Sports-Related Sudden Cardiac Arrest rare but has high survivability: Study

A new study published in The Canadian Journal of Cardiology analyzed sports-related sudden cardiac arrest (Sr-SCA) across 5 Canadian provinces and revealed that middle-aged recreational athletes are more frequently affected than young competitive athletes. The research examined emergency medical services (EMS) records from 2016 to 2020 and found that Sr-SCA, while rare, has a relatively high survival rate due to prompt bystander intervention.

The study reviewed a total of 18,769 out-of-hospital cardiac arrests over a 5-year period and identified 339 cases (1.8%) as sports-related. The vast majority of cases (93.8%) occurred in men, with an average age of 58.1 years. The incidence rate was found to be 1.2 per 100,000 person-years, with men experiencing Sr-SCA at nearly 16 times the rate of women (2.3 vs. 0.2 per 100,000 person-years).

Contrary to the common perception that sudden cardiac arrest mainly affects young elite athletes, this study highlights the prevalence among middle-aged, recreational participants. Sr-SCAs were recorded across 52 different sports, with a significant majority occurring in recreational facilities (60.2%). These locations likely contribute to higher rates of bystander assistance, improving survival outcomes.

One of the key findings of this research was the high level of bystander intervention. Approximately 75.6% of Sr-SCAs were witnessed by others, and 73.6% of victims received bystander-initiated cardiopulmonary resuscitation (CPR). Automated external defibrillators (AEDs) were used by bystanders in 36.1% of cases, a crucial factor in improving survival chances.

Emergency medical services responded within a median time of 6.2 minutes, and 76.9% of cases presented with a shockable rhythm that increases the likelihood of successful defibrillation. Of those with known final outcomes, 52% survived to hospital discharge, though survival rates varied by sport.

The findings underline the importance of access to AEDs and CPR training in recreational sports facilities. The study suggests that increasing awareness and preparedness in these environments could further improve survival rates. Overall, the study highlights its impact on middle-aged recreational athletes and reinforces the importance of rapid response measures in saving lives, despite sports-related sudden cardiac arrest being rare.

Reference:

Visanji, M., Allan, K. S., Charette, M., Grunau, B., Roy, C., Goldstein, J., Choisi, T., de Montigny, L., Lin, S., Brissaw, J., Cameron-Dermann, L., Donoghue, M., Haines, M., Hutton, J., Nowroozpoor, A., Olszynski, P., Quinn, R., Vaillancourt, C., Carter, A., … Dorian, P. (2025). Sports-related sudden cardiac arrest in Canada: Incidence and survival. The Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2024.11.017

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Diabetes patients at higher risk of developing postoperative endophthalmitis after cataract surgery: Study

Researchers have found in a new study that patients with diabetes undergoing cataract surgery face a significantly higher risk of postoperative complications, including a 17% increased chance of postoperative endophthalmitis (POE) and more than three times the likelihood of posterior capsule rupture. However, the use of intracameral and topical antibiotics has been shown to effectively reduce the risk of endophthalmitis in these patients. This study published in the Journal of Ophthalmic Inflammation and Infection was conducted by Kai-Yang Chen and colleagues.

In order to evaluate the association of diabetes with the risk of POE, a systematic review and meta-analysis of articles until September 10, 2024, based on the data from PubMed, Scopus, Medline, Embase, and Google Scholar were done. Randomized controlled trials and observational studies were included if they compared POE outcomes in cataract surgery patients with individuals with and without diabetes.

Nine studies participated in the systematic review, among which seven were included in the meta-analysis. Researchers used random-effects models for estimating pooled odds ratios (ORs) at 95% confidence intervals (CIs), keeping results into consideration for the variability of study.

Key Findings

General incidence of POE was found to be 0.261% in the diabetic population and 0.242% among non-diabetics.

The combined odds ratio (OR) for POE development among individuals with diabetes was 1.174 (95% CI: 1.109 to 1.242; p = 0.000), validating significantly increased risk.

Men with diabetes were at increased risk as well, OR = 1.634 (p = 0.048).

It was significantly greater among those who had diabetes along with hypertension with an OR = 3.961 (p < 0.001).

Posterior capsule rupture (PCR) is an intraoperative complication of known etiology, more frequently observed in patients with diabetes, and its incidence was correlated with an OR of 3.434 (95% CI: 1.789 to 6.591; p = 0.0001) for POE.

Reduction in risk of POE among all the patients significantly associated with postoperative intracameral and topical application of antibiotics had an OR of 0.231 (p = 0.000), proving prophylactic antibiotic therapy as the best defense.

This meta-analysis reaffirms that individuals with diabetes who undergo cataract surgery have a considerably higher risk of developing postoperative endophthalmitis and posterior capsule rupture. The risk is further enhanced in males and patients with co-existing hypertension. Significantly, the study also illustrates that prophylactic antibiotic treatment markedly decreases POE risk in all patients.

Reference:

Chen, KY., Chan, HC. & Chan, CM. Do people with diabetes have a higher risk of developing postoperative endophthalmitis after cataract surgery? A systematic review and meta-analysis. J Ophthal Inflamm Infect 15, 24 (2025). https://doi.org/10.1186/s12348-025-00483-9

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Optimized perioperative fluid management, may help mitigate risk of Postoperative urinary retention: Study

Optimized perioperative fluid management, may help mitigate the risk of Postoperative urinary retention (POUR) suggests a new study published in the BMC Surgery.

Postoperative urinary retention (POUR) was reported as a common complication in patients undergoing primary total knee arthroplasty (pTKA), but descriptions of its prevalence and negative outcomes vary widely and remain inadequately studied. A retrospective cohort study was conducted using the National Inpatient Sample database from 2005 to 2014. The annual incidence, baseline characteristics, and inpatient outcomes of Postoperative urinary retention after pTKA were recorded. Logistic regression analysis was performed to estimate potential predictors of POUR. Statistical significance was defined as P < 0.01. Results: A total of 1,228,621 patients undergoing pTKA were identified. The incidence of Postoperative urinary retention after pTKA is increasing annually from 2005 (1.51%, 95%CI 1.44-1.59%) to 2014 (2.29%, 95%CI 2.21-2.37%), and the cumulative incidence of Postoperative urinary retention was 1.91% (95%CI 1.89-1.93%). POUR was significantly associated with higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores, and higher medical costs. In patients experiencing pTKA, the Top 5 most significant risk factors for developing Postoperative urinary retention were male gender (odds ratio [OR] = 3.40; 95% confidence interval [CI] 3.30–3.51; P < 0.0001), fluid and electrolyte disorders (OR = 2.02; 95% CI 1.94–2.10; P < 0.0001), age over 60 (OR = 1.97; 95% CI 1.89–2.05; P < 0.0001), paralysis (OR = 1.78; 95% CI 1.46–2.17; P < 0.0001), and psychoses (OR = 1.57; 95% CI 1.43–1.72; P < 0.0001). Although POUR did not result in higher inpatient mortality (0.1% vs. 0.07%, P = 0.1242), it may be associated with the occurrence of other complications such as acute myocardial infarction (0.42% vs. 0.20%, P < 0.0001), pulmonary embolism and infarction (0.80% vs. 0.42%, P < 0.0001), acute renal failure (6.06% vs. 1.49%, P < 0.0001), deep venous thrombosis (0.71% vs. 0.45%, P < 0.0001), acute posthemorrhagic anemia (28.89% vs. 19.45%, P < 0.0001), and infection (0.29% vs. 0.15%, P < 0.0001). Although Postoperative urinary retention has no effect on inpatient mortality, our large-scale national study provides new insights that it increases postoperative complications and impairs clinical outcomes. Given the increasing incidence of Postoperative urinary retention, early identification of high-risk patients, particularly those with identified comorbidities, should be prioritized. Preventive strategies, such as optimized perioperative fluid management, may help mitigate the risk of Postoperative urinary retention. Future research should focus on developing preventive strategies to mitigate its impact.

Reference:

Li, J., Li, Q., Zhang, J. et al. Incidence, outcomes and risk factors of postoperative urinary retention in patients undergoing primary total knee arthroplasty: a national inpatient sample database study. BMC Surg 25, 186 (2025). https://doi.org/10.1186/s12893-025-02930-9

Keywords:

Li, J., Li, Q., Zhang, J, Comorbidities, National inpatient sample, Outcomes, Postoperative complications, Postoperative urinary retention, Total knee arthroplasty, BMC Surgery

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New ACP guideline recommends combination therapy for acute episodic migraines

The American College of Physicians (ACP) has developed new recommendations for treatment of acute episodic migraines in nonpregnant adults in outpatient settings. ACP evaluated pharmacologic treatments known to be effective for migraine treatment using the best available comparative effectiveness evidence of benefits and harms, patients’ values and preferences, and economic evidence in order to prioritize the most effective treatments. The new guideline is published in Annals of Internal Medicine.

In its guideline, ACP makes two recommendations:

  • ACP recommends that clinicians add a triptan to a nonsteroidal anti-inflammatory drug to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to a nonsteroidal anti-inflammatory drug.
  • ACP suggests that clinicians add a triptan to acetaminophen to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to acetaminophen.

ACP also provides guidance to clinicians to consider counseling nonpregnant adults to begin treatment for acute migraine headache as soon as possible after its onset by utilizing combination therapy: a triptan with an NSAID or a triptan with acetaminophen.

Migraine is characterized by recurrent episodes of usually moderate to severe intensity headache lasting 4 to 72 hours with or without sensory disturbances, generally pulsating and often accompanied by nausea, vomiting, or aversion to light or sound. The condition remains underdiagnosed and undertreated.

ACP recently published a companion guideline, Prevention of Episodic Migraine Headache using Pharmacologic Treatments in Outpatient Settings, which addressed new recommendations for the prevention of episodic migraine in nonpregnant adults. In that guideline, ACP prioritized treatments based on economic and public and patient’s values and preferences evidence because the benefits and harms of evaluated treatments were balanced. However, for migraine treatment, ACP prioritized the combination of a triptan and an NSAID or acetaminophen because benefits outweighed the harms compared with other pharmacologic treatments.

Reference:

Amir Qaseem, Jeffrey A. Tice, Itziar Etxeandia-Ikobaltzeta, et al. Pharmacologic Treatments of Acute Episodic Migraine Headache in Outpatient Settings: A Clinical Guideline From the American College of Physicians. Ann Intern Med. [Epub 18 March 2025]. doi:10.7326/ANNALS-24-03095.

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Ovary removal may increases heart failure risk, reports research

Women of childbearing age who had both ovaries removed, in a procedure called bilateral oophorectomy, were more likely to develop heart failure later in life, according to a study presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).

Bilateral oophorectomy is often recommended to treat and, in some cases, prevent certain health issues, including endometriosis, pelvic inflammatory disease, heavy bleeding and ovarian cancer. The new study sheds light on the potential and unique role that this procedure might play in heightening cardiovascular risk given that it abruptly stops the production of estrogen and other hormones and, depending on timing, can induce early onset menopause, which researchers said may be distinct from other causes of early menopause.

“We know that sex hormones, including estrogen and progesterone levels, play a crucial role in cardiovascular risk. Our study shows that there is an association between removing both ovaries and future development of heart failure, in particular.” said Narathorn Kulthamrongsri, MD, a first-year internal medicine resident at the University of Hawaii in Honolulu. “We believe this may be due to early menopause. However, in this case, early menopause results from the planned surgical removal of the ovaries, which differs from other causes such as occult infections, autoimmune diseases or unexpected genetic disorders. Understanding this allows us to anticipate and manage potential complications, particularly cardiovascular disease.”

The study uses data from 6,814 female patients who participated in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. The average age of women undergoing the procedure was 43.6 years and 57 years for heart failure diagnosis. The ages at oophorectomy and heart failure onset were self-reported.

Compared with women in the general population who have their ovaries, those who underwent a bilateral oophorectomy had a 1.5-fold increased risk of developing heart failure after adjusting for race, age, gender, diabetes, smoking status and high cholesterol. White women and those who had their ovaries removed at younger ages had an even higher, twofold increased risk of developing heart failure.

“The age at which a woman has her ovaries removed appears to [impact] her heart failure risk,” Kulthamrongsri said. “We found that as the age at which a woman has her ovaries removed goes up by one year, the development of heart failure happens about 0.6 years later.”

According to researchers, their findings also underscore the need to integrate cardiovascular risk discussions and closer heart monitoring for women contemplating oophorectomy before natural menopause (defined as not having a period for one full year), which usually occurs at 51 years of age, on average.

“Women must do what is medically necessary in terms of oophorectomy, but our findings suggest they should have an informed discussion with their health care team about how to monitor their cardiovascular health and manage potential risk factors for heart failure, including adopting a healthy lifestyle as much as possible and perhaps asking about any potential role of hormone replacement therapy,” Kulthamrongsri said.

While some women may not have a choice in terms of when they undergo this procedure, for those who do, an informed discussion about the best timing based on their age and health is important to be able to discuss and weigh the potential added cardiovascular risks. This may be especially important for White women who appear to have a much higher risk of developing heart failure.

“This racial disparity is surprising, as previous research shows that Black individuals have a higher prevalence of worse outcomes in heart failure due to greater risks of hypertension, diabetes and obesity. In contrast, White individuals more often develop heart failure from ischemic heart disease and tend to have more lifestyle-related risk factors, such as smoking, poor diet and physical inactivity. This finding might be explained by the etiology of heart failure that develops in early surgical menopause, related to myocardial infarction or other etiologies in which sex hormones play a crucial role,” Kulthamrongsri said.

The study is limited in that it relied on self-reported data and the researchers were only able to look at lifelong risk of heart failure rather than being able to determine if oophorectomy was more likely to lead to heart failure within a certain period after the procedure.

However, Kulthamrongsri said the findings add to a growing body of evidence that early surgical menopause may have long-term cardiovascular consequences, particularly an increased risk of heart failure. This concern is especially relevant given the number of women who undergo oophorectomy procedures.

Additional studies should be done to validate these findings using larger, global datasets. Future research should also explore possible preventive solutions, including cardiovascular screening recommendations and the use of prophylactic heart medications.

Reference:

Ovary removal increases heart failure risk, American College of Cardiology, Meeting: American College of Cardiology’s Annual Scientific Session.

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Low iron could cause brain fog during menopause transition, OU study suggests

New research from the University of Oklahoma sheds light on an understudied area of science: iron levels in the blood and their relationship to cognitive performance in women transitioning into menopause. The findings are good news for women experiencing brain fog and other symptoms.

Published in the journal Nutrients, the study suggests that when women have adequate levels of iron in their blood during the menopausal transition, they perform better on cognitive tasks. Moreover, sufficient iron in the blood did not equate to unsafe levels of iron in the brain, which has been shown to elevate the risk for neurodegenerative diseases like Alzheimer’s.

“When a woman makes the menopausal transition, she’s no longer losing blood on a monthly basis, which means she’s no longer losing iron,” said Michael Wenger, Ph.D., a professor of psychology at the OU College of Arts and Sciences and a lead author of the study. “We wanted to see if the cost of being low on iron disappears during the menopausal transition. Very few studies have been done in this area.”

The research team measured iron levels in the blood, conducted MRIs to see the amount of iron in the brain, and assessed behavioral measures of cognition. None of the women in the study were deficient in iron; however, quite a few were below where they should be for their age. The women who were below expected levels of iron in the blood performed worse on measures of memory, attention and cognition.

“Our previous research has shown that being iron-deficient extracts some serious costs in terms of cognitive performance,” Wenger said. “If I were to give a woman with iron deficiency a simple task in which she presses a button every time an asterisk appears on a screen, the deficiency would cost her about 150 milliseconds. That doesn’t sound like a lot, but we make simple decisions like that when we choose every word we say in a sentence. Those 150 milliseconds add up.”

Importantly, the amount of iron in the blood did not predict how much iron was deposited in a woman’s brain, Wenger said. “We have known for some time that the accumulation of iron in the brain is a risk factor for developing conditions like Alzheimer’s and vascular dementia,” he said. “This data was surprising, and good news because it appears that having iron levels that are at or above what you should expect for your age does not mean you’re accumulating more iron in your brain.”

Being deficient in iron is not the same thing as being anemic. Low iron is a risk factor for anemia, Wenger said, but people can become anemic for other reasons. However, women visiting their OB-GYN typically are not tested for iron deficiency, which may be a missed opportunity.

“Low iron could easily be one of the reasons that a woman is experiencing brain fog during the menopausal transition,” he said. “It also may be why some women talk about their eyesight changing during menopause. Iron is a critical element in the synthesis of the neurotransmitter dopamine, and the eye is dependent upon dopamine for basic signaling at the first point of contact with light.”

Although taking iron supplements is usually not the best course of action since they cause major gastrointestinal side effects, a low dose could be effective, as would diet changes to consume more foods high in iron, Wenger said.

“Making these minor changes could make a woman’s transition from pre- to post-menopause easier to bear,” he said.

Because part of the study was conducted during the COVID-19 pandemic, enrollment wasn’t as high as the research team would have liked. They plan to seek funding to conduct a larger study.

“I feel like we’ve had a pretty good understanding of post-menopause health, such as watching for cardiovascular issues and osteoporosis, but we haven’t known as much about what to do during this in-between phase, and it’s actually way more bothersome to people,” said OB-GYN and study co-author Pamela Miles, M.D., an associate professor in the OU College of Medicine.

Reference:

Barnett, A.L.; Wenger, M.J.; Miles, P.; Wu, D.; Isingizwe, Z.R.; Benbrook, D.M.; Yuan, H. Cognitive Performance in Relation to Systemic and Brain Iron at Perimenopause. Nutrients 2025, 17, 745. https://doi.org/10.3390/nu17050745

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Only around 1 in 10 common non-surgical and non-invasive treatments effective for back pain: BMJ

Only around 1 in 10 common non-surgical and non-invasive treatments for lower back pain is effective, suggests a pooled data analysis of the available research, published online in BMJ Evidence Based Medicine.

And the pain relief they offer is only marginally better than that achieved with a placebo, the findings indicate.

Low back pain is common and debilitating, and 80%-90% of it is categorised as non-specific, because there’s no immediately identifiable cause, note the researchers.

Non-surgical and non-invasive approaches are recommended as the initial treatment approach. But many such options are available, and it’s not always easy to know which ones are effective, point out the researchers.

To build on the evidence base, the researchers scoured research databases for published randomised placebo-controlled trials of non-surgical and non-interventional treatments for people with non-specific low back pain, with the aim of pooling the results.

The approaches included were pharmacological, such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, and non-pharmacological, such as exercise, massage, and spinal manipulation.

A total of 301 trials investigating 56 different treatments or treatment combinations were included in the pooled data analysis. The trials were carried out in a total of 44 countries in Africa, North America, South America, Asia, Australia, and Europe.

The most common interventions were NSAIDs (27 trials), opioids (26 trials), laser and light therapy (25), acupuncture (24), and gentle manual therapy (mobilisation; 19 trials).

Fifty two trials sampled participants with acute low back pain; 228 trials with chronic low back pain; and 21 trials participants with both types. Pain intensity was most often assessed using the Visual Analogue Scale or the Numeric Rating Scale.

Of the 69 treatment comparisons included in the trials, the certainty of the evidence was moderate for 11 (16%), low for 25 (36%), and very low for 33 (48%), as assessed by the GRADE system.

The pooled data analysis showed that compared with placebo, no non-pharmacological treatments and only NSAIDs emerged as effective for acute low back pain; exercise, spinal manipulation, and taping, antidepressants and drugs that target pain receptors (TRPV1 agonists) emerged as effective for chronic low back pain.

But the effects were small.

Moderate quality evidence showed that treatments for acute low back pain that weren’t effective included exercise, steroid injections and paracetamol, while anaesthetics (i.e. Lidocaine) and antibiotics weren’t effective for chronic low back pain, the analysis showed.

The evidence was inconclusive for 10 non-pharmacological and 10 pharmacological treatments for acute low back pain. It was also inconclusive for a wide range of 22 non-pharmacological treatments, including acupuncture, massage, osteopathy and TENS, and 16 pharmacological treatments, including antidepressants + paracetamol, complementary medicines, bisphosphonates, and muscle relaxants for chronic back pain.

The researchers point out that many of the available trials included only a few participants and reported inconsistent results, added to which, the type and quality of some of the placebos used varied considerably, potentially affecting the certainty of the findings.

But they say: “Our review did not find reliable evidence of large effects for any of the included treatments, which is consistent with clinical guidelines and our previous review. While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time.”

They emphasise: “There is a clear need for large, high-quality, placebo-controlled trials to reduce uncertainty in efficacy estimates for many non-surgical and non-interventional treatments.” 

Reference:

Cashin AG, Furlong BM, Kamper SJ, et alAnalgesic effects of non-surgical and non-interventional treatments for low back pain: a systematic review and meta-analysis of placebo-controlled randomised trialsBMJ Evidence-Based Medicine Published Online First: 18 March 2025. doi: 10.1136/bmjebm-2024-112974

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Visualizing Success: How Airway Ultrasound Enhances Tracheal Intubation Outcomes, study finds

Recent study investigates the potential of preoperative airway ultrasonography (USG) measurements to predict difficult intubation. Specifically, it focuses on hyomental distances measured in neutral and extended head positions, along with the pre-epiglottic space and the distance between the epiglottis and the vocal cords. By analyzing a cohort of 190 patients scheduled for elective surgeries requiring general anesthesia, the researchers aimed to correlate these USG parameters with the Cormack-Lehane (CL) grading system and intubation difficulty scores (IDS). Out of the 190 patients, data from 188 were analyzed, and significant correlations were identified between certain USG measurements, particularly the PreE/E-VC ratio, and both the CL grade and IDS. These measurements provide critical insight into the anatomical structures influencing intubation. The significant findings highlight that as the PreE/E-VC ratio increases, so does the likelihood of encountering a higher CL grade indicative of difficult intubation. Conversely, the hyomental distance ratio (HMDR) showed a poor correlation with these variables and therefore did not serve as an effective predictor for difficult intubation. The study’s discussion underlines the importance of understanding the dynamics of direct laryngoscopy (DL). During DL, head positioning and the displacement of structures like the hyoid bone and epiglottis play pivotal roles in creating a clear passage for tracheal intubation. Measurements of USG parameters are crucial for evaluating the anatomical challenges that may arise due to the two essential phases of DL: the static phase involving head positioning and the dynamic phase concerning soft tissue displacement.

Correlation Results

The results revealed that while PreE, E-VC, and the PreE/E-VC ratio correlated significantly with CL grades and IDS, other parameters such as HMDe, HMDn, and HMDR did not show such correlations. The study specifically noted that parameters related to cervical mobility were excluded from the cohort, potentially influencing the predictive capability of HMDR. These findings suggest that the anatomical and tissue factors impacting airway structures directly related to intubation difficulty must be considered in future studies.

Study Limitations

Although the study successfully correlated some USG parameters with intubation difficulty, the limitations included a restricted patient demographic—those excluded had known predictors for difficult intubation such as cervical mobility limitations and edentulous states. Furthermore, relying on a single investigator for USG measurements, while minimizing inter-observer variability, raises concerns about external validation of results.

Future Research Directions

The implications of this research advocate for broader studies involving diverse patient populations to establish more precise cut-off values for various ethnicities and body types. Additional directions for future research involve the creation of automated algorithms for real-time interpretation of USG measurements to enhance clinical practice. Integrating USG airway assessment into standard clinical evaluations could potentially improve airway management outcomes and better predict difficulties in intubation scenarios. In conclusion, the study underscores the potential of specific preoperative USG parameters in predicting difficult intubation, with a particular emphasis on the significance of anatomical assessments through the PreE/E-VC ratio, which offers greater predictive reliability than traditional HMDR measurements. Future investigations are encouraged to validate these findings within more varied populations and to explore advanced methodologies for interpreting USG data in clinical settings.

Key Points

– Preoperative airway ultrasonography (USG) measurements, including hyomental distances and distances related to the epiglottis, were investigated for their ability to predict difficult intubation, with significant correlations found between specific measurements and the Cormack-Lehane grading system and intubation difficulty scores.

– Notable correlations were identified particularly with the PreE/E-VC ratio; as this ratio increased, there was a corresponding increase in the likelihood of higher Cormack-Lehane grades, indicating more challenging intubation scenarios.

– The study found that the hyomental distance ratio (HMDR) did not correlate effectively with predicted intubation difficulties, suggesting that this measurement is not a reliable predictor compared to the other USG parameters analyzed.

– The anatomical dynamics examined during direct laryngoscopy (DL) highlighted the importance of head positioning and displacement of airway structures such as the hyoid bone and epiglottis, underscoring how these factors impact visible anatomical features relevant for intubation.

– Limitations of the study included the exclusion of patients with known predictors of difficult intubation, such as those with cervical mobility limitations and edentulous states, along with the reliance on a single investigator for USG measurements, which raises questions about external validation.

– Future research directions emphasize the need for larger, more diverse populations to identify cut-off values for various demographics and the potential development of automated algorithms for real-time USG interpretation, aimed at enhancing clinical practice and improving intubation outcomes.

Reference –

Roopali Phulli et al. (2025). Can Point-Of-Care Ultrasound Predict The Difficulty In Intubation? – A Prospective Observational Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_1066_24.

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Clinical Photograph Assessment Shows High Accuracy in Caries Detection: Study Finds

China: Researchers have found in a new study that visual assessment of clinical photographs for caries detection shows clinically acceptable accuracy compared to direct intraoral examination, with high specificity indicating strong reliability in identifying healthy tooth structures. The findings were published online in the Journal of Dentistry. 

The researchers note that dental caries, though preventable, can lead to serious oral health issues if not detected early. Traditionally identified through visual exams, its diagnosis now faces challenges like clinic access and examiner subjectivity. With the rise of teledentistry, especially after COVID-19, clinical photography has gained prominence for remote diagnosis. It aids in caries detection, monitoring, and education, though more research is needed to validate its accuracy compared to conventional methods.

Against the above background, Jason Chi-Kit Ku, Faculty of Dentistry, The University of Hong Kong, Hong Kong, S.A.R., China, and colleagues assessed the accuracy of detecting dental caries through clinical photographs compared to traditional visual intraoral examination.

For this purpose, the researchers conducted a systematic review, registered in PROSPERO (CRD42024598814) and aligned with PRISMA-DTA guidelines, to assess the accuracy of clinical photography in detecting dental caries compared to visual intraoral examination. Accuracy measures such as sensitivity, specificity, diagnostic odds ratio (DOR), the area under the curve (AUC), and partial AUC (pAUC) were analyzed. Eighteen studies involving 1300 participants were included from PubMed, Web of Science, Scopus, and EMBASE. The risk of bias, assessed using the QUADAS-2 tool, was frequently observed across several domains.

The key findings were as follows:

  • The pooled sensitivity and specificity for visual assessment of clinical photographs in detecting enamel caries were 0.74 and 0.95, respectively, with a diagnostic odds ratio (DOR) of 52.94 and an AUC of 0.813.
  • For dentine caries, the pooled sensitivity was 0.81, and specificity was 0.98, with a DOR of 142.01 and an AUC of 0.935 (partial AUC: 0.857).
  • For any caries depth, the pooled sensitivity was 0.81 and specificity was 0.99, with a DOR of 245.04 and an AUC of 0.957 (partial AUC: 0.902).
  • Subgroup analysis indicated that factors such as caries depth, dentition type (primary vs. permanent; p = 0.584 for dentine caries, p = 0.923 for any caries depth), imaging technology (smartphone camera vs. intraoral camera; p = 0.993), and photographer (dental professional vs. layperson; p = 0.466) did not significantly affect diagnostic performance.

“The findings showed that the visual assessment of clinical photographs shows clinically acceptable accuracy for detecting dental caries when compared with visual clinical intraoral examination. The consistently high specificity across diagnostic thresholds highlights its reliability in correctly identifying sound tooth structures,” the authors concluded.

Reference:

Ku, J. C. K., Mao, K., Wang, F., Carreiro, A. D. F. P., Lam, W. Y. H., & Yu, O. Y. (2025). Accuracy of clinical photography for the detection of dental caries: A systematic review and meta-analysis. Journal of Dentistry, 157, 105737. https://doi.org/10.1016/j.jdent.2025.105737

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Calycosin involved in protective role against adriamycin-induced nephrotic syndrome: Study

A new study published in the BMC Nephrology highlighted the potential of calycosin (extracts from the traditional Chinese herb Astragali Radix), in reducing proteinuria and reducing symptoms associated with nephrotic syndrome. 

This study used a rat model induced by adriamycin, which is a chemotherapeutic agent known to cause kidney damage, to replicate the pathological features of nephrotic syndrome. The objective was to explore whether calycosin (C16H12O5) could offer a protective effect against the damage.

The experiment involved two adriamycin injections (4 mg/kg in week one and 2 mg/kg in week two) to trigger renal injury. Following this induction, rats were treated with either 10 mg/kg or 20 mg/kg of calycosin administered intraperitoneally over a four-week period. Before the animals were euthanized, researchers collected blood and urine samples and measured body weights to assess the compound’s effects.

The findings revealed that calycosin significantly reduced 24-hour urine protein levels as well as serum levels of blood urea nitrogen (BUN) and serum creatinine (SCR), which reflect kidney function. In addition, it helped lower elevated cholesterol (TC) and triglyceride (TG) levels often associated with nephrotic syndrome. These biochemical markers showed a dose-dependent improvement with calycosin treatment, especially at the higher 20 mg/kg dose.

The kidney index was also reduced by indicating decreased kidney swelling and inflammation. Histological analysis of kidney tissues showed that calycosin reduced glomerular structural damage, reduced inflammatory cell infiltration, and prevented thickening of the basement membrane, all hallmarks of nephrotic injury.

On a cellular level, calycosin appeared to protect podocytes, the specialized cells crucial to kidney filtration. Western blot analysis showed restored expression of podocyte-specific proteins like podocin and nephrin, both of which were suppressed by adriamycin. Also, TUNEL assays demonstrated that calycosin reduced renal cell apoptosis, further affirming its protective effect.

This study identified a molecular mechanism underlying the efficacy of calycosin; the suppression of the Notch1/Snail signaling pathway. This pathway, known to be activated in kidney injury, contributes to podocyte damage and fibrosis. The ability of calycosin to inhibit this signaling axis offers new insight into how traditional herbal compounds can be harnessed to target complex kidney diseases.

Overall, the findings suggest that calycosin may represent a natural and effective candidate for developing treatments against nephrotic syndrome and other forms of chronic kidney disease, which warrants further investigation and clinical exploration.

Source:

Ma, X., Guan, B., & Pang, L. (2025). Calycosin ameliorates albuminuria in nephrotic syndrome by targeting Notch1/Snail pathway. BMC Nephrology, 26(1), 198. https://doi.org/10.1186/s12882-025-04113-3

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