Genicular artery embolization improves knee function for 3 months in knee osteoarthritis patients

Osteoarthritis is a common musculoskeletal disease that affects weight-bearing joints like the hip and knee. It affects 13.4% of the European population. Knee osteoarthritis, in particular, can significantly reduce a person’s ability to work and participate in leisure activities. There is no cure for knee osteoarthritis, but medications and non-pharmacological treatments can help manage symptoms and slow its progression. In severe cases, total or partial knee replacement surgery may be necessary.

An Original article published in Diagnostic and Interventional Imaging concluded thatGenicular artery embolization improves pain and knee function for at least three months in patients with a history of knee osteoarthritis.

This study is published according to a study published on December 15 in Diagnostic and Interventional Imaging.

This study assessed the safety and efficacy of transient genicular artery embolization (GAE) with an ethiodized oil-based emulsion for treating KOA.

This study was a prospective, single-arm, open-label, multicenter, first-in-human cohort trial. The main inclusion criterion was a diagnosis of KOA with a VAS pain score of ≥40 mm despite conservative treatment for at least three months. Treatment efficacy was assessed using changes in VAS pain score, normalized WOMAC function score (ranging from 0-100), and OMERACT-OARSI responder criteria.

Key findings from this study are:

  • Twenty-two patients with a mean age of 66 years were included and underwent GAE.
  • The emulsion consisted of a mixture of ioversol and ethiodized oil in a ratio of 1:3, which was prepared extemporaneously.
  • The serious adverse events rate attributed to GAE within one month was 5%, with reversible worsening of renal function. The immediate technical success rate was 100%.
  • The mean VAS pain score dropped from 74.4 ± 16.5 mm to 37.2 ± 26.7 mm (from baseline to three months).
  • The mean WOMAC function score decreased from 57.3 ± 17.1 to 33.5 ± 25.9 at three months.
  • At three months, 16/22 participants (73%) were considered responders according to the OMERACT-OARSI set of responder criteria, including high improvement in either pain or WOMAC function or improvement in both.

In conclusion, they wrote, “Our study highlighted that Genicular artery embolization is a new treatment modality for managing cases of KOA. They found ethiodized oil-based emulsion to be safe in the treatment.

Reference:

Sapoval et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial. Diagnostic and Interventional Imaging.

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Modified Epley maneuver bests traditional approach for treating PC-benign paroxysmal positional vertigo

China: A recent study has revealed the modified Epley maneuver is more effective than the traditional Epley maneuver in improving the single repositioning success rate and reducing the canal switching rate for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV).

A modified Epley maneuver for posterior semicircular canal BPPV treatment, involving extended time in the healthy side-lying position and final bowing, achieved an impressive 85% success rate after the first attempt, compared to the traditional Epley maneuvre’s success rate of 63%,” the researchers reported in Frontiers in Neurology.

” After two attempts, the experimental group reached 100% repositioning success, while the control group required three attempts for an 86% success rate.”

Benign paroxysmal positional vertigo is a prevalent cause of vertigo, accounting for 17–42% of reported cases. Manifesting as brief episodes of nystagmus and vertigo, BPPV is triggered by alterations in head position relative to gravity, such as turning over, lying down, or standing up. BPPV is further divided based on the involved semicircular canal, with posterior canal BPPV (PC-BPPV) being the most prevalent, accounting for 80% of cases.

Xiaosu Chen, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou, China, and colleagues compared the repositioning effect of the modified Epley maneuver and the traditional Epley maneuver for posterior semicircular canal benign paroxysmal positional vertigo.

The study included sixty-five patients with unilateral PC-BPPV. They were randomly divided into two groups: the experimental group received the modified Epley maneuver, which prolonged the time in the healthy side-lying position and the final bowing position and the control group received the traditional Epley maneuver.

The researchers recorded and compared the number of successful repositions after one, two, and three attempts and the total number of successful repositions between the two groups. A BPPV virtual simulation model was used to analyze the mechanism of the modified Epley maneuver.

The study revealed the following findings:

  • The first repositioning success rate of the experimental group was significantly higher than that of the control group (85% versus 63%).
  • The experimental group achieved a 100% repositioning success rate after two attempts, while the control group needed three attempts to reach an 86% repositioning success rate.
  • Four cases in the control group experienced canal switching during the repositioning process, while none in the experimental group did.
  • The BPPV virtual simulation model showed that the modified Epley maneuver could facilitate the passage of otoliths through the posterior arm of the posterior semicircular canal, especially through the location of the obstruction.

“Our study contributes a novel treatment approach for posterior canal BPPV patients, particularly those with refractory cases, offering a promising therapeutic option,” the researchers concluded.

Reference:

Chen, X., Mao, J., Ye, H., Fan, L., Tong, Q., Zhang, H., Wu, C., & Yang, X. (2023). The effectiveness of the modified Epley maneuver for the treatment of posterior semicircular canal benign paroxysmal positional vertigo. Frontiers in Neurology, 14, 1328896. https://doi.org/10.3389/fneur.2023.1328896

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Thrombolytics in cardiac arrest from pulmonary embolism may lead to return of spontaneous circulation

USA: The use of intravenous (IV) thrombolytics during cardiac arrest due to presumed pulmonary embolism (PE) may provide clinical benefits, findings from a meta-analysis have shown. The findings were published online in the Journal of Intensive Care Medicine on November 30, 2023. 

“Using IV thrombolytics in cardiac arrest due to presumed or confirmed PE is linked with increased return of spontaneous circulation (ROSC) but not survival to hospital or change in bleeding complications,” reported Jordan Feltes, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, and colleagues.

They continued, “Currently, we recommend continuing to follow existing consensus guidelines supporting thrombolytics use for this indication.”

IV thrombolytics are commonly used for patients whose underlying aetiology of cardiac arrest is presumed to be related to pulmonary embolism during cardiopulmonary resuscitation. Dr Feltes and colleagues aimed to evaluate clinical outcomes in patients who received thrombolytics during cardiac arrest secondary to pulmonary embolism.

For this purpose, the researchers performed a systematic review and meta-analysis of the existing literature focusing on thrombolytics use for cardiac arrest due to confirmed or presumed PE. Outcomes of interest included the return of spontaneous circulation, neurologically intact survival, survival to hospital discharge, and bleeding complications.

The review included thirteen studies comprising 803 patients. Most studies included were retrospective and single-armed.

The study led to the following findings:

  • Thrombolytic agent and dose were heterogeneous between studies.
  • Among those with control groups, intravenous thrombolysis was associated with higher rates of ROSC (OR 2.55), but without a significant difference in survival to hospital discharge (OR 1.41) or bleeding complications (OR 2.21).

The authors noted that most of the studies included were prospective observational trials, retrospective reviews, or subgroup analyses of randomized clinical trials (RCTs) and demonstrated significant heterogeneity in methods and outcomes.

“The findings showed that ROSC was more common among patients who received thrombolytics compared with those who did not; however, there was no significant difference in bleeding complications or survival to hospital discharge,” the researchers wrote.

“There is a need for larger randomized studies to validate this finding,” they concluded.

Reference:

Feltes, J., Popova, M., Hussein, Y., Pierce, A., & Yamane, D. (2023). Thrombolytics in Cardiac Arrest from Pulmonary Embolism: A Systematic Review and Meta Analysis. Journal of Intensive Care Medicine. https://doi.org/10.1177/08850666231214754

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Prolonged second stage of labor in epidural analgesia deliveries tied to increased risk of postpartum urinary retention

Japan: A recent study published in the Journal of Obstetrics and Gynaecology Research revealed a significantly higher postpartum urinary retention rate (30% versus 11%) in the case of epidural analgesia deliveries compared to the no epidural group.

The researchers identified a prolonged second stage of labour as an independent risk factor for postpartum urinary retention (OR: 3.18), along with other factors such as primiparity. All patients recovered from postpartum urinary retention by day 4.

Keisuke Miyamoto, Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan, and colleagues aimed to determine the postpartum urinary retention rate and risk factors after delivery using epidural analgesia in a single-centre retrospective study.

The study included 341 women who gave birth after at least 37 weeks of gestation from April to August 2021; from this cohort, 208 patients were examined. A comparison was done of the postpartum urinary retention rate between the epidural analgesia group (n = 101) and the no epidural analgesia group (n = 107. In the epidural analgesia group, risk factors for postpartum urinary retention were investigated.

The study revealed the following findings:

  • After adjustment by propensity score matching for age, body mass index, being primiparous, and labour induction as covariates, the analysis of the incidence of postpartum urinary retention revealed that the epidural analgesia group exhibited a significantly higher postpartum urinary retention rate than the no epidural analgesia group (30% versus 11%).
  • The investigation results regarding risk factors for postpartum urinary retention in the epidural analgesia group obtained through a univariate analysis showed that being primiparous and having a prolonged second stage of labour were significantly correlated with postpartum urinary retention.
  • Multivariate analysis indicated that a prolonged second stage of labour was an independent risk factor for postpartum urinary retention (odds ratio: 3.18).
  • All patients recovered from postpartum urinary retention by day 4.

“The findings show that the postpartum urinary retention rate after delivery using epidural analgesia was 25.7%,” the researchers wrote. “In the case of epidural analgesia deliveries, a prolonged second stage of labour was an independent risk factor for postpartum urinary retention.”

Reference:

Miyamoto, K., Komatsu, H., Nagata, H., Nagira, K., Motomura, E., Shimizu, N., & Tanaka, A. Prolonged second stage of labor in delivery using epidural analgesia is a risk factor for postpartum urinary retention. Journal of Obstetrics and Gynaecology Research. https://doi.org/10.1111/jog.15867

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CABG associated with lower six-year mortality among women with multivessel disease

A comprehensive retrospective study comparing the outcomes of two common treatments, percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), for women with multivessel coronary artery disease reveals crucial differences in long-term results. The researchers found that CABG is associated with lower six-year mortality among women with multivessel disease.

This study was published in The Journal Of Thoracic and Cardiovascular Surgery by Edward Hannan and colleagues.

The research, conducted using the New York State cardiac registry data from 2012 to 2018, assessed outcomes in women with multivessel coronary artery disease who underwent either PCI with everolimus-eluting stents or CABG. Here are the primary findings:

  • Mortality Risk: PCI was associated with a higher six-year risk of mortality compared to CABG (25.75% vs. 23.57%).

  • Composite Major Adverse Cardiac Events: PCI showed a higher rate of the composite outcome of death, myocardial infarction, and stroke (36.58% vs. 32.89%).

  • Myocardial Infarction: Patients undergoing PCI had a significantly higher rate of myocardial infarction compared to those undergoing CABG (14.94% vs. 9.12%).

  • Stroke: There was no significant difference in stroke rates between the two interventions.

  • Repeat Revascularization: PCI was associated with higher rates of repeat revascularization (21.53% vs. 11.57%).

The study’s analysis suggests that for women with multivessel coronary artery disease, CABG appears to offer more favorable long-term outcomes compared to PCI with everolimus-eluting stents. The findings highlight the importance of considering the optimal treatment strategy, especially for female patients with this specific condition.

  • No Mortality Difference in Certain Groups: Notably, when PCI patients received complete revascularization or had non-complex lesions, and among women without diabetes, there was no significant mortality difference between the interventions.

  • Lower Repeat Revascularization with CABG: The study also underscores the advantage of CABG over PCI in reducing the need for repeat revascularization procedures in this patient population.

The study findings highlight the importance of weighing the risks and benefits of different treatment strategies for women with multivessel coronary artery disease. While PCI with everolimus-eluting stents remains a viable option, the study suggests that CABG might offer more favorable long-term outcomes, emphasizing the need for individualized treatment approaches in clinical practice.

Reference:

Hannan, E. L., Wu, Y., Harik, L., Tamis-Holland, J., Jacobs, A. K., Chikwe, J., Cozzens, K. S., & Gaudino, M. Coronary artery bypass surgery vs. Percutaneous interventions for women with multivessel coronary artery disease. The Journal of Thoracic and Cardiovascular Surgery,2023. https://doi.org/10.1016/j.jtcvs.2023.12.009

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Gut microbiota dysbiosis tied to progression of chronic kidney disease

Diet, drugs, and toxins affect gut bacteria, which can contribute to chronic kidney disease. Understanding the gut microbiota may lead to new ways to slow CKD progression.

According to a recent original paper on Nephrology published in International Urology and Nephrology, gut microbiota dysbiosis significantly affects CKD progression. CKD patients exhibit distinct microbial profiles, indicating the potential for microbiota-based interventions to slow CKD progression.”

Gut microbiota dysbiosis significantly contributes to the development and complications of chronic kidney disease (CKD). By comprehending the intricacies of the intestinal microbiota, this research endeavor holds the potential to offer novel perspectives on strategies to mitigate CKD progression.

This study analyzed the gut microbiota composition of 44 stage 3-4 CKD patients and 132 healthy volunteers. Faecal samples were collected, and 16 s rDNA sequencing was conducted to examine the gut microbiota composition.

The key points of this study are:

  • Researchers reported altered diversity of intestinal microbiota in faecal samples in stage 3–4 CKD patients.
  • Among the 475 bacterial genera, 164 were shared, while 242 dominant genera were exclusive to healthya subjects and 69 to CKD stages 3–4 samples.
  • Healthy volunteers had a prevalence of intestinal Firmicutes and Bacteroidetes.
  • CKD patients had a higher abundance of Proteobacteria and Actinobacteria.
  • The presence of uncultured Coprobacillus sp. significantly aided the distinction between the two groups.
  • ROC curve analysis distinguished microbiota with high diagnostic accuracy for differentiating CKD stage 3-4 patients from healthy people.
  • Metabolic dominant pathway analysis found that healthy individuals had NADH dehydrogenase pathways, while stage 3-4 CKD patients had a phosphate acetyltransferase pathway. Additionally, CKD patients had more Gram-negative bacteria and facultative anaerobes.
  • CKD cohort had a higher proportion of Gram-negative bacteria and facultative anaerobes.

Von et al. and colleagues said, “Our research emphasizes the significant impact of gut microbiota imbalances on chronic kidney disease (CKD) progression. The unique microbial patterns identified in CKD patients suggest that microbiota-focused interventions could effectively slow down CKD progression.”

Reference:

Yang, X., Cai, S., Gong, J. et al. Characterization of gut microbiota in patients with stage 3–4 chronic kidney disease: a retrospective cohort study. Int Urol Nephrol (2023). https://doi.org/10.1007/s11255-023-03893-7

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Study Suggests Genetic Factors Influence Dementia-Linked Mortality

New insights into the link between dementia and mortality have emerged from a comprehensive investigation utilizing case-control and co-twin control models. Conducted by researchers using data from the Swedish Twin Registry, the study explored the interplay of genetic and environmental influences on the association between dementia and increased mortality risk. This study was published in the journal Alzheimer’s & Dementia by Jung Yun Jang and colleagues.

The study encompassed 987 twins diagnosed with dementia and 2938 age- and sex-matched controls. Results revealed that individuals with dementia exhibited a significantly greater mortality risk compared to their matched controls, with a hazard ratio (HR) of 2.02. However, the mortality risk, while still elevated, was notably lower in twins from discordant pairs—where one had dementia and the other did not—particularly in identical twins. For instance, comparing identical twins with dementia to their non-dementia co-twin controls yielded an HR of 1.48.

The findings, based on twin pairs discordant for dementia, suggest that genetic factors might play a significant role in influencing the association between dementia and mortality. Interestingly, identical twins with dementia and their non-dementia co-twins displayed a similar survival time, implying a potential genetic basis influencing the link between dementia and mortality.

Participants: 987 twins diagnosed with dementia and 2938 matched controls

Co-twin Control Design: Analyzed 90 monozygotic (MZ) and 288 dizygotic (DZ) twin pairs discordant for dementia

Mortality Risk Comparisons:

Twins with dementia had a higher mortality risk compared to matched controls (HR = 2.02)

Mortality risk was notably lower in discordant twin pairs, particularly among identical twins (HR = 1.48)

These intriguing findings prompt further exploration into the genetic underpinnings influencing the association between dementia and mortality. Understanding the role of genetic factors in this link may open avenues for more targeted interventions or personalized approaches in managing dementia-related mortality risks.

The study, shedding light on the potential genetic influence on dementia-related mortality, underscores the need for continued research to elucidate the intricate mechanisms driving this association.

Reference:

Jang, J. Y., Beam, C. R., Karlsson, I. K., Pedersen, N. L., & Gatz, M. Dementia and mortality in older adults: A twin study. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association,2023. https://doi.org/10.1002/alz.13553

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KEA Releases List Of Candidates With Incorrect Bank Details Along With Details Related To NEET UG Refund Process

Karnataka: Karnataka Examinations Authority (KEA) has released the list of candidates with incorrect bank account details along with details related to the NEET UG refund process.

The list of candidates who have not filled the correct bank account details has been released. These candidates will have to fill in the correct details till 31.12.2023. They must fill in the details online using their user ID and password. The list includes the Application, CETNO, and Candidate Name. The detailed list is enclosed in the notice below.

As per the notice, the refund process is under process. The refund money will be transferred directly to the bank account of the candidates who are eligible to get the refund as per the rules and who have cancelled their seats or paid excess fees or deposited the caution fee amount. The money will be transferred to the account mentioned in the application form.

Also Read:KEA Releases 1st Round Of Seat Allotment Schedule For MSc Nursing Courses

Karnataka Examinations Authority is governed by the Governing Council headed by the Honourable Minister of Higher Education. The Government of Karnataka established the Common Entrance Test Cell in the year 1994 for conducting entrance tests and determining the eligibility/merit for admission to the first year or first semester of full-time professional courses for Government share of seats in Medical, Dental, Indian systems of medicine and Homeopathy, etc.

Recently Medical Dialogues team reported that KEA has released the schedule for the BSc Allied Health Sciences mop-up round schedule. The process will begin on 28th December 2023 and be carried out till 5th January 2023. The process will begin with a document verification process and end with reporting to the allotted college. On 1st January 2023, the allotment result will be published, and the last day to report to the allotted college is 5th January 2023 before 5.30 pm.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/refundpublishmergedenglish-228718.pdf

Also Read:KEA Releases Schedule For BSc Allied Health Sciences Mop-Up Round

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Negligence: Doctor suspended by Gujarat Medical Council for 3 months

Taking action against a Surat-based doctor from Guru Nanak Hospital, the Gujarat Medical Council (GMC) has suspended his licence for three months for his alleged negligent approach while treating a patient, who ultimately died.

Even though the patient, who was initially taken to the hospital for treatment of common cold and fever, was physically weak, saline bottles were administered to her. Consequently, her condition worsened resulting in heart failure.

For more details, check out the link given below:

Negligence: Gujarat Medical Council Suspends Doctor For Three Months

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Northeast’s Folk medicine prowess to be harnessed with sustained effort at NEIAFMR: Shri Pema Khandu

New Delhi: Union Minister of Ports, Shipping & Waterways and Ayush, Shri Sarbananda Sonowal, and the Chief Minister of Arunachal Pradesh, Shri Pema Khandu laid the foundation stones for capacity expansion at the North Eastern Institute of Ayurveda and Folk Medicine Research (NEIAFMR) at Pasighat, Arunachal Pradesh today.

With a total investment of ₹53 crores, additional infrastructure will be developed at the institute.

The event was also graced by the Speaker of Arunachal Pradesh Legislative Assembly, Pasang Dorjee; the Minister of Health & Family Welfare, Women & Child Development and Tribal Affairs, Govt of Arunachal Pradesh, Alo Libang; the MP (Lok Sabha) for Arunachal East, Tapir Gao; MLA of 38 Pasighat East, Kaling Moyong; MLA of Pasighat West, Ninnog Ering; State Information Commissioner of Arunachal Pradesh, Gumjhum Haider; the Vice Chancellor of Arunachal Pradesh State University, Prof Tomo Riba among other dignitaries.

Also Read:Ayurveda boon in the era of nuclear power, pesticides, toxic environment: AYUSH Minister

Speaking on the occasion, the Union Minister of Ports, Shipping & Waterways and Ayush Shri Sarbananda Sonowal said, “Folk medicine has a rich heritage of healing humanity for thousands of years. It has remained among our communities helping generations to enrich their lives. Under the visionary leadership of Prime Minister Shri Narendra Modi ji, a sincere effort has been made to rejuvenate the traditional medicine including the folk medicine to bolster our healthcare system and provide people with an experience of enriched life experience.

Supplementing this effort, the Modi government has committed investment to build additional infrastructure at the North Eastern Institute of Ayurveda and Folk Medicine Research (NEIAFMR) which will build its capacity to act as a catalyst to strengthen its research and development in Ayurveda and folk medicine from the region. I am also happy to share with you all that a new centre on Sowa Rigpa will be set up in Arunachal Pradesh soon.”

The institute has also been working towards scientifically document, record, research as well as validate the folk medicine of the Northeast. The capacity expansion at the institute include an Academic building, hostels for boys and girls students, staff quarters as well as director’s bungalow. The hostels will accommodate 70 boys and 70 girls students from the institute.

The investment will cater to develop of additional infrastructure for opening of Ayurveda college for imparting quality in undergraduate course in Ayurveda, Bachelor of Ayurveda Medicine and Surgery (BAMS) as well as Post Graduate courses in due course of time. The new Ayurveda college at NEIAFMR, Pasighat will promote and develop Ayurveda through Education, Research and Extension Services. The Engineering Projects (India) Limited, a Government of India enterprise, is the executing agency for the project.

Speaking on the occasion, the Chief Minister of Arunachal Pradesh, Pema Khandu said, “We are very happy that an institution of Arunachal Pradesh – North Eastern Institute of Ayurveda and Folk Medicine Research (NEIAFMR) – is working towards harnessing the richness of folk medicine of the Northeast. Under the inspiring leadership of Prime Minister Shri Narendra Modi ji, institute capacity is being expanded that will not only help the traditional medicine from the region but also is an opportunity to document our age old folk medicine in a scientific manner for wider application in patient care beyond its traditional geographical reach.

Modi ji has always laid emphasis on the rejuvenation of India’s traditional medicine as it has proven its effectiveness to treat various ailments and enabling a better life experience. The region’s rich variety of medicinal plants with great commercial potential for Pharmaceutical, Ayurvedic & aromatic sectors unlocking commercial avenues for the state as well as for the Northeast.”

Elaborating on the role of NEIAFMR, the Shri Sarbananda Sonowal said, “Under the visionary leadership of Prime Minister Shri Narendra Modi, the Government is working towards rejuvenating the traditional form of medicines like Ayurveda, Yoga, Unani, Siddha, Homoeopathy, Sowa Rigpa and Naturopathy. As the nation cruise towards becoming an Atmanirbharta, the Ayush ministry is working relentless towards enabling our rich traditional medicinal system with scientific validation for wider usage in the pharmaceutical and patient care areas of medical science.

This is going to not only benefit our traditional healers community but also expand the scope of folk medicine, allowing it to reach greater number of people to heal and enrich their lives. The NEIAFMR is a leading institute of India that has been dedicatedly working towards reviving the folk medicine from the region. Our rich heritage of Ayurveda can also flourish from the local rich traditional medicinal practices. With this idea, the institute incorporated Ayurveda to further rejuvenate with a wider range of patient care solutions. In order to further bolster its effort, we are committed to develop this institute as the national hub of folk medicine.”

The North Eastern Institute of Ayurveda & Folk Medicine (NEIAFMR), Pasighat was established to strengthen and develop traditional healthcare, with special focus on the Northeast. It is functioning as the apex Research Centre for all aspects of Local Health Traditions (LHTs) and Ethno Medicinal Practices (EMPs). The Institute has also been working as a common ground for traditional healers, Ayurvedic researchers as well as scientific community in order to scientifically prove & validate the efficacy of traditional medicine towards enrichment of human lives.

The Govt aims to further strengthen NEIAFMR with infrastructure like (Regional Raw Drug Repository (RRDR) & Museum, Sophisticated Analytical Instrument Facility (SAIF), State of Art Panchakarma Treatment & Research Center, Paramedical Teaching Center, etc at NEAIFMR, Pasighat in the near future.

Also Read:Strenghthen AYUSH programmes to enhance quality of lives of people: Shri Sarbanand Sonowal

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