Low vitamin D levels associated with increased cardiovascular disease risk in young adults

Low vitamin D levels associated with increased cardiovascular disease risk in young adults suggests a new study published in the Journal of Endocrinological Investigation.

Vitamin D deficiency is related to metabolic disturbances. Indeed, a poor vitamin D status has been usually detected in patients with cardiovascular disease (CVD). However, the relationship between vitamin D and CVD risk factors in young adults remains controversial at present. This study aimed to examine the association between circulating 25-hydroxyvitamin D (25(OH)D) and CVD risk factors in young adults. The present cross-sectional study included a cohort of 177 young adults aged 18-25 years old (65% women). 25(OH)D serum concentrations were assessed using a competitive chemiluminescence immunoassay. Fasting CVD risk factors (i.e., body composition, blood pressure, glucose metabolism, lipid profile, liver, and inflammatory markers) were determined by routine methods. A panel of 63 oxylipins and endocannabinoids (eCBs) was also analyzed by targeted metabolomics. Results: Circulating 25(OH)D concentrations were inversely associated with a wide range of CVD risk factors including anthropometrical (all P ≤ 0.005), body composition (all P ≤ 0.038), glucose metabolism (all P ≤ 0.029), lipid profile (all P < 0.035), liver (all P ≤ 0.011), and pro-inflammatory biomarkers (all P ≤ 0.030). No associations of serum 25(OH)D concentrations were found with pro-inflammatory markers (all P ≥ 0.104), omega-6 and omega-3 oxylipins, nor eCBs concentrations or their analogues (all P ≥ 0.05). The present findings support the idea that 25(OH)D could be a useful predictor of CVD risk in young individuals.

Reference:

Amaro-Gahete FJ, Vázquez-Lorente H, Jurado-Fasoli L, Dote-Montero M, Kohler I, Ruiz JR. Low vitamin D levels are linked with increased cardiovascular disease risk in young adults: a sub-study and secondary analyses from the ACTIBATE randomized controlled trial. J Endocrinol Invest. 2024 Jan 4. doi: 10.1007/s40618-023-02272-4. Epub ahead of print. PMID: 38172418.

Keywords:

Low vitamin D, vitamin levels, cardiovascular disease, risk, young adults, Amaro-Gahete FJ, Vázquez-Lorente H, Jurado-Fasoli L, Dote-Montero M, Kohler I, Ruiz JR, 25-hydroxyvitamin D; Cardiovascular risk; Inflammation; Oxylipins; Young adults

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Mean Platelet Volume independently Linked to Mortality among Peritoneal Dialysis Patients

In a groundbreaking exploration at the intersection of platelet volume and patient outcomes, a recent study has illuminated the potential role of mean platelet volume (MPV) as a significant indicator of mortality risks in individuals undergoing peritoneal dialysis (PD). While MPV has previously been associated with severity and mortality in sepsis patients, this study expands its relevance to the realm of renal care. The study found that MPV is independently associated with both all-cause mortality and cardiovascular mortality in patients undergoing peritoneal dialysis.

The study results were published in the journal BMC Cardiovascular Diseases. 

Also Read: Adults receiving hemodialysis at higher risk of developing AF versus peritoneal dialysis

In the realm of medical research, the mean platelet volume (MPV) has emerged as a valuable indicator, demonstrating associations with severity and all-cause mortality in patients with sepsis. However, a recent study has delved into uncharted territory, exploring the relationship between MPV and all-cause mortality, as well as cardiovascular mortality, in patients undergoing peritoneal dialysis (PD). The primary objectives of this retrospective study were to uncover the potential links between MPV and both all-cause mortality and cardiovascular mortality among patients treated with PD.

Researchers retrospectively gathered data from 1,322 patients undergoing PD between November 1, 2005, and August 31, 2019. The study’s primary outcomes were identified as all-cause mortality and cardiovascular mortality. To classify MPV, the researchers employed the X-tile software. The correlation between MPV and mortality was assessed using Cox models, and survival curves were generated using the Kaplan-Meier method.

Key Findings:

  • The median follow-up period for the study participants was 50 months (ranging from 30 to 80 months), during which a total of 360 deaths were recorded.
  • For all-cause mortality, patients with MPV ≥ 10.2 fL exhibited a significantly higher risk across three different models.
  • Furthermore, PD patients with MPV ≥ 10.2 fL demonstrated a notably elevated risk of cardiovascular mortality in all three models.

This groundbreaking study concludes that MPV is independently associated with both all-cause mortality and cardiovascular mortality in patients undergoing peritoneal dialysis. These findings offer valuable insights into the potential role of MPV as a prognostic marker for mortality risks in the context of PD. 

Also Read: Abbreviated DAPT regimen more beneficial to women compared to men: JAMA

The implications of this research extend beyond the specific patient population studied, prompting further exploration of MPV as a potential biomarker in other medical contexts. As the scientific community continues to uncover the intricate relationships between platelet volume and health outcomes, these findings open new avenues for understanding and managing mortality risks in diverse patient groups.

Further reading: Mean platelet volume and the association with all-cause mortality and cardiovascular mortality among incident peritoneal dialysis patients. https://doi.org/10.1186/s12872-023-03551-x

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Type 1 diabetes during pregnancy may increase risk of most types of congenital heart defects in offsprings: JAMA

Finland: A recent study published in JAMA Network Open has revealed type 1 diabetes (T1D) to be a risk factor associated with all subtypes of congenital heart defects (CHDs), while obesity and overweight were associated with certain CHD types, indicating distinct teratogenic mechanisms.

The cohort study of over 620,000 children revealed that maternal T1D was associated with a 3.77-fold increase in adjusted odds for any CHD in offspring and the risk was increased in six of nine CHD subgroups. There are associations between obesity and overweight with odds of offspring CHD in a few anatomical subgroups.

Maternal diabetes and obesity or overweight are known to be associated with increased CHD risk in offspring, but no large studies have analyzed outcomes associated with these factors in 1 model. To fill this knowledge gap, Riitta Turunen, Helsinki University Hospital and University of Helsinki, Helsinki, Finland, and colleagues aimed to investigate the association of maternal diabetes and overweight or obesity with CHDs among offspring in 1 model in a nationwide, population-based register study.

The study was conducted in a birth cohort from Finland comprising children born from 2006-2016 (620 751 individuals) and their mothers. The researchers assessed maternal prepregnancy body mass index (BMI), categorized as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obesity (≥30). They also classified maternal diabetes status as no diabetes, type 1 diabetes, type 2 or other diabetes, and gestational diabetes, was assessed.

Odds ratios (ORs) of isolated CHDs were found in children. In addition, nine anatomical CHD subgroups were studied.

The study led to the following findings:

  • Of 620 751 children (51.0% males; 92.3% of mothers aged 20-40 years) born in Finland during the study period, 1.7% of children had an isolated CHD.
  • Maternal type 1 diabetes was associated with increased odds of having a child with any CHD (OR, 3.77) and 6 of 9 CHD subgroups (OR range, 3.28 for other septal defects to 7.39 for transposition of great arteries) compared with no maternal diabetes.
  • Maternal overweight was associated with left ventricular outflow tract obstruction (OR, 1.28) and ventricular septal defects (OR, 0.92), and obesity was associated with complex defects (OR, 2.70) and right outflow tract obstruction (OR, 1.31) compared with normal maternal BMI.

The cohort study emphasizes T1D as a risk factor linked with offspring CHDs, whereas gestational diabetes and maternal obesity and overweight were associated with a smaller risk in risk, at least in this high-resource setting with universal antenatal care. The risk at the population level is substantial with an increasing prevalence of maternal overweight and GD.

It has been shown that standard maternal diabetes treatment is linked with a lowered risk of anatomical malformations in offspring. This, primary prevention of maternal obesity and overweight and careful treatment of pregestational diabetes may hold the opportunity to lower the disease burden.

“The prevention of these CHD subtypes may be further improved by a better understanding of the underlying mechanisms of maternal obesity and obesity in increased offspring risk for left ventricular outflow tract obstruction (LVOTO), right ventricular outflow tract obstruction (RVOTO), and other complex defects,” the researchers wrote.

Reference:

Turunen R, Pulakka A, Metsälä J, et al. Maternal Diabetes and Overweight and Congenital Heart Defects in Offspring. JAMA Netw Open. 2024;7(1):e2350579. doi:10.1001/jamanetworkopen.2023.50579

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Totally magnetic technique effective option for sentinel lymph node detection and breast cancer localization

Totally magnetic technique effective option for sentinel lymph node detection and breast cancer localization suggests a new study published in the JAMA Surgery

Guidewires have been the standard for breast lesion localization but pose operative and logistic challenges. Paramagnetic seeds have shown promising results, but to the authors’ knowledge, no randomized comparison has been performed.

A study was done to determine whether the combination of a paramagnetic seed and superparamagnetic iron oxide (SPIO) is equivalent to guidewire and SPIO for breast cancer localization and sentinel lymph node detection (SLND).

This was a phase 3, pragmatic, equivalence, 2-arm, open-label, randomized clinical trial conducted at 3 university and/or community hospitals in Sweden from May 2018 to May 2022. Included in the study were patients with early breast cancer planned for breast conservation and SLND. Study data were analyzed July to November 2022.

Participants were randomly assigned 1:1 to a paramagnetic seed or a guidewire. All patients underwent SLND with SPIO.

Results

A total of 426 women were included in the study. The re-excision rate was 2.90%, and the median (IQR) resection ratio was 1.96 (1.15-3.44). No differences were found between the guidewire and the seed in re-excisions (6 of 211 [2.84%] vs 6 of 209 [2.87%]; difference, −0.03%; 95% CI, −3.20% to 3.20%; P = .99) or resection ratio (median, 1.93; IQR, 1.18-3.43 vs median, 2.01; IQR, 1.11-3.47; P = .70). Overall SLN detection was 98.6% (95% CI, 97.1%-99.4%) with no differences between arms (203 of 207 [98.1%] vs 204 of 206 [99.0%]; difference, −0.9%; 95% CI, −3.6% to 1.8%; P = .72). More failed localizations occurred with the guidewire (21 of 208 [10.1%] vs 4 of 215 [1.9%]; difference, 8.2%; 95% CI, 3.3%-13.2%; P < .001). Median (IQR) time to specimen excision was shorter for the seed (15 [10-22] minutes vs 18 [12-30] minutes; P = .01), as was the total operative time (69 [56-86] minutes vs 75.5 [59-101] minutes; P = .03). The experience of surgeons, radiologists, and surgical coordinators was better with the seed.

The combination of SPIO and a paramagnetic seed performed comparably with SPIO and guidewire for breast cancer conserving surgery and resulted in more successful localizations, shorter operative times, and better experience.

Reference

Pantiora E, Jazrawi A, Hersi A, et al. Magnetic Seed vs Guidewire Breast Cancer Localization With Magnetic Lymph Node Detection: A Randomized Clinical Trial. JAMA Surg. Published online December 27, 2023. doi:10.1001/jamasurg.2023.6520

Keywords:

Totally, magnetic, technique, effective, option, for, sentinel, lymph, node, detection, and, breast, cancer, localization, Pantiora E, Jazrawi A, Hersi A, JAMA Surgery

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Heat shock protein 90 inhibition effective and safe option against Hidradenitis Suppurativa

In a recent clinical trial discovered promising outcomes of heat shock protein 90 inhibition by RGRN-305 for individuals suffering from moderate to severe Hidradenitis Suppurativa (HS), a painful immune-mediated disorder. This results were published in Journal of American Medical Association.

The randomized clinical study was conducted from September 22, 2021, to August 29, 2022 at the Department of Dermatology, Aarhus University Hospital in Denmark. The study included 15 patients who met eligibility criteria-aged 18 or older with moderate to severe HS and aimed to evaluate the feasibility of using RGRN-305, a heat shock protein 90 inhibitor in treating the disorder.

The patients randomly received either oral RGRN-305, a 250-mg tablet, or a matching placebo once daily for 16 weeks. The primary efficacy endpoint was the percentage of patients achieving Hidradenitis Suppurativa Clinical Response 50 (HiSCR-50) at week 16.

The trial demonstrated that the RGRN-305 group outperformed the placebo group in achieving HiSCR-50 at week 16, with 60% compared to 20%, respectively. Secondary endpoints included HiSCR-75 and HiSCR-90, Dermatology Life Quality Index scores, and a pain numeric rating scale, also showed significant improvements in the RGRN-305 group.

The safety of RGRN-305 was significant in the study, with no deaths or serious adverse events reported. Treatment-emergent adverse events were equally distributed between the RGRN-305 and placebo groups which indicated that this treatment was well-tolerated.

These highlights suggest that heat shock protein 90 inhibition by RGRN-305 presents a promising mechanism of action against Hidradenitis Suppurativa. The success of this trial underscores the importance of further evaluation in larger-scale cohorts to improve and ease the quality of life of individuals with this painful immune disorder.

Source:

Ben Abdallah, H., Bregnhøj, A., Emmanuel, T., Ghatnekar, G., Johansen, C., & Iversen, L. (2023). Efficacy and Safety of the Heat Shock Protein 90 Inhibitor RGRN-305 in Hidradenitis Suppurativa. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2023.4800

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Elevated preclinical blood glucose may increase hospitalization and associated mortality risk of patients

Germany: A single-centre retrospective cohort study published in the Journal of the American College of Emergency Physicians Open has shed light on the association of preclinical blood glucose with hospitalization rate and in-hospital mortality.

The researchers revealed that elevated prehospital blood glucose (PBG) ≥140 mg/dL was associated with a higher mortality risk, longer stay, and higher hospitalization risk. They may, therefore, be useful in risk assessment scores.

Critical illness is often accompanied by increased blood glucose which is correlated with increased mortality and morbidity. Prehospital blood glucose levels might be an easy-to-perform and useful tool for risk assessment in emergency medicine. Simon Kloock, Department of Internal Medicine Division of Endocrinology and Diabetes University Hospital University of Würzburg Würzburg Germany, and colleagues aimed to analyze the association of prehospital glucose measurements with in-hospital mortality and hospitalization rate.

For this purpose, the researchers analyzed records of 970 patients admitted to a university hospital by an emergency physician. A comparison was drawn between patients with a PBG ≥140 mg/dL (G1, n = 394, equal to 7.8 mmol/L) and patients with a PBG <140 mg/dL (G2, n = 576). Multivariable logistic regression models were used to correct for prediagnosed diabetes, age, and sex. Five hundred thirty-four patients (55%) were hospitalized.

The study revealed the following findings:

  • In comparison to normoglycemic patients, hyperglycemic patients were more likely to be hospitalized with an adjusted odds ratio (OR) of 1.48, more likely to die in the hospital with an adjusted OR of 1.84, and more likely to be admitted to the intensive care unit (ICU) with an adjusted OR of 1.74.
  • Hospitalized hyperglycemic patients had a median length of stay of 6.0 days compared to 3.0 days in the normoglycemic group.
  • In the subgroup analysis of cases without known diabetes, patients with PBG ≥140 mg/dL were more likely to be hospitalized with an adjusted OR of 1.49 and more likely to be admitted to ICU/intermediate care with an adjusted OR of 1.80, compared to normoglycemic patients.

“Prehospital point-of-care testing (POCT) of glucose might indicate stress hyperglycemia and show an association with the patient’s in-hospital mortality rate and admission rate,” the researchers wrote. “Therefore, it might contribute to the risk assessment of a patient.”

“As elevated prehospital blood glucose might be more relevant in specific diseases, there is a need for further studies to identify specific diagnoses with high relevance of elevated PBG,” they concluded, adding that an elevated PBG might contribute to future scoring systems.

Reference:

Kloock, S., Skudelny, D., Kranke, P., Güder, G., Weismann, D., Fassnacht, M., Ziegler, C., & Dischinger, U. (2024). Association of preclinical blood glucose with hospitalization rate and in-hospital mortality: A single-center retrospective cohort study. Journal of the American College of Emergency Physicians Open, 5(1), e13091. https://doi.org/10.1002/emp2.13091

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Eligibility certificate: NMC Gives Deadline to 1060 students for rectifying deficiencies in applications

Delhi: The National Medical Commission (NMC) has given a deadline to all students, who have proceeded abroad without obtaining an Eligibility Certificate, for submitting their deficiencies through the eligibility portal of NMC. 1060 applicants are mentioned in the list released the NMC.

The NMC notified on the recent scrutiny process of applications received for eligibility certificates. EMRB, NMC has diligently reviewed the applications submitted by various applicants. After careful evaluation, NMC has identified deficiencies in applications at Annexure-I in the notice below.

In this connection, attention is invited to section 13(4B) of the Indian Medical Council Act, 1956it is stated that –

“(4B) A person who is a citizen of India shall not, after such date as may be specified by the Central Government under sub-section (3), be eligible to get admission to obtain medical qualification granted by any medical institution in any foreign country without obtaining an eligibility certificate issued to him by the Council and in case any such person obtains such qualification without obtaining such eligibility certificate, he shall not be eligible to appear in the screening test referred to in sub-section (4A): Provided that an Indian citizen who has acquired the medical qualification from foreign medical institution or has obtained admission in foreign medical institution before the commencement of the Indian Medical Council (Amendment) Act, 2001 shall not be required to obtain eligibility certificate under this sub-section but, if he is qualified for admission to any medical course for recognized medical qualification in any medical institution in India, he shall be required to qualify only the screening test prescribed.”

Also Read:972 Students went to study MBBS abroad sans eligibility certificate, NMC gives deadline for applications, warns of rejection

The requirement of taking an Eligibility Certificate before proceeding abroad has been dispensed w.e.f the declaration of result of NEET-UG 2019 vide public notice dated 05.04.2019 and accordingly after 05 June 2019, qualifying NEET-UG Exam has been made mandatory and shall be deemed to be treated as an Eligibility Certificate for Indian/OCI citizen intending to take admission in MBBS or equivalent Medical Course in any Foreign Medical Institution.

It is observed that applicants whose name is mentioned in Annexure-I have proceeded abroad without obtaining an Eligibility Certificate. Therefore, it has been decided by the Board to give 03 days’ time to all such applicants (Annexure-I) to submit their deficiencies through the eligibility portal of NMC. In case, the applicants whose name is mentioned in Annexure-I do not fulfil the deficiency or do not submit the applications within 03 days from the date of publication of this notice the applications will be summarily rejected.

Timely rectification of the deficiencies will expedite the processing of the eligibility certificates otherwise found fit for grant of such Certificates and help the applicants move forward with their respective endeavours.

The detailed list of applicants who must submit their deficiencies is enclosed in the notice below. 1060 applicants are mentioned in the list.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/public-notice-regarding-pending-with-initiator-dated-07012024-229533.pdf

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Justify Durvalumab dose: CDSCO Panel Tells AstraZeneca on Study of Dato-DXd and Durvalumab

New Delhi: Reviewing the drug major AstraZeneca’s Phase III clinical trial protocol of the anti-cancer drug of Dato-DXd and Durvualumab, the Subject Expert Committee (SEC) functional under the Central Drug Standard Control Organisation (CDSCO) has recommended the firm to submit supportive documents for the selection of Durvalumab dose of 1120mg every three weeks instead of 1500mg.

Furthermore, the expert panel suggested to include more geographically distributed government sites.

This came after the drug major AstraZeneca presented Phase III clinical trial protocol No. D7630C00001. This study is a phase III study of Dato-DXd with or without Durvalumab compared with the investigator’s choice of chemotherapy in combination with Pembrolizumab in patients with PD-L1 positive locally recurrent inoperable or Metastatic Triple-negative Breast Cancer (TNBC).

This is a Phase III, randomised, open-label, 3-arm, a multicentre, international study assessing the efficacy and safety of Dato-DXd with or without durvalumab compared with investigator’s choice chemotherapy in combination with pembrolizumab in participants with PD-L1 positive locally recurrent inoperable or metastatic TNBC.

Datopotamab Deruxtecan (Dato-DXd), a Novel TROP2-directed Antibody–drug Conjugate, demonstrates potent antitumor activity by efficient drug delivery to tumor cells. The pharmacologic activity and mechanism of action of Dato-DXd were investigated in several human cancer cell lines and xenograft mouse models including patient-derived xenograft (PDX) models.

Durvalumab injection is in a class of medications called monoclonal antibodies. It works by helping the immune system to slow or stop the growth of cancer cells.

Durvalumab is used alone to treat non-small cell lung cancer (NSCLC) that spreads to nearby tissues and cannot be removed by surgery but has not worsened after being treated with other chemotherapy medications and radiation treatments. It is also used in combination with tremelimumab-actl (Imjudo) and platinum-based chemotherapy to treat a certain type of NSCLC that has spread throughout the lungs and to other parts of the body.

Durvalumab injection is also used in combination with chemotherapy agents to treat extensive-stage small cell lung cancer (ES-SCLC) in adults whose cancer has spread throughout the lungs and to other parts of the body. It is also used in combination with chemotherapy agents to treat biliary tract cancer (BTC; cancer in the organs and ducts that make and store bile, the liquid made by the liver) in adults whose cancer has spread to nearby tissues or to other parts of the body.

At the recent SEC meeting for Oncology and Hematology held on 21st and 22nd December 2023, the expert panel reviewed the Phase III clinical trial protocol No. D7630C00001.

After detailed deliberation, the committee opined that the firm should submit supportive documents for the selection of Durvalumab dose of 1120mg every three weeks instead of 1500mg and include more geographically distributed Govt. sites for further review by the committee.

Also Read: Justify Clinical Relevance of Higher Strength of Caroverine Capsules: CDSCO Panel Tells Lincoln Pharma

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Use of intra-articular vancomycin safe in primary hip and knee arthroplasty

The use of a single dose of intra-articular antibiotic (IAA) has been reported in reducing the rate of prosthetic joint injection after total hip and knee arthroplasty. A.W.R. Burns et al examined the safety of IAA in primary hip and knee replacement surgery and the blood levels and joint fluid levels of vancomycin utilising this technique. It has been published in “Journal of Orthopaedics.”

From August to October 2021, 68 patients undergoing primary total joint arthroplasty (THA & TKA) were given 1g vancomycin intra-articularly (IA) after closure of the fascia. All patients received 2g cefazolin intravenously (IV) 30 min prior to the procedure as is the standard prophylaxis, and 21 of the patients (IA + IV) were also administered an additional 1 gm vancomycin IV. Post-operative blood vancomycin, creatinine and eGFR level monitoring was performed day1 and day3. To determine the post-operative intra-articular vancomycin levels, surgical drain fluid was sampled at day 1 and 2, in 10 patients.

Key findings of the study were:

• In the group where vancomycin was injected after fascial closure, the average blood vancomycin level day 1 was 5.2 μg/ml (range 2.0–10.9) and day 3 was < 1.4 μg/ml.

• The average pre-op creatinine levels were 69.4 μmol/L (56.1–82.6) compared to 70.2 μmol/L (57.0–83.4) on day 1 and 66.1 μmol/L (52.6–79.6) on day 3, (p = 0.663).

• The average pre-op eGFR levels (ml/ min/1.73 m2) were 82.2 (76.0–88.3) compared to 81.7 (75.6–87.8) on day 1 and 83.0 (76.8–89.2) on day 3 (p = 0.736).

• Samples of joint fluid aspirated from surgical drains on day 1 and day 2 showed average vancomycin levels of 224 μg/ml and 51 μg/ml respectively, significantly higher than the MIC for Staph aureus.

The authors concluded that – “The use of IA vancomycin in TJA is appears safe, providing high antibiotic levels within the joint itself, with no renal or auditory complications in our investigation. Whilst role of IA antibiotics is evolving and its position in total joint replacement has not yet been fully determined, these finding may stimulate further study in this area of clearly significant importance in the prevention of PJI.”

Further reading:

The use of intra-articular vancomycin is safe in primary hip and knee arthroplasty

Alexander W.R. Burns, Tat Chao et al

Journal of Orthopaedics 46 (2023) 161–163

https://doi.org/10.1016/j.jor.2023.10.017

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Direct Percutaneous Endoscopic Jejunostomy Effective Alternative to surgical jejunostomy for Feeding Access

A recent retrospective study by John Locke and team suggests important inputs on the efficacy and safety of various methods for jejunostomy tube placements which provides enteral access for patients who are unable to meet nutritional needs orally. The findings were published in the journal of Gastrointestinal Endoscopy.

The study was conducted to compare procedural success rates and complications by examining three approaches: direct percutaneous endoscopic jejunostomy (DPEJ), laparoscopic (lap-J), and open laparotomy (open-J). These methods are imperative for patients who require alternative feeding routes due to their inability to consume sufficient nutrients orally.

The research was based on data from 201 patients which was classified into DPEJ, lap-J, and open-J cohorts, demonstrated comparable procedural success rates among the three groups (DPEJ 96.9%, Lap-J 99.1%, Open-J 100%, p=0.702). The infection and bleeding rates were also similar across the board with no reported cases of gastrointestinal perforation.

This study uncovered significant findings related to tube dysfunction within 90 days. The cases requiring complete removal and/or replacement were notably lower in the DPEJ group (0%) when compared to the surgical groups (lap-J 35.1%, open-J 40.0%, p<0.001). This discrepancy was primarily from increased incidents of tube clogging and dislodgement in the surgical approaches.

The findings of the study concludes that DPEJ emerges is a safe and effective alternative to surgical jejunostomy for eligible patients. DPEJ might offer a potential advantage beyond its efficacy by significantly reducing the complication rates at the critical 90-day mark. This outcomes are important for medical practitioners and patients who seek optimal enteral access solutions when considering the postoperative recovery and maintenance aspects of the jejunostomy tube placements.

Reference:

Locke, J., Norwood, D., Forrister, N., Ahmed, A. M., Aryan, M., Oster, R., Reddy, S., Kabir Baig, K. K., & Peter, S. (2023). Safety and Efficacy of Direct Percutaneous Endoscopic Jejunostomy Tube Placement Compared with Surgical Jejunostomy: A Tertiary Care Analysis. In Gastrointestinal Endoscopy. Elsevier BV. https://doi.org/10.1016/j.gie.2023.12.013

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