What is the Connection between Diabetes and Vascular Disease? How to prevent Vascular Complications in Diabetes? – Dr Krishna Chaitanya

Diabetes is a
chronic condition that affects millions of people worldwide. Apart from its
well-known impact on blood sugar levels, diabetes can have a profound effect on
the vascular system. The interplay between diabetes and vascular health is
crucial, as individuals with diabetes are at a significantly higher risk of
developing vascular complications.

Vascular diseases include a range of
conditions such as atherosclerosis, peripheral artery disease (PAD), coronary
artery disease, and stroke, among others. Understanding how to prevent vascular
complications in diabetes is essential for improving the overall well-being of
those affected. This comprehensive guide will explore the steps you can take to
protect your vascular health and reduce the risk of complications associated
with diabetes.

The Diabetes-Vascular Disease Connection:

Before diving into prevention strategies, it’s crucial to comprehend
the link between diabetes and vascular complications. Diabetes, both type 1 and
type 2, can have detrimental effects on the vascular system. The elevated blood
sugar levels characteristic of diabetes can lead to a cascade of events that
damage blood vessels over time. Here’s how it happens:

High Blood Sugar Levels:

Uncontrolled diabetes results in consistently high levels of glucose
in the bloodstream. This excess sugar can injure the delicate inner lining of
blood vessels, leading to inflammation and the formation of fatty deposits.

Atherosclerosis:

Atherosclerosis, often referred to as “hardening of the
arteries,” is a condition where fatty deposits accumulate on the walls of
blood vessels. Over time, these deposits, known as plaques, can narrow and
block blood flow, increasing the risk of heart disease and stroke.

Microvascular Complications:

Diabetes can also affect the small blood vessels throughout the
body. This may lead to microvascular complications such as retinopathy (eye
damage), nephropathy (kidney damage), and neuropathy (nerve damage).

Preventing Vascular Complications:

Preventing vascular complications in diabetes involves a combination
of medical management, lifestyle changes, and proactive self-care. Here are
essential strategies for safeguarding your vascular health:

1. Blood Sugar Control

The cornerstone of diabetes management is controlling blood sugar
levels. Regular monitoring, medication adherence, and following your healthcare
provider’s guidance are crucial in maintaining optimal glucose levels.

2. Healthy Eating

A balanced diet that’s low in saturated and trans fats, cholesterol,
and sodium can significantly reduce the risk of atherosclerosis. Focus on
incorporating whole grains, fruits, vegetables, lean proteins, and healthy fats
into your meals.

3. Regular Physical Activity

Exercise plays a pivotal role in vascular health. It helps manage
blood sugar, lowers blood pressure, and keeps your weight in check. Aim for at
least 150 minutes of moderate-intensity exercise per week.

4. Medications

Your healthcare provider may prescribe medications to manage risk
factors such as high blood pressure, cholesterol, or blood-thinning agents.
Complying with your medication regimen is crucial.

5. Smoking Cessation

Smoking damages blood vessels and accelerates atherosclerosis. If
you smoke, seeking support to quit is one of the most significant steps you can
take to protect your vascular health.

6. Regular Check-Ups

Frequent check-ups with your healthcare provider are essential for
monitoring your vascular health. They can conduct tests to assess your risk
factors and identify issues in their early stages.

7. Foot Care

For individuals with diabetes, foot care is paramount. Nerve damage
can lead to reduced sensation in the feet, making them susceptible to injuries
and infections. Regularly inspect your feet, keep them clean and moisturized,
and choose appropriate footwear.

8. Medication Management

If you’ve been prescribed medications, follow your healthcare
provider’s instructions carefully. This includes taking prescribed dosages,
adhering to schedules, and reporting any side effects or concerns.

Conclusion:

Preventing vascular complications in diabetes is a proactive and
ongoing process. By adopting a comprehensive approach that combines medical
management, a heart-healthy lifestyle, and vigilant self-care, individuals with
diabetes can significantly reduce their risk of vascular issues.

Keep in mind
that personalized guidance from your healthcare provider is indispensable in
crafting a plan that suits your unique needs and circumstances. Protecting your
vascular health is an investment in your overall well-being and longevity.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Lupin, Sun Pharma recall rheumatoid arthritis, thyroid drugs in US

New Delhi: Leading drugmakers Sun Pharma and Lupin are recalling products in the US market over manufacturing issues, as per the US Food and Drug Administration (USFDA).

Mumbai-based Sun Pharmaceutical Industries is recalling 96,192 bottles of Liothyronine Sodium Tablets in the US that are used to treat an underactive thyroid, according to the latest enforcement report issued by the American health regulator.

Princeton-based Sun Pharmaceutical Industries Inc, a unit of the company, is recalling the affected lot that was produced at the drugmaker’s Dadra-based facility. The company is recalling the lot due to ”failed impurities/degradation specifications”, the USFDA stated. The company commenced the voluntary nationwide Class II recall on December 4, this year.  

Read also: Zydus, Dr Reddy’s Labs and 1 other recall products in US over manufacturing issues

USFDA stated that Mumbai-based Lupin is also recalling an unspecified number of penicillamine tablets in the US. The medication is used to treat rheumatoid arthritis and Wilson’s disease. Baltimore-based Lupin Pharmaceuticals Inc, a unit of the company, is recalling the affected lot that was produced at the drugmaker’s Nagpur-based facility. As per the USFDA, the company is recalling the affected lot due to ”failed dissolution specifications”. The company initiated the Class II nationwide (US) voluntary recall on November 22.

Read also: Cipla US arm recalls Vigabatrin for Oral Solution, USP 500mg over pouch leakage issues

As per the USFDA, a class II recall is initiated in a situation in which the use of, or exposure to, a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote. The Indian pharmaceutical industry is the third largest in the world by volume. The US is the world’s largest market for pharmaceutical products.

Read also: Sun Pharma arm recalls 144 bottles of anti-depression medicine in US over manufacturing issue

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Standards of Care in Diabetes 2024: ADA releases new recommendations for screening of PAD and heart failure

USA: The American Diabetes Association (ADA) has released new screening and obesity management recommendations for diabetes patients. The updated Standards of Care in Diabetes—2024 is available online and is published as a supplement to the January 2024 issue of Diabetes Care.

The ADA’s Standards of Care for 2024 include new recommendations to screen for heart failure, type 1 diabetes risk, and peripheral arterial disease (PAD), along with new obesity management guidance. It also includes new recommendations related to bone health and liver disease. The Standards of Care are essentially the global guidelines for the care of individuals with diabetes and those at risk.

The ADA’s Professional Practice Committee developed the document via a scientific literature review. The panel comprised 21 professionals, including physicians from many specialities, certified diabetes care and education specialists, nurse practitioners, pharmacists, and dieticians.

This article will mainly focus on the ADA’s updates on updated recommendations for screening peripheral arterial disease (PAD) and heart failure.

Atherosclerotic cardiovascular disease (ASCVD) defined as coronary heart disease (CHD), peripheral artery disease (PAD), or cerebrovascular disease is the leading cause of mortality and morbidity for people with diabetes. Addressing multiple cardiovascular risk factors (lipid control, glycemic, and blood pressure) can lead to large benefits.

Heart failure is another major cause of morbidity and mortality from cardiovascular disease.

The increased risk for heart failure in diabetic patients is classified as the presence of stage A heart failure, i.e., an increased risk for heart failure but without symptoms, structural heart disease, or biomarker evidence of myocardial strain. People with stage B heart failure are asymptomatic but have evidence of structural heart disease or functional cardiac abnormalities, including elevated biomarkers of myocardial strain or increased filling pressure. During these asymptomatic stages of heart failure, people with diabetes are at particularly high risk for progression to symptomatic stage C and D heart failure.

Recommendations For Heart Failure Screening 

  • The committee recommends considering screening asymptomatic adults with diabetes for the development of cardiac structural or functional abnormalities (stage B heart failure) by measurement of natriuretic peptides, including BNP or NT-proBNP levels.
  • Risk stratification for incident heart failure (stage A) and identification of people with asymptomatic cardiac abnormalities (stage B) may prevent progression to the symptomatic stages of heart failure (stages C and D).
  • People with diabetes and an elevated natriuretic peptide level without any symptoms of heart failure should be considered to have stage B heart failure, as there is evidence for increased filling pressure and wall strain.
  • In people with diabetes and an abnormal natriuretic peptide level, echocardiography is recommended as the next step to screen for structural heart disease and echocardiographic Doppler indices for evidence of diastolic dysfunction and increased filling pressures.

Screening for Asymptomatic Peripheral Artery Disease in People With Diabetes

  • The committee recommends screening for asymptomatic PAD using ankle-brachial index in people with diabetes at high risk for PAD, including any of the following: age ≥50 years, diabetes with duration ≥10 years, comorbid microvascular disease, clinical evidence of foot complications, or any end-organ damage from diabetes.
  • The committee recommends screening people with diabetes and high risk for PAD, including those aged≥50 years, diabetes with duration ≥10 years, microvascular disease, clinical evidence of foot complications, or any end-organ damage from diabetes.

Screening for asymptomatic PAD may lead to early detection and treatment strategies to reduce the risk for progression of PAD and limb preservation. In addition, secondary prevention of PAD has been shown to reduce adverse cardiovascular and limb outcomes.

Reference:

American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S179–S218. https://doi.org/10.2337/dc24-S010

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Study reveals increased risk of arrhythmias including atrial fibrillation after COVID-19

Sweden: A recent study published in the European Heart Journal Open has revealed an increased risk of cardiac arrhythmias following COVID-19, particularly in elderly vulnerable individuals, and those with severe COVID-19. 

Individuals infected with COVID-19 are also at an increased risk of suffering from heart rhythm disturbances, such as atrial fibrillation, according to a study at Umeå University, Sweden, which is one of the largest studies of its kind in the world.

“The results underline the importance of both being vaccinated against COVID-19 and that the healthcare system identifies people at increased risk of this type of complications so that the correct diagnosis is made and appropriate treatment is started in time,” says Ioannis Katsoularis, first author of the study and cardiologist at University Hospital of Northern Sweden in Umeå.

The researchers were able to show that those who had been ill with COVID-19 could also suffer from heart rhythm disturbances, both in the form of so-called tachycardias, when the heart rate is high, and bradyarrhythmias, when the heart is slow so that a pacemaker is sometimes needed.

The study shows that the risk of atrial fibrillation and flutter was increased up to two months after infection. In the first month, the risk was twelve times greater than for people who did not suffer from COVID-19 infection.

Even the risk of a specific subset of tachycardias, paroxysmal supraventricular tachycardiaswas elevated up to 6 months after the infection and was five times greater in the first month. For the bradyarrhythmias, the risk was increased up to 14 days after the infection and was three times greater in the first month compared to subjects without COVID-19. Previous research in this area had not focused as much on which individuals are most at risk.

“We found that the risks were higher in older individuals, individuals with severe COVID-19 and during the first wave of the pandemic. We could also see that unvaccinated people were at higher risk than vaccinated people. Overall, the severity of the infection was the strongest risk factor,” says Anne-Marie Fors Connolly, who leads the research group at Umeå University that is behind the study.

In the study, information from large national registers was cross-checked. All people who tested positive for the virus in Sweden from the start of the pandemic until May 2021 were included, but also a comparison group of individuals without a positive test for the virus. Over one million individuals with COVID-19 and over four million control individuals were included in this nationwide study, which is one of the largest of its kind in the world. Researchers at Umeå University have previously shown that COVID-19 leads to an increased risk of blood clots, myocardial infarction and stroke.

Reference:

Ioannis Katsoularis, Hanna Jerndal, Sebastian Kalucza, Krister Lindmark, Osvaldo Fonseca-Rodríguez, Anne-Marie Fors Connolly, Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study, European Heart Journal Open, Volume 3, Issue 6, November 2023, oead120, https://doi.org/10.1093/ehjopen/oead120.

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A nomogram may predict conversion of laparoscopic surgery to open surgery for choledocholithiasis.

Approximately 3-18% of gallbladder stone patients have secondary choledocholithiasis. Laparotomy was previously the standard treatment but required large abdominal incisions and caused postoperative infections, pain, and longer hospital stays. Laparoscopic common bile duct exploration (LCBDE) surgery is now favored as it is less invasive and has a lower risk of infection. Those with common bile duct (CBD) stones also have intrahepatic bile duct (IHD) stones. Laparoscopic hepatectomy (LH) may be safe for those with IHD stones.

Yitao Zheng and colleagues, in a recent study published in BMC Surgery, said, We developed a nomogram to predict conversion to open surgery in laparoscopic surgery for choledocholithiasis, which aids surgeons in planning surgery and timely converting to laparotomy during surgery to minimize the risk of harm to the patient.

Laparoscopic surgery effectively treats common bile duct stones, but high surgeon requirements and conversion to laparotomy risk exist. Our study established a nomogram model to predict the conversion of laparoscopic to laparotomy for choledocholithiasis.

A total of 867 choledocholithiasis patients who underwent laparoscopic surgery were randomly divided into a training and a validation group. A logistic regression analysis-based nomogram was constructed, and its predictive performance was evaluated using AUC, calibration curve, and DCA (decision curve analysis).

Key findings from the study are:

  • The nomogram included Previous upper abdominal surgery, maximum diameter of stone ≥12 mm, medial wall of the duodenum stone,
  • gallbladder wall and CBD wall thickening, stone size/CBD size ≥0.75, and simultaneous laparoscopic hepatectomy.
  • The AUC values were 0.813 and 0.804 in the training and validation groups, respectively.
  • The calibration curve presented excellent consistency between the nomogram predictions and actual observations.
  • DCA presented a positive net benefit for the nomogram.

In our study, 25 out of 41 conversion surgeries for dense abdominal adhesions were due to PUAS. In our nomogram, stones in the medial wall of the duodenum scored higher with 86 points.

The maximum stone diameter was the transverse diameter perpendicular to the CBD wall. A large ratio increases the difficulty of stone removal. Removing IHD stones is more challenging than liver neoplasm due to the risk of liver inflammation, perihepatic adhesions, and anatomical distortion, the author writes.

Reference:

Zheng, Y et al. A nomogram to predict conversion of laparoscopic surgery to laparotomy for Choledocholithiasis. BMC Surg 23, 372 (2023).

 

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Healthful Vegetarian diet may improve insomnia, finds study

A recent cohort study, the Tzu Chi Health Study, sheds light on the potential link between dietary patterns and insomnia risk, uncovering intriguing findings about the benefits of plant-based diets in reducing the likelihood of developing insomnia. This study was published in the European Journal Of Clinical Nutrition by Zuo Hua Gan and colleagues.

Researchers aimed to explore whether plant-based diets, specifically vegetarianism, could influence the risk of insomnia. Over 5,800 participants without prior insomnia were enrolled in the study from 2007 to 2009 and followed up until 2018. Two distinct dietary classification methods were employed: traditional categorization into vegetarians and non-vegetarians, and a Healthful Plant-Based Index (hPDI) to gauge adherence to plant-based dietary patterns. Incident cases of insomnia were tracked by linking participant data with the National Health Insurance Research Database (NHIRD).

Throughout 55,562 person-years of follow-up, 464 new cases of insomnia were identified. The study revealed noteworthy associations between plant-based diets and insomnia risk. Male vegetarians exhibited a substantially lower risk of insomnia compared to non-vegetarians, showing hazard ratios (HR) of 0.47 and 0.71 for males and females, respectively. Additionally, among male participants with the highest adherence to the healthful plant-based index (hPDI), there was a notable reduction in insomnia risk (HR 0.50) compared to those in the lowest quintile. Surprisingly, no significant association between adherence to hPDI and insomnia risk was observed in female participants.

The findings underscore a potential protective effect of vegetarianism against insomnia, highlighting the sleep-related benefits of plant-based diets. However, the study also suggests that the relationship between adherence to healthful plant-based diets and insomnia risk might vary by gender, showcasing sex-specific associations.

The study outcomes emphasise the potential additional benefits of plant-based diets beyond their known health advantages. The reduced risk of insomnia among vegetarians hints at the relevance of dietary choices in managing sleep-related issues. Yet, the gender-specific differences in the relationship between plant-based diet adherence and insomnia warrant further investigation.

These findings offer valuable insights into the intricate interplay between diet and sleep health, paving the way for future research exploring the mechanisms underlying these associations and potentially tailoring dietary recommendations for improved sleep outcomes.

Reference:

Gan, Z. H., Chiu, T. H. T., Lin, C.-L., Lin, M.-N., & Kuo, P.-H. Plant-based dietary patterns and risk of insomnia: a prospective study. European Journal of Clinical Nutrition,2023;1–8. https://doi.org/10.1038/s41430-023-01380-x

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Yoga Nidra practice may improve sleep, memory, and cognition: Study

India: Yoga Nidra practice can improve cognitive processing and night-time sleep, a recent study published in PLOS ONE has revealed. Yoga Nidra is a kind of mindfulness training. 

“Practicing yoga nidra might improve sleep, cognition, learning, and memory, even in novices, “Karuna Datta of the Armed Forces Medical College in India, and colleagues wrote in their pilot study. After a two-week intervention with a cohort of novice practitioners, the researchers found that the percentage of delta-waves in deep sleep increased and that all tested cognitive abilities improved. 

Unlike more active forms of yoga, which focus on physical postures, breathing, and muscle control, yoga nidra guides people into a state of conscious relaxation while they are lying down.

While it has been reported to improve sleep and cognitive ability, those reports were based more on subjective measures than on objective data.

The new study used objective polysomnographic measures of sleep and a battery of cognitive tests.

Measurements were taken before and after two weeks of yoga nidra practice, which was carried out during the daytime using a 20-minute audio recording.

Among other things, polysomnography measures brain activity to determine how long each sleep stage lasts and how frequently each stage occurs.

After two weeks of yoga nidra, the researchers observed that participants exhibited a significantly increased sleep efficiency and percentage of delta-waves in deep sleep.

They also saw faster responses in all cognitive tests with no loss in accuracy and faster and more accurate responses in tasks including tests of working memory, abstraction, fear and anger recognition, and spatial learning and memory tasks.

The findings support previous studies which link delta-wave sleep to improved sleep quality as well as better attention and memory.

The authors believe their study provides objective evidence that yoga nidra is an effective means of improving sleep quality and cognitive performance.

Yoga nidra is a low-cost and highly accessible activity from which many people might therefore benefit.

The authors add: “Yoga nidra practice improves sleep and makes brain processing faster. Accuracy also increased, especially with learning and memory related tasks.”

Reference:

Karuna Datta, Anna Bhutambare, Mamatha V. L., Yogita Narawa, Rajagopal Srinath, Madhuri Kanitkar. Improved sleep, cognitive processing and enhanced learning and memory task accuracy with Yoga nidra practice in novices. PLOS ONE, 2023; 18 (12): e0294678 DOI: 10.1371/journal.pone.0294678.

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Xpert Ultra important tool for rapid diagnosis of spinal tuberculosis

A recent study revealed promising outcomes for Xpert Ultra, a non-invasive approach in enhancing spinal tuberculosis (STB) diagnosis. The key findings were published in Open Forum Infectious Diseases.

The study was conducted from November 2020 to December 2021 and focused on evaluating the efficacy of Xpert MTB/RIF Ultra, comparing it with traditional Mycobacterium tuberculosis (Mtb) culture and histopathology. 

The study was aimed to refining diagnostic procedures of STB and showed compelling results. Xpert Ultra demonstrated a remarkable sensitivity of 94.7% and an impressive specificity of 100%, outperforming the conventional Mtb culture and histopathology as the reference standard. This breakthrough is poised to transform the landscape of STB diagnosis, when considering the limitations associated with current methods, predominantly reliant on open surgeries for specimen collection.

The prospective diagnostic accuracy study included 31 adult patients exhibiting signs and symptoms of STB. Xpert Ultra’s diagnostic prowess remained consistent across both open and CT-guided biopsy samples, improving the sensitivity and specificity to 100% for open biopsies and 89% and 100%, respectively, for CT-guided ones. However, Mtb culture exhibited a notable specificity gap for CT-guided biopsies, hovering at 43%.

Also, the study found that HIV-1 co-infection did not influence the accuracy of Mtb abundance measures by Xpert Ultra or culture. Xpert Ultra surpassed traditional culture methods for STB diagnosis even in patients concurrently undergoing treatment for pulmonary TB.

The study’s conclusion brings out the ability of Xpert Ultra to detect more STB cases than conventional culture methods, particularly in CT-guided biopsy samples, and maintaining consistent sensitivity for open biopsies, Xpert Ultra emerges as a crucial tool for swift and accurate diagnosis, especially when open surgery is impractical or when simultaneous treatment for pulmonary TB is underway.

Source:

Waters, R., Laubscher, M., Dunn, R. N., Adikary, N., Coussens, A. K., & Held, M. (2023). Higher sensitivity of Xpert MTB/RIF Ultra over TB culture for the diagnosis of spinal tuberculosis using open or CT-guided biopsies. In Open Forum Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/ofid/ofad621

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Preconception paternal drinking habits can negatively affect fetal development

USA: In an article published in Andrology, the lab of Dr. Michael Golding has demonstrated that it takes much longer than previously believed, longer than a month, for the effects of alcohol consumption to leave the father’s sperm.

Researchers at Texas A&M University have already shown that paternal drinking habits before conception can harm fetal development semen from men who regularly consume alcohol impacting placenta development, fetal alcohol syndrome (FAS)-associated brain and facial defects, and even IVF outcomes.

“When someone is consuming alcohol on a regular basis and then stops, their body goes through withdrawal, where it has to learn how to operate without the chemical present,” said Golding, a professor in the School of Veterinary Medicine & Biomedical Sciences’ Department of Veterinary Physiology & Pharmacology. “What we discovered is that a father’s sperm are still negatively impacted by drinking even during the withdrawal process, meaning it takes much longer than we previously thought for the sperm to return to normal.”

The Dangers Of Paternal Drinking

One of the major risks associated with alcohol consumption before and during pregnancy is FAS, which causes abnormal facial features, low birth weight and/or height, attention and hyperactivity issues, and poor coordination.

Currently, doctors are required to confirm only that the mother has consumed alcohol-not the father-to diagnose a child with FAS.

“For years, there’s really been no consideration of male alcohol use whatsoever,” Golding said. “Within the last five to eight years, we’ve started to notice that there are certain conditions where there’s a very strong paternal influence when it comes to alcohol exposure and fetal development.

“With this project, we wanted to see how long it would take for the effects of alcohol on sperm to wear off,” he said. “We thought it would be a relatively quick change back to normal, but it wasn’t. The withdrawal process took over a month.”

When drinking alcohol, an individual’s liver experiences oxidative stress, leading the body to overproduce certain chemicals, which then interrupts normal cellular activity. Golding’s team discovered that withdrawal causes the same kind of oxidative stress, effectively lengthening the duration of alcohol’s effects on the body beyond what was previously thought.

“During withdrawal, the liver experiences perpetual oxidative stress and sends a signal throughout the male body,” Golding said. “The reproductive system interprets that signal and says, ‘Oh, we are living in an environment that has a really strong oxidative stressor in it. I need to program the offspring to be able to adapt to that kind of environment.’ But Golding suspects that the adaptations to the sperm aren’t beneficial-they lead to problems like FAS.”

He also noted that it doesn’t take excessive alcohol use for a person to experience withdrawal.

“In the models we’re using, even drinking three to four beers after work several days a week can induce withdrawal when the behavior ceases,” Golding said. “You may not feel inebriated, but your body is going through chemical changes.”

Changing The Narrative

Golding’s work is vital to improving pregnancy outcomes by changing the conversation about who is responsible for alcohol-related birth defects, since society has historically placed all blame on mothers, even when they do not consume alcohol during their pregnancy.

“There’s psychological trauma associated with the question, ‘Did you drink while you were pregnant?’ It’s also difficult for physicians to have that conversation,” he said. “But if they don’t, then FAS doesn’t get diagnosed right away and the child may not get the support that they need until later in life.”

Because of this, it’s crucial that couples planning on getting pregnant know how far in advance to stop drinking in order to prevent birth defects.

While Golding and his lab will continue to research the effects of paternal drinking to help doctors advise couples, he suggests that fathers abstain from alcohol at least three months prior to conceiving, given this groundbreaking discovery.

“There’s still a lot of work to be done to get a hard answer, but we know that sperm are made over the course of 60 days, and the withdrawal process takes at least one month,” he said. “So, my estimate would be to wait at least three months.”

Reference:

Roach AN, Bhadsavle SS, Higgins SL, Derrico DD, Basel A, Thomas KN, Golding MC. Alterations in sperm RNAs persist after alcohol cessation and correlate with epididymal mitochondrial dysfunction. Andrology. 2023 Dec 3. doi: 10.1111/andr.13566. 

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AI accurately predicts malignancy on breast ultrasound, cuts down excessive follow-ups and biopsies

Turkey: A recent study published in Academic Radiology has shown the effectiveness of artificial intelligence (AI) to accurately predict malignancy on breast ultrasound based on BI-RADS (Breast Imaging-Reporting and Data System) assessment.

The study revealed that an AI method showed comparable performance to that of radiologists and can help avoid unnecessary biopsies and follow-up exams, which, in turn, can contribute to sustainability in healthcare practices.

“By considering AI-assigned BI-RADS 2 as safe, we could potentially avoid 11% of benign lesion biopsies and 46.2% of follow-ups,” Nilgun Guldogan, Breast Clinic, Acibadem Altunizade Hospital, Istanbul, Turkey, and colleagues reported.

Previous studies have shown increased use of artificial intelligence systems in breast ultrasonography. These studies have shown how AI aids in image interpretation, reduces false-positive cases, and potentially helps decrease the workload of radiologists. Therefore, Dr Guldogan and colleagues evaluated the performance of an AI system for the BI-RADS category assessment in breast masses detected on breast ultrasound.

For this purpose, the researchers analyzed 715 masses detected in 530 patients. Nine breast radiologists and three breast imaging centres of the same institution participated in the study. One radiologist performed an ultrasound and obtained two orthogonal views of each detected lesion. A second radiologist blinded to the patient’s clinical data retrospectively reviewed these images. The images were evaluated by a commercial AI system.

The level of agreement between the AI system and the two radiologists and their diagnostic performance were calculated according to dichotomic BI-RADS category assessment.

The study revealed the following findings:

· The study included 715 breast masses. Of these, 18.75% were malignant, and 81.25% were benign.

· The agreement between AI and the first and second radiologists was moderate statistically in discriminating benign and probably benign from suspicious lesions.

· The sensitivity and specificity of radiologist 1, radiologist 2, and AI were calculated as 98.51% and 80.72%, 97.76% and 75.56%, and 98.51% and 65.40%, respectively.

· For radiologist 1, the positive predictive value (PPV) was 54.10%, the negative predictive value (NPV) was 99.58%, and the accuracy was 84.06%.

· Radiologist 2 achieved a PPV of 47.99%, NPV of 99.32%, and accuracy of 79.72%.

· The AI system exhibited a PPV of 39.64%, NPV of 99.48%, and accuracy of 71.61%.

· None of the lesions categorized as BI-RADS 2 by AI were malignant, while 2 of the lesions classified as BI-RADS 3 by AI were subsequently confirmed as malignant.

· By considering AI-assigned BI-RADS 2 as safe, 11% of benign lesion biopsies and 46.2% of follow-ups could be potentially avoided.

“Artificial intelligence proves effective in predicting malignancy,” the researchers wrote, they added, “Integrating it into the clinical workflow has the potential to reduce short-term follow-ups and unnecessary biopsies, which, in turn, can contribute to sustainability in healthcare practices.”

Reference:

Guldogan, N., Taskin, F., Icten, G. E., Yilmaz, E., Turk, E. B., Erdemli, S., Parlakkilic, U. T., Turkoglu, O., & Aribal, E. (2023). Artificial Intelligence in BI-RADS Categorization of Breast Lesions on Ultrasound: Can We Omit Excessive Follow-ups and Biopsies? Academic Radiology. https://doi.org/10.1016/j.acra.2023.11.031

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