed on the International Prostate Symptom Score.
  • No side effects were reported after treatment or during follow-up.
In conclusion, ESWT showed significant improvements in pain and quality of life in male CPPS patients; this non-invasive therapy is a safe and effective addition to the existing treatment options for CPPS, based on clinical evidence.
Study limitations include a lack of a control group, a small sample size and slow recruitment.
Reference:
Lee, K., Law, Y. X. T., Shen, L., Pek, X. W. G., Lim, Q., Tan, Y., Chia, J., & Li, M. (2023). Extracorporeal Shockwave Therapy of the Perineum for male patients with chronic pelvic pain syndrome: A Pilot Study. Prostate International. https://doi.org/10.1016/j.prnil.2023.11.001

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Bariatric surgery provides superior long-term treatment for type 2 diabetes in patients with obesity: JAMA

Research by Cleveland Clinic and three other U.S. medical centers has found that bariatric surgery provides better long-term control of blood glucose levels in patients with obesity and type 2 diabetes, compared with medical therapy.

Study participants who had bariatric surgery also experienced higher rates of complete diabetes remission up to 12 years after their surgical procedure.

In addition, participants who underwent bariatric surgery, also called metabolic or weight-loss surgery, were more likely to stop needing diabetes medications and had higher rates of diabetes remission up to 12 years post-surgery. Pennington Biomedical’s Dr. John Kirwan and Dr. Philip Schauer were among the lead investigators for the 12-year study, titled “Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type2 Diabetes,” or ARMMS-T2D.

The research has been published in JAMA.

Ali Aminian, M.D., a co-investigator of the ARMMS-T2D study and the director of Cleveland Clinic’s Bariatric & Metabolic Institute, said: “ARMMS-T2D provides the largest analysis with the longest follow-up in the setting of randomized clinical trial to compare bariatric surgery with medical therapy for the treatment of type 2 diabetes in patients with obesity.”

According to the Centers for Disease Control and Prevention, about1 in 10 Americans have diabetes and approximately 90% of the diabetes cases in the USA are type 2 diabetes. The chronic condition happens when an individual has persistently high blood sugar levels. Without treatment, type 2 diabetes can cause various health problems, like heart disease, kidney disease, and stroke.

For the ARMMS-T2D, 262 eligible participants were enrolled between 2007 and 2013 and followed until 2022. The medical group included 96 participants and the surgical groups had 166 participants. Patients in the medical group received a variety of medications for the treatment of type 2 diabetes, including FDA-approved incretin/GLP-1 agonists. Those medications help lower blood sugar levels and promote weight loss. Bariatric surgery included gastric bypass, gastric sleeve, and adjustable gastric banding. The average age was 50; 68% of the participants were female; and 67% were white. The average body mass index (BMI) was 36.4.

Researchers reported the change in blood sugar levels – measured in this study as HbA1c level – immediately after surgery up to 12 years. HbA1c is a standard laboratory test that reflects average blood sugar over the past three months. Between the surgical group and the medical therapy group, researchers noted a large difference in HbA1c of 1.4% at seven years and 1.1% at 12 years with bariatric surgery providing superior blood glucose control.

Researchers also looked at diabetes remission over time (defined in this study as a HbA1c level less than 6.5% without need for diabetes medications for at least 3 months). In the bariatric surgery group, 50.8% of the participants achieved remission of diabetes at one year, compared with 0.5% of participants in the medical group. At seven years, 18.2% of the participants in the bariatric surgery group still had remission of their diabetes.

Dr. Aminian said: “The magnitude of benefits of bariatric surgery is very large and durable. Patients with diabetes usually need more medications over time to control their blood glucose. However, a two-hour surgery could help many of them to control their diabetes without needing any medications, including insulin.”

• Study results showed that 40% of patients in the bariatric surgery group and only 4% of patients in the medical group were off diabetes medications at seven years.

• The use of insulin after bariatric surgery was also significantly lower (16%) than in the medical group (56%) at seven years.

• The use of incretin/GLP-1 agonist medications was greater in the medical group across all annual visits.

Researchers also looked at changes in weight over time. During the seven-year follow-up, researchers noted 19.9% weight loss in the surgical group, compared to 8.3% weight loss in the medical group. At 12 years, the bariatric surgery group continued to have superior weight loss (19.3%) compared to the medical group (10.8%).

In the bariatric surgery group, anemia, fractures, and gastrointestinal symptoms were more common. Dr. Aminian said it is important for patients to be treated by a multidisciplinary team, including nutrition specialists, so that the necessary vitamins and supplements can be recommended after bariatric surgery.

Bartolome Burguera, M.D., Ph.D., an endocrinologist and Chief of the Medical Specialty Institute at Cleveland Clinic, said: “Type 2 diabetes and obesity are chronic diseases that need long-term treatment. This study shows that bariatric surgery provides long-term benefits for the treatment of type 2 diabetes in many patients with obesity. We now have recently FDA-approved medications for the treatment of type 2 diabetes – such as semaglutide and tirzepatide – but access to those medications needs to be improved. I think it’s important to discuss with our patients all the available treatment options for type 2 diabetes and obesity so that we can identify the best long-term therapy for each patient.”

During the ARMMS-T2D follow-up, 25% of the study participants that were in the medical group did not want to continue with that treatment and underwent bariatric surgery after a few years. Researchers accounted for that change in their analysis.

Reference:

Courcoulas AP, Patti ME, Hu B, et al. Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 Diabetes. JAMA. 2024;331(8):654–664. doi:10.1001/jama.2024.0318.

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3 nurses filming reels in Hospital OT, suspended

Three nurses were dismissed from service for allegedly filming reels in the operation theatre of a Dau Kalyan Singh PG Institute and Research Centre in Raipur in Chhattisgarh and sharing them on social media.

The services of Pushpa Sahu, Tripti Dasar and Tej Kumari, who were daily wage staff nurses at Dau Kalyan Singh PG Institute and Research Centre Raipur, were terminated on February 23 after a complaint was received against them, said facility deputy superintendent Dr Hemant Sharma.

For more information click on the link below:

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