J-shaped curve apparent between dietary thiamine and worsening mental acuity

There seems to be a J-shaped curve between dietary thiamine (vitamin B1) and worsening mental acuity among cognitively healthy older people, suggests research published in the open access journal General Psychiatry.

The sweet spot seems to be a daily intake of 0.68 mg, below which there is relatively little impact. But higher daily intake was strongly associated with cognitive decline, with the optimal maintenance dose 0.6 to less than 1 mg/day, the findings show.

Thiamine is an essential water-soluble B vitamin involved in energy metabolism and brain neurotransmitter activity. Good dietary sources include whole grains, fortified breakfast cereals, legumes, liver, and salmon.

Small previously published studies suggest that high doses can improve cognitive function in people with mild cognitive impairment or early stage dementia. But it’s not clear if usual dietary intake is associated with slowing, or speeding up, cognitive decline.

To explore this further, the researchers used publicly available data from the China Health and Nutrition Survey (CHNS), a long term multipurpose study which began in 1989, and which included nearly half the country’s population by 2011.

In 1997, 2000, 2004 and 2006, mental acuity was repeatedly assessed for cognitively healthy participants aged 55 and above. The current study is based on 3106 participants, with an average age of 63, and at least two rounds of survey data.

Information on diet was collected in each survey round, supplemented by detailed data on personal dietary intake over 24 hours on 3 consecutive days of the week, and collected in person by trained investigators. Nutrient intake was calculated using the Chinese food composition tables.

Three tests of immediate and delayed recall of a 10-word list, counting backwards from 20, and serial subtraction of 7 five times from 100, taken from the Telephone Interview for Cognitive Status–modified (TICS-m), were used to evaluate verbal memory, attention, and numerical fluency, respectively.

A higher score for each item (including verbal memory [0-20 points], attention [0-2 points] and calculation [0-5 points]) indicates better cognitive function, with a global cognitive score ranging from 0 to 27 points and also a composite score ranging from -1.82 to 1.67 standard units.

The average monitoring period was nearly 6 years, during which time a J-shaped association emerged between dietary thiamine intake and the pace of decline in cognitive function over 5 years.

Average thiamine intake was 0.93 mg/day, but the threshold seemed to be a daily intake of 0.68 mg. There was no significant association with cognitive decline below this level.

But above 0.68 mg/day, each daily unit (1 mg/day) increase in thiamine intake was associated with a significant fall of 4.24 points in the global cognitive score and 0.49 units in the composite score within 5 years. Since the global cognitive score ranges from 0 to 27 points, a decline of about 4 points means a decline in cognitive function of at least 15%

These associations were stronger among those who were obese, had high blood pressure or who were non-smokers, although after further in depth analysis, the modifying effect of high blood pressure and smoking became statistically insignificant,

To further explore the optimal range of dietary thiamine for maintaining cognitive function, intake was further divided into 0.4, 0.6, 0.8, 1, 1.2 and 1.4 mg/day.

This showed that the lowest risk was associated with a thiamine intake of 0.6 to less than 1 mg/day. Similar patterns were also observed after accounting for daily intake of other B vitamins (riboflavin and niacin) and other foods, such as red or processed meat.

None of the other variables, including age, sex, alcohol consumption and dietary intake of fat, protein or carbohydrate, significantly changed the findings.

This is an observational study, and as such, can’t establish cause, acknowledge the researchers. And 24-hour dietary recall only captures information on specific days and may not be completely accurate. The study also focused on older people in China, so the findings may not be applicable to other nationalities and age groups, they add.

“Thiamine deficiency may lead to an insufficient supply of energy to the neurons of the brain and decreased acetylcholine signalling in the brain, which may impair cognitive function,” suggest the researchers, by way of an explanation for their findings.

“If substantiated by further research, our study highlights the importance of maintaining optimal dietary thiamine intake levels in the general older population to prevent cognitive decline.”

Reference:

https://gpsych.bmj.com/lookup/doi/10.1136/gpsych-2023-101311

Powered by WPeMatico

Advances in pediatric sepsis biomarkers: A pediatric investigation review

Sepsis is a life-threatening condition triggered by a severe infection. Severe sepsis and septic shock are progressive stages of sepsis, associated with multi-organ failure and death. Mortality for pediatric sepsis ranges from 4% to 50%, depending on illness severity, risk factors, and geographic location. The risk of recurrence after surviving severe sepsis is significantly high in most cases.

One of the persistent challenges in treating sepsis is the lack of timely diagnosis. Non-symptomatic children can rapidly present morbid symptoms in a short span of 36 to 72 hours. Current practices rely on broad-ranged biomarkers such as CRP (C-reactive protein, an inflammation marker), PCT (procalcitonin, a pro-hormone), and lactate for the detection of sepsis. Despite recent advances in science and technology, there is currently no singular diagnostic test that reliably detects sepsis.

Their review, published in Pediatric Investigation, systematically classifies biomarkers according to the sepsis progression stage in patient samples and provides a comprehensive overview of research advancements across various omics levels. The study authors emphasize that timely and precise identification and treatment are crucial for minimizing the risk of sepsis and enhancing the prognosis. Multi-omics profiling technology, encompassing genomics, transcriptomics, proteomics, and metabolomics, is employed to identify reliable biomarkers.

The combined summary is as follows: Genomics delves into genetic variations linked to sepsis susceptibility, spotlighting primary immunodeficiency disease (PID) gene variants, along with polymorphisms in genes such as PAI-1 and CD143. Transcriptomics, focusing on transcription patterns, identifies diagnostic targets of some mRNAs or miRNAs. For proteomics, it was observed that IL-27 screening combined with procalcitonin enhanced the predictability of sepsis screening. The review also took stock of metabolites, chemicals released by cells during cellular processes, as potential biomarkers. Similar to lactate, which has already been established as a sepsis biomarker, 2-hydroxybutyrate, 2-hydroxyisovalerate, creatine, and glucose, are common metabolites that may detect sepsis severity. However, these potential sepsis biomarkers still require validation in a large patient cohort in the future.

An ideal sepsis biomarker should enable the detection of the infection group, provide insights into the progression stage of sepsis, and highlight the susceptibility of high-risk patients. Early detection of sepsis can aid in targeted treatment rather than broad-spectrum antibiotic, antiviral, or antifungal therapies.

The complexity of genomic factors and analysis of differentially expressed genes and co-expression networks reveals potential biomarkers for distinguishing pediatric sepsis patients. While high-throughput screening identifies immune factors and gene expression patterns, further validation and larger sample sizes are needed for robust biomarker assessment in pediatric sepsis. The integration of multilevel omics data, aided by artificial intelligence, holds promise for discovering sepsis biomarkers. While no single biomarker serves as the gold standard, a panel of genes or markers may enhance early diagnosis, treatment, and prognosis, emphasizing the need for further research and clinical validation.

Reference:

Xinyu Wang, Rubo Li, Suyun Qian, Dan Yu, Multilevel omics for the discovery of biomarkers in pediatric sepsis, Pediatric Investigation, https://doi.org/10.1002/ped4.12405.

Powered by WPeMatico

Pannexin channel protein may protect against obesity-related hypertension, researchers suggest

USA: A recent study published in Science Signaling has revealed that a pannexin channel protein may be protective against obesity-related hypertension.

Endothelial pannexin 3 (Panx3) and Bcl6 abundance were reduced in hypertensive, obese individuals, indicating that reductions in endothelial Panx3 may drive obesity-associated hypertension.

“Our findings provide insight into a channel-independent role of Panx3 wherein its interaction with Bcl6 determines vascular oxidative state, particularly under the adverse conditions of obesity,” Abigail G. Wolpe, University of Virginia School of Medicine, Charlottesville, VA, USA, and colleagues wrote.

Obesity induces endothelial dysfunction that can result in hypertension. Dr. Wolpe and the team uncovered a role for Panx3 as a scaffolding protein that limits oxidative stress in the endothelium and hypertension.

Panx3 bound to and stabilized the transcriptional repressor Bcl6, which suppressed Nox4 expression, the gene encoding a hydrogen peroxide–producing enzyme. Mice lacking Panx3 in endothelial cells or treated with a peptide that disrupted the Panx3-Bcl6 interaction demonstrated greater oxidative stress in the endothelium and developed hypertension. Furthermore, there was a decrease in Panx3 mRNA expression and Bcl6 protein abundance, and Nox4 mRNA expression was increased in mice with diet-induced obesity, but not in mice with pharmacologically induced hypertension.

In the study, the researchers report that the abundance of endothelial Bcl6 is determined by its interaction with Golgi-localized Panx3 and that Bcl6 transcriptional activity protects against vascular oxidative stress.

Key observations were as follows:

  • Consistent with data from obese, hypertensive humans, mice with an endothelial cell–specific deficiency in Panx3 had spontaneous systemic hypertension without obvious changes in channel function, as assessed by Ca2+ handling, ATP amounts, or Golgi luminal pH.
  • Panx3 bound to Bcl6, and its absence reduced Bcl6 protein abundance, suggesting that the interaction with Panx3 stabilized Bcl6 by preventing its degradation.
  • Panx3 deficiency was associated with increased gene expression encoding the H2O2-producing enzyme Nox4, normally repressed by Bcl6, resulting in H2O2-induced oxidative damage in the vasculature.
  • Catalase rescued impaired vasodilation in mice lacking endothelial Panx3. Administration of a newly developed peptide to inhibit the Panx3-Bcl6 interaction recapitulated the increase in Nox4 expression and blood pressure in mice with endothelial Panx3 deficiency.
  • Panx3-Bcl6-Nox4 dysregulation occurred in obesity-related hypertension, but not when hypertension was induced in the absence of obesity.

Using pharmacological and genetic approaches, the researchers demonstrated the Panx3-Bcl6 interaction as a regulator of vascular oxidative stress and systemic blood pressure. The study findings illuminate the dysregulation of Panx3/Bcl6/Nox4 as a pathway by which obesity can drive endothelial dysfunction and hypertension.

“Together, these data suggest that Panx3 oligomers exhibit diverse stoichiometric,” the research group concluded. “In the endothelium, there is no direct evidence for channel functionality, and we instead posit that Golgi-localized Panx3 protects against oxidative stress in the cardiovascular system through protein-protein interactions with Bcl6.”

Reference:

Wolpe, A. G., Luse, M. A., Baryiames, C., Schug, W. J., Wolpe, J. B., Johnstone, S. R., Dunaway, L. S., Juśkiewicz, Z. J., Loeb, S. A., Askew Page, H. R., Chen, L., Sabapathy, V., Pavelec, C. M., Wakefield, B., Cifuentes-Pagano, E., Artamonov, M. V., Somlyo, A. V., Straub, A. C., Sharma, R., . . . Isakson, B. E. (2024). Pannexin-3 stabilizes the transcription factor Bcl6 in a channel-independent manner to protect against vascular oxidative stress. Science Signaling. https://doi.org/adg2622

Powered by WPeMatico

Anorexia nervosa can be life threatening in males

Anorexia nervosa affects males as well as females, and affected males have a sixfold higher mortality rate than males in the general population. A new article published in CMAJ (Canadian Medical Association Journal) aims to raise awareness of this life-threatening eating disorder. 

“Early identification and prompt treatment are essential,” writes Dr. Basil Kadoura, a specialist in adolescent health, British Columbia Children’s Hospital and University of British Columbia, Vancouver, BC, with coauthors.

Five things to know about anorexia nervosa in males:

1.Up to 0.3% of males will be diagnosed with anorexia nervosa. Stigma, poor mental health literacy and gendered stereotypes reduce help-seeking behaviours and lead to delayed treatment and worse outcomes.

2. Certain adolescent males are at higher risk. Athletes involved in body- and strength-focused sports like cycling, running, and wrestling, are a higher risk of developing the disorder, as are racially and ethnically diverse males and gay, bisexual, trans, and queer people.

3. Screening for muscle-enhancing goals and behaviours is important to assess for anorexia nervosa. Diet changes, vomiting, over-exercising, and supplement and anabolic steroid use are potential red flags. The Muscularity Oriented Eating Test is a tool used to assess for these eating behaviours.

4. Complications can be life threatening. These include vital sign instability, slower than normal heart rate, electrolyte abnormalities and other conditions. A detailed history, physical examination and bloodwork will help identify serious medical issues and guide treatment.

5. Family-based treatment is recommended for outpatients. In this guideline-recommended approach, parents are considered experts in their adolescent and lead in re-nourishing their child.

“Most adolescent males with anorexia nervosa can be treated as outpatients with family-based treatment and ongoing medical monitoring. However, some adolescents may require treatment in hospital,” write the authors.

Reference:

Basil Kadoura, Kyle T. Ganson and Debra K. Katzman, Anorexia nervosa in adolescent males, CMAJ February 20, 2024 196 (6) E191; DOI: https://doi.org/10.1503/cmaj.230001.

Powered by WPeMatico

Female reproductive factors closely associated with COPD risk: BMJ study

A recent study published in the BMJ Thorax unveiled the intricate relationship between female reproductive factors and the development of Chronic Obstructive Pulmonary Disease (COPD). This research looks into how aspects like the age at menarche, childbirth, miscarriage, stillbirth and menopause could influence the susceptibility of woman to COPD. 

This study analyzed data across three cohorts from over 280,000 women that makes it one of the most extensive investigations into this subject. Over a median follow-up period of 11 years, 3.8% of the participants were diagnosed with COPD. The findings revealed a U-shaped relationship was observed between age at menarche and COPD risk which indicates that both early and late onset of menstruation could increase susceptibility. Also, women with three or more children were found to have an increased risk of COPD when compared to those with fewer offspring, with a similar pattern observed in the individuals who experienced multiple miscarriages or stillbirths.

Among postmenopausal women, an earlier onset of natural menopause was associated to an elevated risk of COPD. The individuals who experienced menopause before the age of 40 were almost twice as likely to develop COPD when compared to those who reached menopause between the ages of 50 and 51. These findings underline the complex relationship between reproductive health and respiratory outcomes in women. While previous studies have primarily focused on the impact of smoking and environmental factors on COPD risk, this study in particular, highlights the significance of considering female-specific variables.

This study emphasized the importance of the outcomes in informing healthcare strategies and personalized interventions for COPD prevention in women. The findings highlight the need for a comprehensive approach to COPD prevention which takes into account the traditional risk factors and reproductive history in addition.

Reference:

Liang, C., Chung, H.-F., Dobson, A. J., Sandin, S., Weiderpass, E., & Mishra, G. D. (2024). Female reproductive histories and the risk of chronic obstructive pulmonary disease. Thorax. https://doi.org/10.1136/thorax-2023-220388

Powered by WPeMatico

Social media platforms can play crucial role in promoting oral health, research suggests

Iran: A recent systematic review published in PLOS One has revealed the positive impact of implementing social media interventions on multiple aspects of oral health among laypeople.

Online platforms such as Instagram, WhatsApp, YouTube, and Telegram can be effectively utilized to promote oral health among patients, the researchers suggested.

They note that although social media offers efficiency and convenience for interventions aimed at preventing and promoting oral health, its utilization is not yet widespread.

While social media can improve content accessibility and enhance knowledge transfer, the success of interventions depends on individual participation and evidence-based approaches, the study stated.

However, it is important to note that there is no single method or platform that can be deemed universally suitable for all regions. Nevertheless, audio-visual platforms may be more effective than text-based social media in promoting oral health.

Social media, described as “a group of internet-based applications that are built on Web 2.0,” has gained significant popularity in recent decades, allowing users to create, share, and participate in social networks. The most commonly used social networking platforms include YouTube, Facebook, WhatsApp, Instagram, and WeChat. These platforms have become a common means of sharing personal experiences, information, and lifestyles. They can also be used as cost-effective methods for individuals to acquire health information and promote oral health.

Against the above background, Zahra Ghorbani, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and colleagues aimed to systematically review the current literature on the interventions taken through social media for promoting lay people’s oral health. The systematic review followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 guidelines.

For this purpose, the researchers conducted a comprehensive search in four electronic databases for relevant articles published between 2012 and 2023. Data such as sample size, study design, utilized social media platforms, follow-up duration and main findings were extracted from the eligible studies.

The quality of the included studies was evaluated by the quality assessment tools for intervention studies recommended by the National Collaborating Centre for Methods and Tools.

Key findings were as follows:

  • Out of the 1934 records identified in the initial search, the qualitative synthesis included ten studies which met the inclusion criteria. These studies consisted of seven randomized control trials, one field trial and two quasi-experimental.
  • Various social media platforms, including Instagram, Telegram, YouTube, WhatsApp and Snapchat, were used for communication with patients.
  • Some studies solely utilized social media interventions, while others combined online and traditional interventions.
  • The quality assessment categorized 30% of the studies as “strong”, 50% as “moderate”, and the remaining as “weak”.
  • The implementation of social media interventions positively influenced multiple aspects of oral health among laypeople.

“Collaborations between oral health professionals, organizations, and influencers on social media will amplify credibility and reach,” the researchers wrote.

“However, these advancements come with ethical considerations, demanding vigilance in combatting misinformation and adhering to privacy regulations.”

“Considering these changes, researchers and practitioners must recognize and address research gaps,” the research team concluded. “Future studies should explore unexplored areas to better understand the intersection between social media and oral health promotion.”

Reference:

Farrokhi, F., Ghorbani, Z., Farrokhi, F., Namdari, M., & Salavatian, S. (2023). Social media as a tool for oral health promotion: A systematic review. PLOS ONE, 18(12), e0296102. https://doi.org/10.1371/journal.pone.0296102

Powered by WPeMatico

Study reveals additive effects of SGLT2i and GLP-1RA in enhancing vascular repair among patients with diabetes and obesity

Canada: A recent study published in Cardiovascular Research has shed light on restoring blood vessel regeneration in the era of the combination of SGLT2 inhibitors and GLP-1 receptor agonist therapy for diabetes and obesity.

In the study, David A Hess, University of Western Ontario, London, Canada, and colleagues focused on the clinical potential of SGLT2i and GLP-1RA therapy to improve oxidative stress levels in the human bone marrow to reverse regenerative cell exhaustion and restore vessel repair capacity. Finally, they explored the use of combination SGLT2i/GLP-1RA therapy to synergize cardiovascular benefits compared to SGLT2i and GLP-1RA monotherapy and commented on the future of this therapeutic strategy in improving RCE and vascular repair.

As sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 receptor agonists (GLP-1RAs) therapies are emerging as a novel therapeutic opportunity for patients with poorly controlled hyperglycemia, potential additive effects in reducing oxidative stress may also enhance vascular repair and further reduce the ischaemic cardiovascular (CV) comorbidities associated with type 2 diabetes (T2D) and obesity, the study stated.

Ischemic cardiovascular diseases, including coronary and peripheral artery disease, stroke, and myocardial infarction remain major comorbidities for individuals with T2D and obesity. During cardiometabolic chronic disease (CMCD), excess adiposity and hyperglycemia elevate oxidative stress and promote endothelial damage, alongside an imbalance in circulating pro-vascular progenitor cells that mediate vascular repair.

Individuals with CMCD demonstrate pro-vascular ‘regenerative cell exhaustion’ (RCE) characterized by excess pro-inflammatory granulocyte precursor mobilization into the circulation, monocyte polarization towards pro-inflammatory versus anti-inflammatory phenotype, and decreased pro-vascular progenitor cell content, impairing the capacity for vessel repair.

Remarkably, targeted treatment with the SGLT2 inhibitor empagliflozin in subjects with type 2 diabetes and coronary artery disease, and gastric bypass surgery in subjects with severe obesity, has been shown to partially reverse these RCE phenotypes.

SGL2 inhibitors and GLP-1 receptor agonists have reshaped the management of patients with T2D and comorbid obesity. In addition to glucose-lowering action, both drug classes have been shown to induce weight loss and reduce mortality and adverse CV outcomes in landmark clinical trials. Furthermore, both drug families also act to reduce systemic oxidative stress through altered activity of overlapping oxidase and antioxidant pathways, providing a putative mechanism to augment circulating pro-vascular progenitor cell content.

“The pleiotropic cardiorenal protective and weight loss benefits of SGLT2 inhibitor and GLP-1 receptor agonist treatments, respectively, present a novel opportunity for combination therapy to abrogate this chronic cardiometabolic cycle and potentially restore progenitor cell-mediated blood vessel repair,” the researchers wrote.

“Further examination of combination therapies in humans is now warranted in the context of the recovery of endogenous vascular regeneration to uncover if the synergistic benefit can be observed in individuals within the CMCD spectrum,” they concluded.

Reference:

Terenzi, D. C., Bakbak, E., Teoh, H., Krishnaraj, A., Puar, P., Rotstein, O. D., Cosentino, F., Goldenberg, R. M., Verma, S., & Hess, D. A. (2024). Restoration of blood vessel regeneration in the era of combination SGLT2i and GLP-1RA therapy for diabetes and obesity. Cardiovascular Research, 119(18), 2858-2874. https://doi.org/10.1093/cvr/cvae016

Powered by WPeMatico

Weight Change Not Associated with Hand Osteoarthritis Progression and Pain

A recent study found the association between weight change and the development of hand osteoarthritis (OA) was investigated. The study published in the Arthritis Care & Research assessed if weight loss or gain have any bearing on the incidence and progression of hand OA along with the development and resolution of hand pain.

The study from the Osteoarthritis Initiative involved a total of 4,598 participants but excluded the individuals with cancer, rheumatoid arthritis or a body mass index under 18.5 kg/m2. The study analyzed weight change from baseline to the 4-year follow-up, as well as its impact on radiographic hand OA and hand pain over an 8-year period utilizing the multivariable logistic regression.

The results found no statistically significant relationship between weight change and the investigated outcomes. For instance, for every 5% weight loss, the odds ratios for the incidence and progression of radiographic hand OA were 0.90 and 0.92, respectively, with confidence intervals that ranged from 0.67 to 1.23 and 0.84 to 1.00. Also, for each 5% weight loss, the odds ratios for the development and resolution of hand pain at the 8-year follow-up were 1.00 and 1.07, respectively, with confidence intervals from 0.92 to 1.09 and 0.91 to 1.25.

The outcomes of this study found no compelling evidence to suggest a strong link between weight change and the risk of developing or progressing radiographic hand OA over a 4-year period. Also, the research did not find any significant association of the development or resolution of hand pain with weight change over a timeframe of 8 years. The weight management remains critical for overall health and well-being, while its direct impact on hand OA progression may be more precise than previously established. Further research may improve the understanding of the complex link between weight change and osteoarthritis development in different joints of the body.

Source:

Salis, Z., Driban, J. B., McAlindon, T. E., Eaton, C. B., & Sainsbury, A. (2024). Association of Weight Loss and Weight Gain With Structural Defects and Pain in Hand Osteoarthritis: Data From the Osteoarthritis Initiative. In Arthritis Care & Research. Wiley. https://doi.org/10.1002/acr.25284

Powered by WPeMatico

Dapagliflozin leads to modest reduction in systolic BP in patients with CKD and albuminuria: Study

USA: Treatment with dapagliflozin in patients with chronic kidney disease (CKD) and albuminuria is associated with modest but clinically meaningful reductions in systolic blood pressure (SBP), according to a pre-specified analysis of data from the DAPA-CKD trial.

In the study published in the American Heart Journal, the placebo-adjusted reduction in systolic BP was evident soon after the initiation of therapy and maintained throughout the trial.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors have emerged as a potent therapy to lower the risk of progressive kidney disease and cardiovascular events in patients with chronic kidney disease. These agents reduce the absorption of sodium and glucose in the proximal tubule, thereby increasing glycosuria and diuresis, typically reducing intravascular volume, which leads to a reduction in blood pressure. However, the consistency and magnitude of BP lowering with dapagliflozin in CKD patients is unknown.

To fill this knowledge gap, Glenn M Chertow, Stanford University School of Medicine, Stanford, California, USA, and colleagues conducted a pre-specified analysis of the DAPA-CKD trial to determine the effect of systolic blood pressure in patients with CKD, with and without type 2 diabetes.

The study included 4304 adults with baseline estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73m2 and urinary albumin-to-creatinine ratio (UACR) 200–5000 mg/g. They were randomized to either dapagliflozin 10 mg or placebo once daily and followed for a median of 2.4 years.

The study’s primary endpoint was a composite of sustained ≥50% eGFR decline, end-stage kidney disease, or death from a cardiovascular or kidney cause. Change in SBP was a pre-specified outcome.

The main findings of the study are as follows:

  • The baseline mean SBP was 137.1 mmHg. By Week 2, dapagliflozin compared to placebo reduced SBP by 3.6 mmHg, an effect maintained throughout the trial (2.9 mmHg, 2.3−3.6 mmHg).
  • Time-averaged reductions in SBP were 3.2 mmHg in patients with diabetes and 2.3 mmHg in patients without diabetes.
  • The time-averaged effect of dapagliflozin on diastolic blood pressure (DBP) was 1.0 mmHg; 0.8 mmHg in patients with diabetes and 1.4 mmHg in patients without diabetes.
  • The benefits of dapagliflozin on the primary composite and secondary endpoints were evident across the spectrum of baseline SBP and DBP.

The findings show that randomization to dapagliflozin in patients with chronic kidney disease and albuminuria is associated with modest reductions in systolic and diastolic BP. 

The magnitude reduction in systolic blood pressure was observed to be similar to that provided by several commonly prescribed antihypertensive agents or following renal denervation.

“These findings should inform clinical decisions undertaken when aiming to optimize control of hypertension in CKD patients,” the researchers concluded. 

Reference:

Heerspink, H. J., Provenzano, M., Vart, P., Jongs, N., Correa-Rotter, R., Rossing, P., Mark, P. B., Pecoits-Filho, R., McMurray, J. J., Langkilde, A. M., Wheeler, D. C., Toto, R. B., & Chertow, G. M. (2024). Dapagliflozin and Blood Pressure in Patients with Chronic Kidney Disease and Albuminuria. American Heart Journal. https://doi.org/10.1016/j.ahj.2024.02.006

Powered by WPeMatico

Is new care strategy required for survivors of critical illnesses with multimorbidity?

Recently published study reviewed the impact of multimorbidity on the recovery trajectories and outcomes of critical illness survivors, aiming to identify factors that predispose such survivors to worse outcomes and explore potential strategies to enhance their long-term recovery.

Influence of Multimorbidity on Critical Illness Outcomes

The study notes that previous research efforts have largely focused on rehabilitation interventions to address physical, psychological, and cognitive functional sequelae after critical illness. However, recent evidence suggests that a person’s existing health status, particularly multimorbidity and frailty, strongly influences long-term outcomes. The review examines the complex relationship between multimorbidity and patient outcomes after critical illness, highlighting the multitude of factors, including the number, severity, and modifiability of medical conditions, treatment burden, functional status, healthcare delivery, and social support, that mediate these relationships.

Factors Mediating the Relationship

Critical illness survivors with multimorbidity, defined as the coexistence of at least two chronic conditions, experience significantly worse recovery trajectories and outcomes compared to previously healthy patients. The review proposes that the impact of the acute illness on survivors with multimorbidity may be overwhelmed by pre-illness factors, leading to worse outcomes. Several factors play a role in mediating the relationship between multimorbidity and outcomes, including biological and pathophysiological mechanisms, specific conditions and multimorbidity clusters, functional impairment and frailty, social context, treatment burden, and healthcare context. The review also explores the potential mechanisms by which critical illness may drive biological aging and exacerbate existing conditions.

To improve outcomes for critical illness survivors with multimorbidity, the review suggests several potential strategies, such as personalized care, shared decision making, identification and optimization of multimorbidity and related factors, and management of treatment burden and self-management support. The proposed care pathways for these patients would need to consider individual patient priorities and preferences, address fragility and social circumstances, and include a multifaceted approach to optimize care. The review recommends enhanced identification and optimization of multimorbidity and related factors, provision of personalized care based on patient priorities and preferences, and orientation towards family and informal carer support.

Recommendations for Enhanced Care

The study proposes the need to enhance care for critical illness survivors with multimorbidity by considering their pre-existing health status and personal factors. It highlights the importance of addressing treatment burden, self-management support, family and informal carer orientation, health and social care context, and the potential benefits of digital health solutions in supporting self-management for these patients. The review concludes by noting that despite the numerous unanswered questions, the identification of multimorbidity and related factors is crucial in developing an optimal model of care for these individuals.

Reference-

Stewart, J., Bradley, J., Smith, S. et al. Do critical illness survivors with multimorbidity need a different model of care?. Crit Care 27, 485 (2023). https://doi.org/10.1186/s13054-023-04770-6.

Powered by WPeMatico