Severe Anemia Elevates Risk of PPH During Elective Labor Induction, reveals research

According to researchers, pregnant women with severe anemia stand at a more substantial risk of experiencing postpartum hemorrhage (PPH) if labor is induced electively during late pregnancy. A new study was recently published in the Journal of Gynecology and Obstetrics conducted by Tuck S. and colleagues.

The most important cause of maternal mortality in many parts of the world is PPH. Anemia in pregnancy is a known risk factor for PPH, though the ways in which anemia severity and methods of labor induction/augmentation interact to influence risk for PPH has not been well understood. This study examines in detail how those factors interact to raise risk for PPH and provides insights that can guide clinical decision-making in obstetric care.

This prospective cohort study enrolled 9,420 pregnant women across India in 13 hospitals. Hemoglobin at ≥28 weeks of gestation was assessed and blood loss after delivery during follow-up. PPH was defined as blood loss ≥500 mL for vaginal births or ≥1,000 mL for cesarean sections. Anemia severity was defined by the following:

  • No/Mild: Hemoglobin ≥10 g/dL

  • Moderate: Hemoglobin 7 to 9.9 g/dL

  • Severe: Hemoglobin <7 g/dL

The indications of labor induction/augmentation were categorized as either clinically indicated or elective, and multivariable Poisson regression was used to compute associations between these factors and PPH, adjusting for confounders.

Anemia Severity and Risk of PPH:

  • Patients with severe anemia (hemoglobin <7 g/dL) were at strongly increased risk of PPH.

  • Associations were not significant at no/mild or moderate anemia levels.

Impact of Labor Induction/Augmentation:

  • Elective labor induction significantly increased the risk for PPH in women with severe anemia (adjusted risk ratio, 3.44; 95% CI: 1.29–9.18).

  • Clinically indicated inductions were not associated with a significant increase in the risk for PPH in this group (adjusted risk ratio, 1.22; 95% CI: 0.42–3.55).

Interaction Between Factors:

  • A significant interaction was found between anemia severity and type of labor induction/augmentation regarding the risk for PPH (P = 0.003).

Labor management should be stratified according to the severity of anemia. Induction/augmentation of labour is safe in most women with anemia, but elective procedures should be avoided in severe cases to minimize the risk of PPH. These findings stress the need for individualised obstetric care for better maternal outcomes.

Reference:

Cheng, T. S., Zahir, F., Solomi, C., V., Verma, A., Rao, S., Choudhury, S. S., Deka, G., Mahanta, P., Kakoty, S., Medhi, R., Chhabra, S., Rani, A., Bora, A., Roy, I., Minz, B., Bharti, O. K., Deka, R., Opondo, C., Churchill, D., … Nair, M. (2024). Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.16008

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Nasal spray version of bumetanide has potential to help treat heart failure, reveals study

A new nasal spray form of the medication bumetanide may reduce the tissue swelling caused by heart failure as effectively as the standard oral and intravenous formulations of the medication, according to late-breaking science presented today at the American Heart Association’sScientific Sessions 2024. This research is simultaneously published today in the American Heart Association journal Circulation.

Heart failure occurs when the heart does not pump blood as well as it should, resulting in decreased blood flow to organs and fluid buildup in the lungs and other tissues. Lifestyle changes, including controlling obesity, smoking cessation, being physically active, controlling high blood pressure and controlling blood glucose levels can help prevent the development of heart failure.

Medications used to treat heart failure include diuretics, which reduce tissue swelling and can be administered orally or intravenously. Bumetanide is one of the standard diuretics administered orally or intravenously to reduce tissue swelling from heart, kidney or liver disease by removing excess salt and water through the urine.

In this clinical trial called RSQ-777-02, researchers explored a new nasal spray form of bumetanide in healthy adults. They compared its absorption and ability to reduce swelling to those of oral and intravenous bumetanide among 68 adults who did not have heart failure or risk factors for heart failure at the time of enrollment.

“In patients with heart failure, the body’s ability to absorb oral medications in the stomach and gut often decreases as fluid overload builds up (this is called diuretic resistance) and, thus, oral medications are often least effective when the body needs them most,” said study presenting author Daniel Bensimhon, M.D., medical director of the Advanced Heart Failure/Mechanical Circulatory Support Program at Cone Health in Greensboro, North Carolina. “Having a diuretic that does not rely on gut absorption to be effective may be a very important tool to help patients with heart failure and other conditions without having to rely on intravenous administration of these medications, which can only be done at hospitals and in heart failure clinics.”

The study found:

  • The nasal spray was absorbed effectively and was safe, meaning that side effects were consistent with the other versions of administration and that it had fewer treatment-emergent adverse events compared to the oral version.
  • Compared with the oral and IV versions of bumetanide, the nasal spray formulation led to a similar amount of urine output.
  • Compared with the oral version, people treated with the nasal spray bumetanide reached a similar blood concentration, and the medication was absorbed 33% faster. The absorption rate of the IV form was faster than both the oral and nasal versions, however, the onset of sodium excretion through urine was faster with the nasal version, the authors noted. Previous research has suggested urinary sodium as a biomarker of diuretic response in heart failure.
  • Study participants received all three forms of bumetanide in various order. The nasal and IV forms of bumetanide were absorbed at more reliable rates than the oral form for each study participant – a measure known as intrasubject variability. The nasal and IV forms had a variability in absorption of 27%, compared to >40% for the oral form, suggesting that the nasal and IV forms are more stable routes of dosing, the authors noted. This would be an advantage for the nasal spray over the oral form for self-administration of the medication at home, they added.

“We were surprised by how fast the nasal spray worked and by how variable the absorption of the oral drug was even in healthy subjects,” Bensimhon said. “Patients who require diuretic treatment for swelling associated with chronic heart failure and liver disease may now have a new, self-administered option, particularly when they are unable to take their oral medication or it no longer works.”

The study’s primary limitation is that participants were healthy and did not have heart failure or risk factors for developing heart failure at the time of enrollment. Now that safety and tolerability have been established in healthy adults, the authors said they will be conducting future studies to evaluate the bioavailability and clinical effectiveness of intranasal bumetanide in patients with heart failure.

“We think this will be a valuable tool for treating heart failure by promoting care at home and potentially reducing the need for costly hospital admissions and readmissions,” Bensimhon said. “Keeping patients at home is good for the patient and our health systems.”

Study background and details:

  • The RSQ-777-02 clinical trial was conducted at Orange County Research Center in Irvine, California, from December 2023 to April 2024.
  • The study included 68 healthy adults, ages 18 to 55 years old, who did not have heart failure or risk factors for developing heart failure at the time of enrollment.
  • 66.2% of participants identified as men; 33.8% as women. 60.3% of participants self-identified as white adults, 27.9% as Black adults, 10.3% as Asian adults and 1.5% self-identified as adults of “other” race. 32.4% identified as Hispanic or Latino ethnicity and 67.6% as not Hispanic or Latino ethnicity.
  • The researchers administered nasal, oral and intravenous bumetanide. Each participant received all three forms of bumetanide in a varied order.
  • Study participants were monitored on-site for 10 days.

Reference:

Nasal spray version of common diuretic has potential to help treat heart failure, American Heart Association, Meeting: AHA Scientific Sessions 2024.

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Transscleral Cyclophotocoagulation effectively lowers IOP among glaucoma patients:Study

Glaucoma encompasses a heterogeneous group of eye diseases
associated with progressive loss of optic nerve fibers, with consequent loss of
corresponding visual field. Several risk factors have been identified for the
development and progression of this condition, but intraocular pressure (IOP)
is still the primary modifiable risk factor. IOP-lowering can be achieved with
eye drops or laser trabeculoplasty (both currently considered to be first line
options in most glaucoma cases), or surgery, which is mostly reserved for
patients who progress despite non-surgical maximal tolerated treatment or if
there is a very advanced disease stage or glaucoma type where non-surgical
treatment is not expected to be able to lower IOP to the levels that are expected
to stop disease progression. The majority of surgeries performed are filtering
surgeries and aim to lower IOP through an increased outflow, but there are also
options that aim for a reduction of aqueous humour (AH) production, such as the
cyclodestructive or cyclomodulating procedures, which are still usually used as
a last resource or when other types of surgery are deemed very likely to be
unsuccessful.

In cyclodestructive procedures, unlike other surgeries, the
IOP lowering effect is obtained by ablation of the ciliary body with subsequent
reduction of AH production. The most widely used technique is Laser Cyclophotocoagulation
(CPC), namely the Diode Laser Transscleral Cyclophotocoagulation (TSCPC).
During TSCPC, a semiconductor diode laser (810 nm) is transmitted through the
overlying sclera and absorbed by melanin in the ciliary processes, leading to
selective thermal coagulation of the ciliary body. Despite the simplicity of
the procedure (comparing to incisional filtering surgery), cycloablation is
feared among some ophthalmologists due to the risk of persistent hypotony,
phthisis bulbi and loss of visual acuity. The risk of hypotony with TSCPC can
be as high as 18% (namely in cases of neovascular glaucoma (NVG). Moreover, the
reported success rates are highly variable (36.7–94.4%), possibly due to
heterogeneity in methodologies regarding the definitions of patient population,
energy settings, success and follow-up duration. It is also important to
acknowledge that the majority of the studies only established an upper IOP
limit for the definition of success, therefore not excluding patients with
hypotony.

Despite the increasing evidence regarding TSCPC, according
to the latest version of the European Glaucoma Society Guidelines, refractory
glaucoma (glaucoma for which the target intraocular pressure (IOP) has not been
achieved despite maximum tolerated medical treatments and/or conventional,
properly performed filtration surgery) or expected incisional surgery failure
remain the only formal indications for TSCPC use.

There is a need for more evidence concerning this procedure,
in order to try to expand its indications. Therefore, this study intended to
provide more data regarding the efficacy and safety of TSCPC, based on a
Portuguese population with glaucoma or ocular hypertension treated at a
tertiary centre, with a 2-year follow-up post-procedure.

Ribeiro et al carried a retrospective review of the records
of all adult patients who underwent their first TSCPC treatment between 2014
and 2019 at Unidade Local de Saúde de São João, Porto, Portugal. Data regarding
intraocular pressure (IOP), best corrected visual acuity, number of
IOP-lowering medications, use of oral acetazolamide, retreatments and
complications during a 2-year period following TSCPC were registered. The
primary outcome was overall success at 2 years, defined as IOP≥ 6 and ≤21 mmHg,
with at least 20% IOP reduction from baseline, with or without IOP-lowering
medications (qualified and complete success, respectively), without the
development of phthisis bulbi or loss of light perception due to glaucoma and
no further glaucoma procedures except TSCPC retreatment.

Ninety-six eyes from 96 patients were included, mean age was
63 (±14) years. Mean IOP at baseline was 39.1 (±13.3) mmHg. Mean IOP reduction
at 2 years was 18.5 (42.9%) mmHg (±16.0, min −16.0, max 56.0) (p < 0.001)
and a significant reduction in the number of IOP-lowering medications and use
of oral acetazolamide was observed. IOP reduction at 2 years was positively
correlated with baseline IOP (r=0.682; p < 0.001). Overall success (including
complete and qualified) was achieved in 42 patients (43.8%), with 34 (35.4%)
presenting qualified success. Neovascular glaucoma (NVG) was the predominant
diagnosis (n = 30, 31.3%), with a higher mean baseline IOP of 46.3 mmHg (±11.8,
min 21.0, max 70.0) and a larger mean IOP reduction at 2 years of 24.7 (51.0%)
mmHg (±16.4, min −2.0, max 55.0). Thirteen patients (13.5%) developed
persistent hypotony, eight of which converted to phthisis bulbi, of which half
had NVG.

The results of the study demonstrated a significant effect
of TSCPC in reducing both IOP and the need for IOP-lowering topical and/or oral
medications in the management of patients with glaucoma. The overall success
rate was 37.5% at 12 months and 43.8% at 24 months. The majority (23 patients,
64%) of patients with overall success after 12 months also achieved success at
24 months without the need of additional TSCPC, suggesting a sustained effect
of this procedure between the first and second year. Nonetheless, the rate of
complications observed is not negligible, with 13 (13.5%) of the patients
developing persistent hypotony, and of these, 8 evolved to phthisis bulbi.
Regarding BCVA, 26.3% of patients with vision (light perception, hand motion
and counting fingers) progressed to no light perception.

In conclusion, the study shows that TSCPC can be an
effective IOP-lowering procedure, demonstrating a stronger effect when
preoperative IOP is highest. Authors confirmed that there is a wide variability
in the effect and a considerable amount of postoperative complications, such as
persistent hypotony and phthisis bulbi, which are more pronounced in certain
glaucoma types such as NVG. More studies are required, ideally with less
advanced cases, to establish appropriate energy levels, duration and extension,
based on each patient’s clinical characteristics, thus allowing for higher
success rates, more predictability and less complications.

Source: Ribeiro et al; Clinical Ophthalmology 2024:18

https://doi.org/10.2147/OPTH.S473788

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Sensitive assessment tools like Teate Depression Inventory may accurately diagnose Antenatal Depression, study finds

Antenatal depression presents as feelings of sadness, sleep problems, disorganized behavior, irritability, and restlessness during pregnancy. If not properly identified, it remains untreated and has links to increased suicide risk, higher chances of postpartum depression, preeclampsia, premature birth, low birth weight, impaired mother-child interactions, and severe obstetric complications. Recent findings highlight the crucial need to prevent depression risk during pregnancy. Recent study examined the predictive validity of socio-demographic and psychological factors in the development of antenatal depression (AD) in a sample of 247 Italian pregnant women. AD is characterized by low mood, insomnia, disorganized behavior, irritability, and agitation during pregnancy. If left untreated, AD can have serious consequences, including increased risk of suicide, postpartum depression, preeclampsia, preterm birth, low birth weight, poor mother-child interactions, and other adverse obstetric outcomes.

Assessment of Depressive Symptoms

The researchers assessed depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and the Teate Depression Inventory (TDI), a new measure designed to better differentiate between depressive symptoms and normal pregnancy-related somatic changes. They also collected data on demographic factors like age, marital status, employment, and education level.

Results and Predictive Risk Factors

The results showed that only the psychological factors, as measured by the TDI, were significant predictive risk factors for AD. There were no significant associations between AD and the demographic variables examined. Specifically, higher scores on the TDI were associated with higher scores on the EPDS, indicating more severe depressive symptoms. In contrast, the demographic factors did not significantly predict EPDS scores.

Implications and Recommendations

These findings suggest that screening for and treating depressive symptoms during pregnancy, rather than focusing on socio-demographic risk factors, may be the most effective approach for preventing the negative consequences of AD. Early identification and intervention for depressive symptoms in pregnancy could help reduce the risk of postpartum depression and associated complications. The researchers recommend using reliable, sensitive assessment tools like the TDI to accurately diagnose and monitor AD. Further research with larger, more diverse samples is needed to confirm and extend these results.

Key Points

1. The study examined the predictive validity of socio-demographic and psychological factors in the development of antenatal depression (AD) in a sample of 247 Italian pregnant women.

2. AD is characterized by low mood, insomnia, disorganized behavior, irritability, and agitation during pregnancy, and can have serious consequences if left untreated.

3. The researchers assessed depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and the Teate Depression Inventory (TDI), and also collected data on demographic factors.

4. The results showed that only the psychological factors, as measured by the TDI, were significant predictive risk factors for AD, while the demographic variables did not significantly predict EPDS scores.

5. The findings suggest that screening for and treating depressive symptoms during pregnancy, rather than focusing on socio-demographic risk factors, may be the most effective approach for preventing the negative consequences of AD.

6. The researchers recommend using reliable, sensitive assessment tools like the TDI to accurately diagnose and monitor AD, and call for further research with larger, more diverse samples to confirm and extend these results.

Reference –

Sergi, M.R., Saggino, A., Balsamo, M. et al. Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study. BMC Pregnancy Childbirth 24, 689 (2024). https://doi.org/10.1186/s12884-024-06704-8.

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Lung ultrasound effective as point-of-care investigation to diagnose childhood pneumonia, reveals research

Lung ultrasound is effective as a point-of-care investigation to diagnose childhood pneumonia, reveals research published in Lung India.

Lung ultrasound is emerging as a rapid, simple and safe alternative for diagnosing pneumonia since it has a higher sensitivity than X-rays and lower radiation exposure than computerized tomography. This is a prospective observational study done at a tertiary care centre in Chennai to study the diagnostic utility of lung ultrasound in pneumonia. Children aged 1 month to 12 years who were admitted to the hospital with complaints of cough, fever and/or breathing difficulty and on examination had tachypnea and/or chest indrawing were included in the study. All children underwent chest X-rays which was a standard hospital protocol. At admission, an independent investigator who was blinded to the clinical and radiological features of the child performed lung ultrasound. In all children, the final diagnosis of pneumonia was made by another independent expert paediatrician on the basis of the clinical features and chest X-ray. The test characteristics of ultrasound and chest X-ray were compared against this gold standard of physician-diagnosed pneumonia. Results: Out of the 252 children studied, 225 (89.3%) had pneumonia while the rest 27 (10.7%) had other diagnoses. Among the 225 children with pneumonia, 223 (99.1%) were detected by ultrasound while 157 (69.8%) were detected by chest X-ray. All the test characteristics such as sensitivity, specificity, positive and negative predictive values of ultrasound were higher than those of chest X-ray. The sensitivity and specificity of ultrasound to diagnose pneumonia were 99.11% and 81.48%, respectively, while the sensitivity and specificity of X-ray for the same were 69.77% and 74.07%, respectively. Overall diagnostic accuracy for chest ultrasonography was 97.22% (94.36% to 98.88%), whereas for chest radiography, it was found to be 70.24% (64.18% to 75.81%).While both modalities were able to diagnose pneumonia significantly, ultrasound had better strength of association (Cramer’s V value = 0.849) than X-ray to the final diagnosis. Lung ultrasound can be employed as a point-of-care investigation to diagnose pneumonia in suspected cases and can even replace chest X-ray in such circumstances.

Reference:

Vaitheeswaran, Gayathri, et al. “Point-of-care Lung Ultrasound in the Diagnosis of Childhood Pneumonia.” Lung India : Official Organ of Indian Chest Society, vol. 41, no. 6, 2024, pp. 411-415.

Keywords:

Lung, ultrasound, effective, point-of-care, investigation, diagnose, childhood, pneumonia, reveals, research, lung India, Vaitheeswaran, Gayathri

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Routine imaging in postoperative follow-up of patients with pancreatic ductal adenocarcinoma may help improve overalls survival: JAMA

Recent research has shown that, in comparison to symptom-based follow-up, routine imaging in follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC) is associated with survival and a higher rate of treatment targeted towards recurrence. The study was conducted by Paul C. and colleagues published in JAMA Surgery journal.

PDAC is considered one of the most aggressive forms of malignancy with high recurrence following surgical resection. The overall objective of this research was to examine how these follow-up interventions impacted overall survival and chances of access to recurrence-specific treatments in patients with recurrent PDAC.

This was a prospective, cross-sectional trial conducted in 13 countries and 33 E-AHPBA centers across the years 2020 to 2021, recruiting patients with PDAC. A total of 333 participants, with a mean age of 65 years (SD, 11 years), and 184 male patients (55%), had follow-up after pancreatic resection assessed. Two approaches to the strategy of follow-up were compared: symptomatic follow-up without routine imaging and routine imaging follow-up. The overall survival was analyzed through Kaplan-Meier estimates. Logistic and Cox proportional hazard models were used to control the confounding factors.

Key Findings

  • Of 333 patients with PDAC recurrence, routine imaging follow-up was done in 71% (235 patients), and the follow-up was based on symptoms in 29% of the patients (98 patients).

  • Median overall survival was significantly longer for the routine imaging group, at 28 months (95% CI, 24-30 months), versus 23 months (95% CI, 19-29 months) in the symptomatic follow-up group (P = 0.01).

  • Routine imaging follow-up was associated with a higher likelihood of receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P =0.01).

  • In contrast, overall survival was prolonged among patients who had routine imaging at regular intervals, with an adjusted hazard ratio of 0.75 (95% CI, 0.56-0.99; P = 0.04).

Routine imaging post-resection of PDAC was independently associated with greater recurrence-focused treatment and longer survival, and an overall survival rate of 28 months in patients monitored by routine imaging versus symptomatic follow-up at 23 months. Specific imaging protocols must be further explored as well as their cost-effectiveness, and then uniform, evidence-based guidelines for follow-up care have to be developed.

Reference:

Andel, P. C. M., van Goor, I. W. J. M., Augustinus, S., Berrevoet, F., Besselink, M. G., Bhojwani, R., Boggi, U., Bouwense, S. A. W., Cirkel, G. A., van Dam, J. L., Djanani, A., Dorcaratto, D., Dreyer, S., den Dulk, M., Frigerio, I., Ghorbani, P., Goetz, M. R., Groot Koerkamp, B., Gryspeerdt, F., … Wellner, U. (2024). Routine imaging or symptomatic follow-up after resection of pancreatic adenocarcinoma. JAMA Surgery. https://doi.org/10.1001/jamasurg.2024.5024

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Children exposed to antiseizure meds during pregnancy face neurodevelopmental risks, Drexel study finds

Children born to mothers who take antiseizure medications to manage seizures and psychiatric conditions during pregnancy may face increased risks of neurodevelopmental conditions, according to new data from researchers at Drexel’s Dornsife School of Public Health.
The current work — using data from more than three million children from the United Kingdom and Sweden, including 17,495 who were exposed to antiseizure medications during pregnancy — found that children exposed to the antiseizure drug lamotrigine in utero were at no additional risk for autism or intellectual disability compared with those exposed to other antiseizure medications. However, children exposed to valproate, topiramate, and carbamazepine were linked to specific neurodevelopmental issues. The findings were published this month in the journal Nature Communications.
However, the absolute risk of neurodevelopmental outcomes in offspring is low, the researchers caution, regardless of antiseizure drug regimen. Compared to children unexposed to antiseizure medications, those exposed to the drug topiramate during pregnancy were 2.5 times more likely to be diagnosed with intellectual disability, which raises their risk to 2.1% by age 12. In comparison with other drugs available, the authors found very little data suggesting that the drug lamotrigine in pregnancy increases the risk of neurodevelopmental issues in offspring.
“Our findings suggest that while certain medications may pose some risk, lamotrigine may be a less risky option,” said co-senior author Brian K. Lee, PhD, a professor in the Dornsife School of Public Health. “Active monitoring of any antiseizure medication is critical to ensure safety and effectiveness, particularly during pregnancy.”
This study contrasts earlier studies in that it did not find a statistically significant link between topiramate or levetiracetam and ADHD in children, regardless of whether the birthing parent had an epilepsy diagnosis.
According to the researchers, the data does not argue against use of antiseizure medications in patients who benefit, but rather encourages these patients to have a conversation with their doctor to determine if their course of treatment is most appropriate for them.
“Decisions should be made that are tailored to individual patients,” said co-lead author Paul Madley-Dowd, PhD, a research fellow at the University of Bristol. “Stopping antiseizure medications can cause individual harm and harm to offspring, so these conversations always need to happen with a clinician.”
This study supports findings from previous research that link the antiseizure drugs valproate, topiramate, and carbamazepine with neurodevelopmental diagnoses in offspring, such as autism, intellectual disability and ADHD. Previous studies in smaller populations also link in utero exposure of these drugs with neurodevelopmental outcomes in offspring, such as ones linking topiramate and intellectual disability, and those associating valproate and lower IQ.
The study utilized data on drug prescriptions in the United Kingdom, and dispensation and self-reported data on drug use in Sweden, as well as electronic health records data for diagnoses. The authors conducted a sibling analysis to help minimize the influence of other factors, such as severity of diagnosis and underlying genetics, that may influence the results.
“The link between these drugs and children’s neurodevelopmental outcomes is there, even if the risk isn’t much higher than it is in the unexposed population,” said co-lead author Viktor H. Ahlqvist, a postdoctoral researcher at Karolinska Institutet. “If you’re pregnant or trying to become pregnant, and taking one of these medications, it may be worth talking with your physician to make sure you’re taking the best medicine for your needs, while minimizing risk to future children.”
Despite the study’s large sample size, the authors say patients could benefit from further research from multiple countries on safety of these drugs as the landscape of options available to patients changes.
In addition to Lee, Madley-Dowd and Ahlqvist, other authors included co-senior authors Cecilia Magnusson from the Karolinska Institutet and Dheeraj Rai from the University of Bristol, and collaborators from Drexel University, Pennylvania State University, London School of Hygiene and Tropical Medicine, University College London, University of Bristol, and the Karolinska Institutet.
References: Paul Madley-Dowd, Viktor H. Ahlqvist, Harriet Forbes, Jessica E. Rast, Florence Z. Martin, Caichen Zhong, Ciarrah-Jane S. Barry, Daniel Berglind, Michael Lundberg, Kristen Lyall, Craig J. Newschaffer, Torbjörn Tomson, Neil M. Davies, Cecilia Magnusson, Dheeraj Rai & Brian K. Lee

Nature Communications volume 15, Article number: 9640 (2024) 

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Cetylpyridinium chloride mouthwash use decreases salivary viral titer of COVID-19 compared to placebo: Study

Cetylpyridinium chloride mouthwash use decreases salivary viral titer of COVID-19 compared to placebo suggests a study published in the Journal of Evidence-Based Dental Practice.

The established effect of cetylpyridinium chloride (CPC) mouthwash on SARS-CoV-2 viral titers is unclear. No clinical trial has examined the impact of on-demand aqueous chlorine dioxide mouthwash on SARS-CoV-2 viral titer. In this multicenter, 3-armed, randomized, open-label, placebo-controlled clinical trial involving mildly symptomatic COVID-19 patients, we randomly assigned them to receive 20 mL of 0.05% CPC, 10 mL of 0.01% on-demand aqueous chlorine dioxide, or 20 mL of purified water as a placebo mouthwash in a 1:1:1 ratio. The primary measurement was the SARS-CoV-2 viral titer in saliva, evaluated by a mixed-effects linear regression model. Results: 49 patients received CPC mouthwash (n=16), on-demand aqueous chlorine dioxide mouthwash (n=16), and placebo (n=17) between January 14, 2024, and February 20, 2024. 0.05% CPC mouthwash significantly reduced salivary viral titer at 10 minutes postuse (-0.97 log10 PFU/mL; 95% CI, -1.64 to -0.30; P = .004), while no such effect was observed at 30 minutes (difference vs placebo, -0.26 log10 PFU/mL; 95% CI, -0.92 to 0.40; P = .435) or 60 minutes (difference vs. placebo, -0.05 log10 PFU/mL; 95% CI, -0.68 to 0.58; P = .877). 0.01% on-demand chlorine dioxide mouthwash did not reduce salivary viral titer at 10 minutes, 30 minutes, or 60 minutes compared to placebo. 10 minutes after using a 0.05% CPC mouthwash, the salivary viral titer of SARS-CoV-2 decreased compared to placebo. 0.01% on-demand aqueous chlorine dioxide mouthwash and placebo had no significant difference in SARS-CoV-2 viral titers.

Reference:

Onozuka D, Takatera S, Matsuo H, Yoshida H, Hamaguchi S, Yamamoto S, Sada RM, Suzuki K, Konishi K, Kutsuna S. Oral mouthwashes for asymptomatic to mildly symptomatic adults with COVID-19 and salivary viral load: a randomized, placebo-controlled, open-label clinical trial. BMC Oral Health. 2024 Apr 25;24(1):491. doi: 10.1186/s12903-024-04246-1. PMID: 38664718; PMCID: PMC11044332.

Keywords:

Cetylpyridinium, chloride, mouthwash, use, decreases, salivary, viral titer, COVID-19, compare, placebo, study , journal of Evidence-Based Dental Practice, Onozuka D, Takatera S, Matsuo H, Yoshida H, Hamaguchi S, Yamamoto S, Sada RM, Suzuki K, Konishi K, Kutsuna S

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Stress Hyperglycemia Ratio may predict one-year mortality in CKD and critically ill patients, suggests study

Stress Hyperglycemia Ratio (SHR) was found to be a
meaningful and valuable biomarker for predicting one-year mortality in
ICU-admitted chronic kidney disease (CKD) patients and high-risk patients as
per a recent study that was published in the journal BMC Nephrology.

Recent trends show an acute increase in chronic kidney diseases
globally associated with increased cardiovascular events, morbidities, and
increased mortality rates. Critically sick patients were also found to have CKD
and had increased mortality compared to non-CKD. Literature showed that stress
hyperglycemia (SHR) is a new biomarker correlated with adverse clinical outcomes
in ICU and chronically sick individuals. Hence researchers hypothesized an association
between SHR and CKD and investigated the relation between SHR and one-year
all-cause mortality rate in ICU-admitted CKD patients.

Also Read: Study Reveals Link Between RBC Transfusion and Reduced Mortality in Septic Patients with CKD

By utilizing data from the Medical Information Mart for
Intensive Care IV (MIMIC-IV) database, Patients diagnosed with CKD and with
data of admission blood glucose (ABG) and glycated hemoglobin (HbA1c) were
included. The primary endpoint was the incidence of all-cause mortality within one
year follow-up. Multivariate restricted cubic spline (RCS) regression analysis
was employed to visualize the relationship between SHR and one-year mortality,
using 5 knots.

Findings:

  • About 1825 CKD patients were included in the study.
  • The multivariate RCS analysis showed a “U-shaped”
    relationship between SHR and one-year mortality indicating that both high and
    low levels of SHR were associated with increased mortality risk.
  • Based on these results the study population was categorized
    into three groups: Group 1 (SHR<0.70), Group 2 (0.70≤SHR≤0.95), and Group 3
    (SHR>0.95).
  • The one-year outcomes were better in group 2 compared to the
    other two groups (p=0.0031) suggesting that moderate SHR levels were associated
    with better outcomes.
  • Subgroup analysis also showed persistent results of this
    survival benefit as stratified by age, sex, CKD stage, anemia, and various
    clinical conditions

Thus, the study concluded that SHR is a valuable tool for physicians
to assess the one-year mortality rate in ICU-admitted CKD patients.

Also Read: Approximately 80 Percent Protection May be Provided by RSV Vaccine Against Severe Disease and Death: Study Suggests

Take-home points:

  • Stress hyperglycemia is an indicator of inflammatory and neuro-hormonal
    derangements during acute conditions and is a more reliable biomarker than
    admission glucose level and fasting blood glucose.
  • A U-shaped correlation indicates that high and low values increase
    the risk of death
  • It is a better biomarker tool for clinicians to monitor ICU-admitted
    CKD patients
  • It helps to identify the high-risk individuals and improve
    the prognostic accuracy.
  • SHR is a valuable tool to manage glucose levels in
    critically ill and CKD patients.

Further Reading: An S, Ye Z, Che W, et al. Predictive value of stress hyperglycemia ratio on one-year mortality in chronic kidney disease patients admitted to intensive care unit. BMC Nephrol. 2024;25(1):358. Published 2024 Oct 17. doi:10.1186/s12882-024-03823-4

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354 PG medical seats available in 25 specialities: KEA releases NEET PG counselling seat matrix

Karnataka- Karnataka Examination Authority (KEA) has announced PG medical seat vacancies in medical degree courses in all medical colleges of Karnataka for the academic year 2024.

As per the seat vacancy, a total of 354 seats are vacant across 25 PG Medical degree courses in all medical colleges of Karnataka for the academic year 2024.

The detailed seat availability is mentioned below-

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SEATS AVAILABILITY IN MEDICAL DEGREE

S.NO

COURSES

SEAT VACANT

1

Anatomy.

13

2

Physiology.

11

3

Biochemistry.

12

4

Pharmacology.

13

5

Pathology.

20

6

Microbiology.

13

7

Community Medicine.

12

8

Forensic Medicine.

7

9

Dermatology.

9

10

Radio Therapy.

2

11

Paediatrics.

24

12

General Medicine.

33

13

Radio Diagnosis.

16

14

Psychiatry.

8

15

Respiratory Medicine.

6

16

Hospital Administration.

1

17

Emergency Medicine.

3

18

Ophthalmology.

16

19

ENT.

15

20

Orthopedics.

23

21

Anaesthesia.

39

22

General Surgery.

30

23

Obstetrics and Gynecology.

26

24

Diploma in Public Health.

1

25

Palliative Medicine.

1

TOTAL

354

Candidates will be allotted seats in government medical colleges, government quota seats in private and minority medical colleges, and private seats in private and minority medical colleges such as KPCF, KRLMPCA, AMPCK, and private universities of Karnataka. Candidates who have secured a minimum percentile or above in NEET PG 2024 are eligible to register for admission to postgraduate medical courses.  

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

KEA does not entitle candidates to admission if they are unable to fulfil the eligibility criteria or fail to produce the prescribed certificates for document verification. Candidates who register and complete the document verification process will be eligible for admission to PG medical and dental courses in government and private colleges in Karnataka.

Candidates will be allotted seats in government medical colleges, government quota seats in private and minority medical colleges, and private seats in private and minority medical colleges such as KPCF, KRLMPCA, AMPCK, and private universities of Karnataka.

To view the seat vacancies, click the link below

https://medicaldialogues.in/pdf_upload/kea-261557.pdf

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