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Patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who were taking cholesterol-lowering statin medications at the start of their cancer treatment had a 61% lower risk of dying from their cancer compared to similar patients who were not taking statins, according to a study published today in the journal Blood Advances.

“This is the first systematic evaluation of the association of statin use with survival outcomes in patients with CLL or SLL who have been treated with contemporary targeted agents such as ibrutinib,” said the study’s principal investigator, Ahmad Abuhelwa, PhD, an assistant professor of pharmacy practice and pharmacotherapeutics at the University of Sharjah in the United Arab Emirates. “Our results highlight a strong link between statin use and improved survival in this patient population.”

CLL is a slow-growing cancer that starts in the blood-forming cells of the bone marrow and is the most common form of leukemia in adults in the United States. SLL, also a slow-growing cancer, affects the same type of cells as CLL but starts in lymphoid tissues such as the spleen instead of in the blood-forming cells.

Statins are among the most widely prescribed medications. It’s estimated that over 90 million adults in the United States take a statin drug to reduce their cholesterol levels and lower their risk for heart disease, which can lead to heart attacks or strokes. Previous studies have linked statin use to reduced death rates from several cancers, including CLL, said Dr. Abuhelwa. However, those studies did not evaluate the effects of statin use in patients who were treated with newer cancer therapies such as the targeted drug ibrutinib, he said.

In the current study, Dr. Abuhelwa and his colleagues analyzed data from 1,467 patients with CLL or SLL who participated in four international clinical trials conducted between 2012 and 2019. In these trials, patients were randomly assigned to treatment with ibrutinib either alone or in combination with other anti-cancer drugs, or to a drug regimen that did not include ibrutinib. A total of 424 patients (29%) were taking a statin at the time they started treatment across the four clinical trials. The median patient age was 65, and 66% were men; 92% had CLL, which was either newly diagnosed, had come back, or had not responded to prior treatment.

The study’s primary endpoints were cancer-specific survival (how long patients lived after starting treatment before dying specifically from their cancer), overall survival (how long patients lived after starting treatment, regardless of the cause of death), and progression-free survival (how long patients lived after starting treatment before their cancer worsened or they died from any cause). The secondary endpoint was the proportion of patients who experienced severe or life-threatening adverse events. The median follow-up time for all patients enrolled in the four trials was five years for overall survival and 22 months for progression-free survival.

To account for potential confounding factors, the investigators adjusted their analysis for variables including each patient’s diagnosis, age, sex, weight, physical functioning (as assessed by doctors), disease severity, length of time since their diagnosis, number of co-existing illnesses, use of other medications for heart conditions or high blood pressure, and the specific anti-cancer treatment regimen received.

Results showed that, regardless of any of these factors, patients who took a statin had, on average, a 61% reduced risk of dying from their cancer, a 38% reduced risk of death from any cause, and a 26% reduced risk of disease progression. Importantly, statin use did not increase the likelihood of severe or life-threatening adverse events.

“These findings don’t allow us to say for certain that statins directly improve cancer outcomes,” said Dr. Abuhelwa. “However, the fact that this association remained strong even after accounting for multiple factors makes it an important area for future research.” As next steps, he recommended conducting laboratory studies to better understand how statins may influence cancer biology, as well as prospective clinical trials in which patients with CLL or SLL are randomly assigned to take a statin or not.

The study has several limitations given its observational nature. For example, patients enrolled in clinical trials tend to be monitored more closely than those who receive treatment outside of a clinical trial, so the study findings may not be generalizable to patients treated in non-clinical trial settings. Additionally, because patients used various statins at different doses, the study could not determine the effects of specific statin types, doses, or duration of use on patients’ survival.

“While our results are very promising, we can’t recommend starting statins for CLL/SLL treatment based on this study alone,” Dr. Abuhelwa said. “Future clinical trials are needed to determine definitively whether statins have a direct benefit on cancer survival.” 

Reference:

Ahmad Y Abuhelwa, Sara A Almansour, Jennifer R. Brown, Humaid O Al-Shamsi, Ziad Abuhelwa, Zelal Kharaba, Yasser Bustanji, Mohammad H Semreen, Salma M. Ali, Ahmad Alhuraiji, Ross A McKinnon, Michael J Sorich, Karem H Alzoubi, Ashley M Hopkins, Statin use and survival in SLL/CLL treated with ibrutinib: Pooled analysis of four randomized controlled trials, Blood Advances, https://doi.org/10.1182/bloodadvances.2024015287

Japan: A recent retrospective analysis has highlighted the tumor diameter-to-prostate volume ratio (TD/PV) as an effective predictive marker for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men undergoing MRI/transrectal ultrasound (MRI/TRUS) fusion-targeted biopsies.

Recent randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

Patient Randomization and Procedures

Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury. The results showed that the incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001). In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

Conclusion and Recommendations

The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Key Points

1. This randomized controlled study compared the use of video laryngoscopy (VL) versus the conventional blind technique for inserting the transoesophageal echocardiography (TEE) probe in 100 pediatric patients (aged 2-10 years) undergoing cardiac surgery.

2. The primary outcome was the incidence of oropharyngeal injury, while the secondary outcomes were the number of insertion attempts, duration of successful insertion, and the relationship between the laryngeal and oesophageal inlet.

3. Patients were randomized into two groups – the conventional group (Group C, n=50) where the TEE probe was inserted using the blind technique, and the VL group (Group VL, n=50) where VL was used to insert the probe. All patients underwent VL examination after TEE probe removal to assess for oropharyngeal injury.

4. The incidence of pharyngeal mucosal injury was significantly lower in Group VL (n=2, 4%) compared to Group C (n=9, 18%, p=0.025). The number of attempts for successful TEE probe insertion was also significantly lower in Group VL (p<0.05). The mean duration for successful insertion on the first attempt was significantly longer in Group VL (28.75±7.65 seconds) compared to Group C (18.55±5.0 seconds, p<0.0001).

5. In Group VL, the oesophageal inlet was found to be posterior in 86% of patients and posterolateral in 14% relative to the laryngeal inlet.

6. The authors concluded that using VL for TEE probe insertion in pediatric cardiac surgery patients significantly reduced the incidence of pharyngeal injury and provided direct visualization of the oesophageal inlet, leading to a higher first-attempt success rate compared to the conventional blind technique. They recommended regular use of VL for TEE probe insertion in this patient population.

Reference –

Guriqbal Singh et al. (2025). A Randomised Controlled Trial Comparing Video Laryngoscopy Versus Conventional Blind Technique For Transoesophageal Echocardiography Probe Insertion In Paediatric Patients Undergoing Cardiac Surgery: A Pilot Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_975_24

Almost half of children who require surgery for complicated appendicitis can safely complete their recovery at home, according to a new study.

The research, led by Murdoch Children’s Research Institute (MCRI) and published in the Journal of Pediatric Surgery, found more than 40 per cent who received care in the home following a complex appendectomy recovered faster and had fewer complications.

More than 300 patients present with appendicitis to The Royal Children’s Hospital (RCH) every year, with about one in three experiencing a burst appendix or severe infection.

The study involved 83 children, aged five to 18 years, admitted to the RCH for a complicated appendicectomy, with 35 suitable for the Hospital in the Home (HITH) program. All patients needed at least five days of intravenous antibiotics (IV) post-surgery. Under the program, a nurse visited the child’s home daily to administer the antibiotics and record clinical observations.

MCRI Associate Professor Penelope Bryant said under this model, patients at home recovered more quickly and didn’t require readmission to hospital.

“Acute post-operative care at home is rare, but we found it’s possible for children to spend 35 per cent less time in hospital after complicated surgery,” she said. This could be done safely and without prolonging IV courses or broadening antibiotic use.

“These findings will help clinicians to identify which children are suitable for HITH care following surgery for complicated appendicitis.”

MCRI Associate Professor Warwick Teague said the HITH program, used heavily during the COVID-19 pandemic, had the added benefits of reduced hospital and family costs, improved quality of life, less time taken from work and prevention of hospital-acquired infections.

“The pandemic presented us with the need and opportunity to deliver care to children in their home,” he said. This study showed even children who had severe appendicitis can be well cared for at home after surgery, freeing up hospital beds for other sick children and those needing surgery.

“Traditionally after surgery for severe appendicitis, surgeons have insisted on daily reviews in hospital by the surgical team. However, in this study we learnt that optimal postoperative care be delivered at home, by well-trained non-surgical clinicians working as a team with surgeons.”

“For complicated appendicitis, the HITH program also saved over $1,400 per day for the hospital and $300 daily for families, reducing cost-of-living pressures with longer-term benefits for healthcare sustainability.”

Reference:

Ling Chen, Sebastian K. King, Misel Trajanovska, Lynda M. Gaynor, Veronica Cerratti, Rosemary Burgess, Gregory J.G. Nolan, Warwick J. Teague, Penelope A. Bryant, Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis, Journal of Pediatric Surgery Open, 2025,https://doi.org/10.1016/j.yjpso.2025.100196.

Recent study discusses the challenges of managing parturients with cardiovascular disease (CVD) during anesthesia, highlighting the increased perioperative morbidity and mortality due to the heightened demands of pregnancy. The preference for regional anesthesia in obstetrics is established, with general anesthesia (GA) and conventional spinal posing risks of hemodynamic instability in CVD patients. The introduction of segmental spinal anesthesia (SSA) has shown promise in providing better hemodynamic stability by confining anesthesia to specific dermatomes, enhancing safety for high-risk patients.

Case Studies of Parturients with Pre-Existing Cardiovascular Disease

The research presented five cases of parturients with significant pre-existing CVD (severe mitral stenosis, aortic stenosis, hypertrophic obstructive cardiomyopathy, and peripartum cardiomyopathy) who successfully underwent cesarean section under SSA at a particular institute from September 2023 to January 2024. The implementation of thorough preoperative evaluation and optimization was emphasized, with a multidisciplinary approach for planning combined epidural and SSA, invasive monitoring, and postoperative intensive care unit (ICU) management. Informed consent and meticulous monitoring were highlighted throughout the procedures.

Anesthetic Technique Employed for Parturients with CVD

The anesthetic technique employed included segmental spinal administration at specific vertebra levels using a combination of bupivacaine and fentanyl to achieve effective blockade and hemodynamic stability. Close monitoring and prompt management of hypotensive episodes with phenylephrine boluses were reported. Postoperative care included ongoing vigilance, epidural analgesia, cardiac function reassessment, and uneventful recovery for all cases.

Discussion on Anesthesia Options for CVD Patients

Different options for anesthesia were discussed, including graded epidural, combined spinal-epidural, and continuous spinal anesthesia, with a preference for SSA due to its muscle relaxation, reduced anesthetic requirement, and stable hemodynamics. The study emphasized the potential risks of GA in CVD patients, suggesting carefully managed GA might be necessary in specific scenarios to ensure patient safety. The findings advocate for SSA as an effective, safe, and viable alternative anesthesia technique for high-risk obstetric cases involving parturients with underlying CVD. The research exhibited successful outcomes, underlining the importance of individualized approaches and meticulous perioperative management to enhance safety and optimize recovery in such complex clinical scenarios.

Key Points

– Regional anesthesia, especially segmental spinal anesthesia (SSA), is preferred over general anesthesia (GA) in managing parturients with cardiovascular disease (CVD) due to the risks of hemodynamic instability associated with GA and conventional spinal anesthesia.

– Five cases of parturients with significant pre-existing CVD successfully underwent cesarean section under SSA, emphasizing the importance of thorough preoperative evaluation, multidisciplinary planning, invasive monitoring, and postoperative intensive care unit (ICU) management to ensure patient safety.

– The anesthetic technique employed involved segmental spinal administration at specific vertebra levels using a combination of medications to achieve effective blockade and stable hemodynamics, with close monitoring and prompt management of hypotensive episodes.

– Different anesthesia options, including graded epidural, combined spinal-epidural, and continuous spinal anesthesia, were discussed, with a preference for SSA due to its muscle relaxation, reduced anesthetic requirement, and stable hemodynamics, highlighting the potential risks of GA in CVD patients.

– The study advocates for SSA as an effective, safe, and viable alternative anesthesia technique for high-risk obstetric cases involving parturients with underlying CVD, stressing the importance of individualized approaches and meticulous perioperative management to enhance safety and optimize recovery in complex clinical scenarios.

– Successful outcomes were achieved with the use of SSA, underscoring the significance of personalized care and detailed perioperative management in improving safety and recovery for parturients with CVD undergoing anesthesia for cesarean sections.

Reference –

Ajit Kumar et al. (2025). Enhancing Recovery In Cervical Spine Surgery With Erector Spinae Plane (ESP) Block- A Case Series. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_690_24.