Study Reveals Winter Spike in Blood Sugar Among Adolescents With Type 1 Diabetes

Israel: A recent study published in Diabetes/Metabolism Research and Reviews has uncovered significant seasonal fluctuations in blood sugar control among adolescents with type 1 diabetes (T1D). HbA1c levels were notably higher during winter-spring (7.75%) compared to summer-autumn (7.24%).

The study, conducted at a pediatric diabetes center between 2021 and 2023, also revealed sex-specific differences in how body composition influences these seasonal changes. In boys, higher appendicular muscle mass was linked to increased HbA1c, while in girls, both muscle and fat mass were associated with the variation. These findings emphasize the need for tailored, sex-specific approaches in managing T1D during different times of the year.

Circannual fluctuations in glycated hemoglobin (HbA1c) levels are well-documented in adults, yet limited evidence exists regarding similar seasonal patterns and their underlying factors in adolescents with type 1 diabetes. To bridge this gap, Hussein Zaitoon from the Faculty of Medicine in Tel Aviv University, Tel Aviv, Israel, and colleagues aimed to explore how HbA1c levels vary across seasons in youth with T1D and to investigate whether these fluctuations are influenced by differences in body composition.

For this purpose, the researchers conducted a retrospective observational study on adolescents with type 1 diabetes who were followed at a pediatric diabetes center between 2021 and 2023. They calculated seasonal HbA1c averages for winter-spring (December to May) and summer-autumn (June to November) and determined ΔHbA1c as the difference between these values. Using bioelectrical impedance analysis (BIA), they assessed body composition and examined correlations between sex- and age-adjusted z-scores of appendicular muscle mass and fat mass with ΔHbA1c.

The key findings include the following:

  • Among 259 adolescents with type 1 diabetes (average age ~16 years), HbA1c levels were significantly higher during winter-spring (7.75%) than in summer-autumn (7.24%).
  • In mmol/mol units, the seasonal HbA1c values were 61.16 in winter-spring and 55.72 in summer-autumn, showing a consistent pattern.
  • In 102 adolescents who underwent body composition analysis, changes in HbA1c levels showed a sex-specific link to body composition.
  • In boys, only appendicular muscle mass (ASMM) was significantly associated with changes in HbA1c.
  • In girls, both muscle mass (ASMM) and fat mass (FATM) showed significant correlations with seasonal HbA1c changes.

The study found that adolescents with type 1 diabetes experience significant seasonal variation in HbA1c levels, with higher values during winter-spring than in summer-autumn. These fluctuations were closely linked to body composition in a sex-specific manner—muscle mass played a key role in boys, while both muscle and fat mass influenced changes in girls.

“These findings highlight the importance of considering sex-specific physiological factors when managing glycaemic control in adolescents. They also emphasized the need for further research to explore the underlying causes and long-term clinical implications of these seasonal patterns,” the authors concluded.

Reference:

Zaitoon, H., Khalil, H., Cohen-Sela, E., Eyal, O., Interator, H., Oren, A., Laurian, I., Dorfman, A., Chorna, E., Lebenthal, Y., & Brener, A. (2025). Seasonal Variations in HbA1c and Body Composition: A Sex-Specific Analysis in Adolescents With Type 1 Diabetes. Diabetes/Metabolism Research and Reviews, 41(4), e70047. https://doi.org/10.1002/dmrr.70047

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ESIC Medical College And Hospital Kalaburagi: Walk In Interview For SR Post, Check out Details

Kalaburagi: The Employees State Insurance Corporation Medical College and Hospital (ESIC Hospital Kalaburagi) has announced vacancies for the Senior Resident Post on a Contractual Basis. The selection will be done based on a walk in interview.

ESIC is a statutory body constituted under an Act of Parliament (ESI Act, 1948) and works under the administrative control of the Ministry of Labour and Employment, Government of India.

Vacancy Details:

Total no. of vacancies- 37

The Vacancies are in the Department of – Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology, Forensic Medicine, General Medicine, General Surgery, Orthopaedics,, Anesthesiology, Radio diagnosis, ICU/MICU(Med), ICCU(Med), and Emergency Medicine.

The date for the walk-in interview is 7th May 2025.

Document Verification & Registration timings: 9:00 AM to 10:30 AM

The venue and Reporting time for an interview is the Office of the Dean, ESIC Medical College & Hospital, Kalaburagi, From 9.00 AM to 10.30 AM.

For more details about Qualifications, Age, Pay Allowance and much more, click on the given link:
https://medicaljob.in/jobs.php?post_type=&job_tags=ESIC+Kalaburagi&location=&job_sector=all

What are the General Conditions for Eligible Candidates?

a) Candidate can walk in and register for interview from 09:00AM to 10:30 AM on 07.05.2025. No candidate will be entertained after 10:30 AM.

b) Application form is enclosed with the advertisement.

c) All eligible candidates should apply through the application form enclosed with the advertisement and must fill the application form before registration process.

d) Candidates should produce all the original documents in respect of all the parameters filled in the form during scrutiny on the day of Walk in Interview. e) Candidates are requested to report by 9 AM at the venue on scheduled dates.

f) Please bring all following relevant Original certificates and their self attested photocopies (1 sets), 2 copies of passport size photographs and the relevant certificates issued by the competent authority in the form prescribed by Government of India, Department of Personnel & Training for consideration of reservation to the reserved candidates failing which they will not be allowed for interview.

“No photocopies will be arranged/ provided by the office under any circumstances”

List of Documents to be produced at the time of the Interview :

• SSC/10th Standard Certificate as proof of age.

• M.B.B.S Certificate

• PG/DNB Certificate

• Registration with Karnataka State Medical Council(KMC)/NMC

• Caste Certificate issued by the competent Authority

• Experience Certificate if any

• Proof of ID (Aadhar Card and PAN Card)

• Passport size 02 photograph

• Other documents if any.

The interviews shall be conducted at the Office of the Dean, ESIC Medical College AND Hospital, Kalaburagi

Also Read:ESIC Hospital Faridabad Jobs 2025: Super Specialist Post, Check Walk In Interview Details

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Impaired Fasting Glucose and Sulfonylureas Raise Heart Risk in Inflammatory Arthritis

Researchers have discovered in a new study that impaired fasting glucose (IFG) and sulfonylurea use are independently linked with an enhanced risk of major cardiovascular events (MACE) in inflammatory arthritis (IA) patients, including rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The findings of the study underscore vigilance in screening fasting glucose level and adjusting choices of anti-diabetic therapy for patients with IA, as such patients already possess heightened cardiovascular risk. The study was conducted by Huan Meng and fellow researchers published in BMC Diabetology & Metabolic Syndrome.

This was a retrospective, population-based cohort study that made use of data available from The Hospital Authority Data Collaboration Lab in Hong Kong. Patients with IA were enrolled between January 2006 and December 2015, and follow-up data were available up to December 2018. A total of 13,905 patients were included in the study, of whom 12,233 had RA and 1,672 had PsA. Time-dependent Cox proportional hazards regression models were used by researchers to examine the relationships between fasting glucose levels, use of anti-diabetic medications, and the risk of a first MACE in this population.

Results

Among a total follow-up duration of 119,571 patient-years, 934 patients (6.7%) had their first MACE. Some differences were found between patients with and without MACE:

• 19.4% of patients with MACE had IFG (5.6–6.9 mmol/l) at baseline, compared to 15.2% of non-MACE patients (p < 0.001)

• 17.6% of the MACE patients had fasting glucose ≥ 7 mmol/l, versus 8.1% without MACE (p < 0.001)

In a subgroup analysis of anti-diabetic therapy-naïve patients, prediabetic status (IFG) independently increased the risk of MACE:

• Hazard Ratio (HR) 2.43 (95% CI 1.97–2.99) in the C-reactive protein (CRP) model

• HR 2.54 (95% CI 1.50–7.71) in the erythrocyte sedimentation rate (ESR) model

In addition, among diabetic patients, sulfonylurea use was linked with a 55% higher risk of MACE with an:

• HR of 1.55 (95% CI 1.14–2.09) after other factors that influenced the risk were controlled

Investigators concluded that impaired fasting glucose and the use of sulfonylureas separately add to the risk of major cardiovascular events. These results identify the absolute need for enhanced cardiovascular risk assessment and individually appropriate management in IA patients, especially those with abnormal glucose metabolism. More stringent fasting glucose monitoring, sulfonylurea avoidance where possible, and a preference for cardiovascular protection in therapeutic choice may diminish somewhat the large cardiovascular risk burden of this at-risk population.

Reference:

Meng, H., So, H., Lam, S.H. et al. Impaired fasting glucose and sulfonylureas increased the risk of major cardiovascular events in patients with inflammatory arthritis. Diabetol Metab Syndr 17, 132 (2025). https://doi.org/10.1186/s13098-025-01689-6

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Implantable Device Shows Long-Term Benefits for Urinary Incontinence, Reveals Research

USA: An implantable tibial neuromodulation system, known as Revi, significantly improved quality of life and symptoms in women with urgency urinary incontinence (UUI) over 24 months, according to research presented at the American Urological Association Annual Meeting and published in The Journal of Urology. The researchers note that the participants who did not meet the trial’s primary efficacy endpoint experienced meaningful benefits.

The Revi system by BlueWind Medical is a new implantable tibial neuromodulation (iTNM) device that features an external, wearable, battery-operated unit. The device’s stimulation parameters can be customized using a Clinician Programmer to optimize its effectiveness. Suzette E. Sutherland from Scottsdale, AZ, and colleagues summarized the quality-of-life (QoL) outcomes from a previously reported prospective, multi-center, single-arm pivotal trial, which evaluated the efficacy and safety of iTNM in treating urgency urinary incontinence in women.

For this purpose, the researchers performed subfascial implantation of the device over the posterior tibial nerve under local anesthesia in 151 female subjects. After initial healing, the subjects used an external wearable ankle cuff for stimulation treatments at home. Voiding diaries were collected at 1, 3, 6, 9, 12, 18, and 24 months, while quality-of-life questionnaires, including the Overactive Bladder Questionnaire (OAB-q), Patient Global Impression of Improvement (PGI-I), and Benefit Satisfaction and Willingness to Continue (BSW), were gathered at 6, 12, and 24 months.

The primary endpoint, UUI response rate (≥50% decrease in UUI episodes), was achieved, with previously reported results showing UUI response rates of 77.8% (112/144) at 6 months, 82.0% (114/139) at 12 months, and 79.4% (77/97) at 24 months.

Key Findings:

  • Consistent quality of life (QoL) benefits were observed throughout the 24 months, with clinically significant (≥ 10 points) and stable improvements in all domains of the OAB-q.
  • At 24 months, 87.2% of participants reported a ≥ 10-point improvement in total transformed Health-Related Quality of Life (HRQL) score.
  • At 24 months, 96.8% of participants reported a treatment benefit, 96.7% (88/91) expressed satisfaction, and 100% were willing to continue the therapy.
  • Even among subjects who did not meet the primary efficacy endpoint at 24 months (N=20; 21%), a significant number still reported notable benefits.
  • At 24 months, 83.3% of these subjects acknowledged a treatment benefit, 66.7% expressed satisfaction, and 100% were willing to continue therapy.

In conclusion, implantable tibial neuromodulation using the Revi system shows promise as an effective treatment for urgent urinary incontinence. The two-year results highlight meaningful and lasting improvements in bladder-related quality of life, even among patients who did not fully meet the primary efficacy criteria.

Reference:

Sutherland SE, Heesakkers JPFA, Ferrante KL, Dmochowski RR. PD39-12 QUALIFY-OF-LIFE OUTCOMES OF IMPLANTABLE TIBIAL NEUROMODULATION FOR URGENCY URINARY INCONTINENCE: TWO-YEAR RESULTS FROM THE OASIS PIVOTAL STUDY USING THE REVI SYSTEM. Journal of Urology [Internet]. 2025 May 1 [cited 2025 May 3];213(5S):e1355. Available from: https://doi.org/10.1097/01.JU.0001110196.19418.44.12

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Inflammation May Be the Link Between Chronic Pain and Depression, suggests study

Chronic pain-or pain that lasts at least three months-is closely intertwined with depression. Individuals living with pain’s persistent symptoms may be up to four times more likely to experience depression, research shows.

Almost 30% of people worldwide suffer from a chronic pain condition such as low back pain and migraines, and one in three of these patients also report co-existing pain conditions.

Now, a new study published in Science Advances shows that a person’s risk of depression increases alongside the number of places in the body in which they experience pain. Furthermore, inflammatory markers such as C-reactive protein (a protein produced by the liver in response to inflammation) help explain the association between pain and depression.

This finding suggests that the mechanisms underlying chronic pain and depression may be driven by systemic inflammation, the researchers say.

“Pain isn’t only physical,” says Dustin Scheinost, PhD, associate professor of radiology and biomedical imaging at Yale School of Medicine (YSM), and the study’s principal investigator. “Our study adds to the evidence that physical conditions can have mental health consequences.”

Inflammatory markers may explain depression risk

The Yale team analyzed data from the UK Biobank-a long-term study in the United Kingdom that has collected extensive health information from more than 400,000 individuals over 14 years. UK Biobank participants reported whether they were experiencing pain that interfered with daily life and identified the sites and duration of their pain. The categories for pain sites included head, face, neck, back, stomach, hip, knee, and general pain. The dataset also included if and when the participants were diagnosed with depression.

The researchers analyzed data from participants with both chronic and acute (lasting less than three months) pain. They found that both types of pain from all body sites were associated with depression, and that chronic pain was more strongly associated than acute pain. Furthermore, having chronic pain in multiple parts of the body was linked to a greater risk of depression than having pain at a single site.

The UK Biobank also included assessments of participants’ blood. The Yale researchers used these data to look for inflammatory markers, such as C-reactive proteins, platelets, and white blood cells.

They found that several of these inflammatory markers helped explain the relationship between pain and depression—and C-reactive proteins in particular were the strongest variable.

“This gives us some preliminary evidence about the inflammatory mechanisms underlying the association between pain and depression,” says Rongtao Jiang, PhD, postdoctoral associate at YSM and the study’s first author.

Illuminating the brain-body connection

The study adds to growing evidence highlighting the significance of the brain-body connection, the authors say.

“We often think of brain health or mental health as separate from cardiac health or liver health, for instance,” says Scheinost. “But all of these body systems influence each other.” Further research into the underlying drivers of pain and depression could help scientists develop new intervention strategies, he adds.

Most of the participants studied were of European ancestry. In future studies, Jiang says he is interested in studying whether these findings also apply to individuals of other ethnicities. Scheinost’s team is also studying the association between chronic pain and opioid use disorder.

“This is another disorder that goes hand-in-hand with the experience of chronic pain,” Scheinost says.

Reference:

Rongtao Jiang et al. ,The inflammatory and genetic mechanisms underlying the cumulative effect of co-occurring pain conditions on depression.Sci. Adv.11,eadt1083(2025).DOI:10.1126/sciadv.adt1083

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Obstructive Sleep Apnea Found to Increase Risk of Sick Sinus Syndrome, unravels study

A recent study revealed that individuals with an inherited susceptibility to obstructive sleep apnea (OSA) are at increased risk for developing sick sinus syndrome (SSS), a bradyarrhythmia involving the heart’s own pacemaker. The study was conducted by Chen W. and fellow researchers published in the journal Nature and Science of Sleep.

OSA is a prevalent sleeping disorder that features recurring blockage of the airway while one is asleep and subsequent periods of intermittent lack of oxygen. SSS, on the other hand, refers to a wrong rhythm of the heart due to defective sinoatrial node function that leads to dizziness, drowsiness, and syncope. Both these diseases have risks of effects on cardiovascular performance, thus it is vital to identify whether one directly affects the other while designing prevention strategies and treatment procedures.

To establish the causal relationship between OSA and SSS, the researchers used a bidirectional two-sample Mendelian randomization (MR) strategy. The technique utilizes genetic differences as instrumental variables to assess causality between an exposure (OSA) and an outcome (SSS), thus eliminating confounding factors.

Genetic information on OSA were accessed from FinnGen genome-wide association studies with a sample of 410,385 participants. Equivalently, SSS association data were from deCODE genetics with a population base of 1,000,187 individuals. The group used various statistical methods for ensuring robustness such as inverse-variance weighting (IVW), MR-Egger regression, weighted median estimation, maximum likelihood, and MR-PRESSO for sensitivity analysis and identification of pleiotropy.

Key Findings

  • The main MR analysis with IVW (fixed effects) found a 49.3% higher risk of SSS among those genetically at risk of OSA (OR = 1.493; 95% CI: 1.120–1.990; P = 0.006). This was calculated on the basis of 7 single nucleotide polymorphisms (SNPs) as instrumental variables.

  • The MR-Egger intercept value of −0.002 (SE 0.030; P = 0.930) provided no indication of horizontal pleiotropy, such that the observed association was not likely to be confounded by genetic effects. The global test for pleiotropy (P = 0.719) also confirmed this result.

  • Reverse MR analysis indicated that there was no reverse causality—i.e., SSS did not predict an increased risk for OSA development (OR = 0.997; 95% CI: 0.926–1.072; P = 0.930).

This Mendelian randomization study presents strong evidence of a causal association between obstructive sleep apnea and elevated risk of sick sinus syndrome, based on large-scale genetic information from more than a million people. These findings underscore the importance of increased awareness and active management of OSA to potentially lower the burden of cardiac conduction disorders in the population.

Reference:

Chen, W., Pan, W., Ling, L., Jiang, B., Zhang, Y., Su, X., Jiang, T., & Lin, J. (2025). Causal effect of obstructive sleep apnea on sick sinus syndrome: A bidirectional Mendelian randomization study. Nature and Science of Sleep, 17, 689–700. https://doi.org/10.2147/nss.s511973

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Previous Gastrectomy independent risk factor for POBL Risk in laparoscopic liver resection Patients: Study

Researchers have found in a new research that previous gastrectomy was as an independent risk factor for post-operative bile leakage (POBL) in patients undergoing laparoscopic liver resection (LLR). Further in order to reduce the incidence of POBL in high-risk cases, meticulous surgical techniques and comprehensive perioperative management are essential.

Postoperative bile leakage is a common cause of major complications following liver resection. Although the use of laparoscopy for liver surgery has expanded rapidly, bile leakage after laparoscopic liver resection has not been well described. This study aimed to identify the risk factors for bile leakage following laparoscopic liver resection. A total of 510 consecutive patients who underwent laparoscopic liver resection for hepatic tumors between January 2009 and December 2023 were included in this study. Bile leakage was defined according to the criteria established by the International Study Group of Liver Surgery. Its occurrence, consequences, clinicopathological characteristics, and surgical details were evaluated retrospectively. Risk factors were identified using a multivariable logistic regression analysis. Bile leakage occurred in a small number of patients. It was more frequently observed in older individuals, those with a history of gastrectomy, and those who experienced other postoperative complications or extended hospital stays. Multivariable analysis revealed that a history of gastrectomy was independently associated with the occurrence of bile leakage. All affected patients were successfully treated using percutaneous drainage, with some also requiring endoscopic nasobiliary drainage. A previous gastrectomy was identified as an independent risk factor for bile leakage in patients undergoing laparoscopic liver resection.

Reference:

Ide, T., Ito, K., Tanaka, T. et al. Influence of previous gastrectomy on postoperative bile leakage after laparoscopic liver resection. BMC Surg 25, 139 (2025). https://doi.org/10.1186/s12893-025-02873-1

Keywords:

Previous, Gastrectomy, independent, risk factor, POBL, Risk, LLR Patients, Study, Ide, T., Ito, K., Tanaka, T, Postoperative bile leakage, Laparoscopic liver resection, Previous gastrectomy

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Thrombectomy Patients Face Higher Stroke Risk After 90 Days, Study Finds

USA: A recent real-world data analysis has highlighted concerns about the long-term outcomes of acute ischemic stroke patients treated with mechanical thrombectomy. While the procedure remains a vital intervention in the acute phase, the study found that risks persist well beyond the initial 90-day recovery period.

“Patients who underwent thrombectomy faced a 25% higher risk of recurrent stroke compared to controls (HR 1.25), with recurrence rates of 63.3% versus 53.1%,” the researchers reported in Frontiers in Neurology. “Additionally, their two-year stroke- and palliative care-free survival was notably lower (36.6% vs. 45.8%). Although mortality rates were similar between the groups, palliative care use was slightly less among thrombectomy patients.” Key factors influencing these outcomes included age, underlying comorbidities, and procedural complications.

While previous studies have primarily focused on 90-day outcomes in acute ischemic stroke patients treated with thrombectomy, little is known about their long-term prognosis. To address this gap, Adnan I. Qureshi, Zeenat Qureshi Stroke Institutes, Columbia, MO, United States, and colleagues compared extended outcomes—specifically, survival rates and the incidence of recurrent strokes—between patients who underwent thrombectomy and those who did not.

For this purpose, the researchers used Oracle Real-World Data—a large, de-identified dataset of multicenter electronic health records from January 2016 to January 2023—to analyze outcomes in 3,934 acute ischemic stroke patients who underwent thrombectomy and 3,934 matched controls who did not. They assessed the risk of death, palliative care, and new stroke beyond 90 days post-admission using Cox proportional hazards regression to adjust for confounding factors. Kaplan–Meier survival analysis was also employed to estimate stroke- and palliative care-free survival rates.

The study led to the following findings:

  • Of the 3,934 acute ischemic stroke patients who underwent thrombectomy, 2,660 either died, received palliative care, or experienced a new stroke during a median follow-up of 775 days.
  • The two-year stroke- and palliative care-free survival rate was 36.6% for thrombectomy patients compared to 45.8% for those who did not undergo the procedure (adjusted HR: 1.19).
  • The risk of palliative care or death was similar between the two groups (adjusted HR: 0.89).
  • Patients who underwent thrombectomy had a higher risk of recurrent stroke compared to controls (adjusted HR: 1.25).

The study found that acute ischemic stroke patients who underwent thrombectomy faced a significantly higher risk of experiencing a new stroke, receiving palliative care, or dying beyond 90 days compared to those who did not receive the procedure. The researchers note that this elevated risk, largely driven by stroke recurrence, highlights the need for long-term monitoring and strengthened preventive strategies to ensure sustained benefits of thrombectomy in this high-risk group.

Reference:

Qureshi, A. I., Baskett, W. I., Bhatti, I. A., Ovbiagele, B., Siddiq, F., Ford, D. E., Gomez, C. R., Hanley, D. F., & Shyu, C. (2025). Post 90-day outcomes of acute ischemic stroke patients following thrombectomy: Analysis of real-world data. Frontiers in Neurology, 16, 1543101. https://doi.org/10.3389/fneur.2025.1543101

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Guideline on platelet and plasma transfusion released by American College of Chest Physicians

The American College of Chest Physicians® (CHEST) recently released a new clinical guideline on the transfusion of fresh frozen plasma (FFP) andplatelets in critically ill adults. Published in the journal CHEST®, the guideline contains seven evidence-based recommendations to provide a framework for clinicians to implement in their own facilities.

“In practice, we see all too often [that] prophylactic transfusion of platelets or fresh frozen plasma is done unnecessarily,” says Angel Coz Yataco, MD, FCCP, lead author on the guideline. “Transfusion is rarely needed prior to bedside procedures, with lumbar puncture being a possible exception. Following the new guideline, we can drastically reduce the use of FFP.”

The panel of experts developed seven Population, Intervention, Comparator, and Outcome questions addressing platelet and FFP transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence and to formulate and grade recommendations.

“In the United States, 20% of platelets and FFP are transfused to critically ill patients, totaling 2.2 million units of each annually,” says Dr. Coz Yataco. “They are scarce resources with variable costs and access globally. If implemented on a large scale, this guideline provides the framework to decrease the use [to] approximately half a million less units of platelets and FFP transfused annually in the United States alone.”

The panel formulated seven conditional recommendations. In addition to four procedure-specific recommendations, the guideline recommends:

• In stable non-bleeding critically ill patients with thrombocytopenia and without high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 10 × 109/L (Conditional recommendation, very low certainty of evidence).

• In stable non-bleeding critically ill patients with thrombocytopenia who are considered at high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 30-50 × 109/L (Conditional recommendation, very low certainty of evidence).

• In critically ill patients with thrombocytopenia and serious active bleeding, we suggest transfusing platelets if platelet counts fall below 50 × 109/L (Conditional recommendation, very low certainty of evidence).

The entire list of recommendations included in the new guideline are as follows-

Summary of Recommendations

The recommendations in this document apply to critically ill patients, excluding trauma and neuro-critical care populations. These recommendations should be implemented in a hierarchal fashion. Recommendations 1-3 should be applied first to critically ill patients with thrombocytopenia, while recommendations 4-7 provide additional guidance for specific situations involving invasive procedures.

1. In stable non-bleeding critically ill patients with thrombocytopenia and without high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 10 × 109/L (Conditional recommendation, very low certainty of evidence).

2. In stable non-bleeding critically ill patients with thrombocytopenia who are considered at high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 30-50 × 109/L (Conditional recommendation, very low certainty of evidence).

3. In critically ill patients with thrombocytopenia and serious active bleeding, we suggest transfusing platelets if platelet counts fall below 50 × 109/L (Conditional recommendation, very low certainty of evidence)

4. Vascular procedures

4 A. In critically ill patients at increased risk of bleeding due to thrombocytopenia undergoing a central venous catheter or arterial line insertion, we suggest against routine prophylactic platelet transfusion (Conditional recommendation, very low certainty of evidence).

4 B. In critically ill patients at increased risk of bleeding due to coagulopathy undergoing a central venous catheter or arterial line insertion, we suggest against routine prophylactic FFP transfusion (Conditional recommendation, very low certainty of evidence).

5. Bedside thoracic or abdominal procedure

5 A. In critically ill patients with increased risk of bleeding due to thrombocytopenia undergoing a bedside thoracentesis or paracentesis, we suggest against routine prophylactic platelet transfusion (Conditional recommendation, very low certainty of evidence).

5 B. In critically ill patients with increased risk of bleeding due to coagulopathy undergoing a bedside thoracentesis or paracentesis, we suggest against routine prophylactic FFP transfusion (Conditional recommendation, very low certainty of evidence).

6. Lumbar Puncture

6 A. In critically ill patients with increased risk of bleeding due to thrombocytopenia undergoing a bedside lumbar puncture, we suggest platelet transfusion if platelets counts are 40-50 × 109/L or lower (Conditional recommendation, very low certainty of evidence).

6 B. In critically ill patients with increased risk of bleeding due to coagulopathy undergoing a bedside lumbar puncture, we suggest FFP transfusion to target INR 1.5-2 before the procedure (Conditional recommendation, very low certainty of evidence).

7. Bedside Endoscopy

Bronchoscopy

7 A. In critically ill patients with increased risk of bleeding due to thrombocytopenia undergoing routine flexible bronchoscopy without biopsy, we suggest against routine prophylactic platelet transfusion (Conditional recommendation, very low certainty of evidence).

7 B. In critically ill patients with increased risk of bleeding due to coagulopathy undergoing a routine bedside flexible bronchoscopy without biopsy, we suggest against routine prophylactic FFP transfusion (Conditional recommendation, very low certainty of evidence).

GI Endoscopy

7 C. In critically ill patients with suspected portal hypertension related GI bleeding and increased risk of bleeding due to thrombocytopenia who are undergoing GI-endoscopy, we suggest against routine platelet transfusion (Conditional recommendation, very low certainty of evidence)

7 D. In critically ill patients with suspected portal hypertension related bleeding and increased risk of bleeding due to coagulopathy who are undergoing GI-endoscopy, we suggest against routine FFP transfusion (Conditional recommendation, very low certainty of evidence).

Reference:

Yataco, Angel Coz et al., Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults, CHEST Journal, DOI:10.1016/j.chest.2025.02.029 

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Pregnancy and Calcium: Study suggests how to Tackle Silent Issue of Hypocalcemia during pregnancy

Maternal hypocalcemia is a significant healthcare issue characterized by low serum calcium levels during pregnancy. This condition is largely influenced by the physiological demands of pregnancy and inadequate dietary calcium intake, particularly prevalent in African nations with socio-economic challenges. The global prevalence of hypocalcemia among pregnant women ranges from 25.5% to 70.6%, with higher instances noted in developing regions. Recent study conducted at Bugando Medical Centre in Mwanza, Tanzania, aimed to ascertain the prevalence of hypocalcemia among pregnant women and identify its key predictors within this demographic.

Physiological Demands for Calcium During Pregnancy

The introduction emphasizes how physiological changes during pregnancy create an increased need for calcium—approximately 300-350 mg per day for fetal bone development—while dietary deficiencies contribute to the risk of maternal hypocalcemia. The importance of adequate maternal calcium levels is underscored; lower levels can trigger physiological responses that may lead to complications such as preeclampsia. The methodology adopted for this study was a cross-sectional design executed from June 2022 to January 2023. Pregnant women with a gestational age of 20 weeks or more were eligible to participate if they provided consent. The sampling involved a calculated size of 382 participants, accounting for potential non-responses. Data were collected through a standardized questionnaire and blood samples were drawn for serum calcium measurement.

Findings on Prevalence and Predictors of Hypocalcemia

Notably, the study found a 23.2% prevalence of hypocalcemia among the 651 pregnant women analyzed. This prevalence is lower than figures reported in several other studies from different regions, possibly due to better access to calcium-rich dietary sources in Tanzania. The study identified several predictors significantly associated with maternal hypocalcemia, including multiple pregnancies, insufficient calcium supplementation, fewer than four antenatal care (ANC) visits, prior history of preeclampsia, and residence in rural areas.

Impact of Multiple Pregnancies and ANC Visits

Multiple pregnancies were linked to a heightened risk of hypocalcemia, attributed to the increased maternal calcium demand. The absence of routine calcium supplementation during ANC visits was found to directly contribute to lower calcium levels, reinforcing that diet alone might be inadequate—especially for populations prone to nutritional deficiencies. Similarly, low frequency of ANC visits correlated with higher hypocalcemia risk, emphasizing ANC’s role in nutritional education and health monitoring.

Historical and Socio-economic Factors Affecting Calcium Levels

Additionally, women with a previous history of preeclampsia displayed challenges in maintaining normal calcium levels in subsequent pregnancies, likely due to persistent physiological effects from earlier pregnancies. Rural residence emerged as a significant risk factor, likely due to limited access to education and healthcare resources, along with poor dietary practices influenced by socio-economic constraints.

Unexpected Findings Regarding Gestational Age

Interestingly, the study indicated that gestational age in the third trimester did not align with the anticipated increase in hypocalcemia risk, suggesting potential influences from the participants’ socio-economic backgrounds and nutritional statuses that could affect calcium levels independently of pregnancy progression.

Study Limitations and Recommendations

Limitations include the study’s focus on patients attending a tertiary hospital, which may limit the generalizability of findings. The study concludes that approximately one in five pregnant women at the facility experienced hypocalcemia. Recommendations entail routine hypocalcemia screening, implementation of regular calcium supplementation during ANC visits, and enhancing nutritional education focused on calcium-rich food sources as vital strategies to mitigate risk and improve maternal and fetal health outcomes.

Reference –

Godluck H Mlay et al. (2025). Predictors Of Maternal Hypocalcemia Among Pregnant Women Attending At A Tertiary Referral Hospital In Tanzania: A Cross-Sectional Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07536-w.

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