Systemic dexamethasone proven treatment for bronchopulmonary dysplasia but role for hydrocortisone uncertain: JAMA

Researchers have discovered that dexamethasone can significantly increase survival free of cerebral palsy in preterm infants at high risk of bronchopulmonary dysplasia (BPD) but may even harm babies with a lower risk of BPD. This underlines that systemic corticosteroid treatments need to be customised according to the individual level of BPD risk in neonatal care. A recent study was conducted by Lex W. and colleagues published in JAMA Pediatrics.

The most frequent complication in former preterm infants is BPD, with later outcomes often severe. In recent years, systemic postnatal corticosteroids, including dexamethasone and hydrocortisone, have been extensively administered to prevent BPD. The objective of this study was to elucidate whether the type of corticosteroid used and the timing of treatment significantly affect survival without cerebral palsy in preterm infants.

This comparative effectiveness study reviewed 26 randomized clinical trials that supported 3,700 infants born preterm and at BPD risk. The studies were conducted across 10 countries between 1989 and 2022 and measured outcomes such as the incidence of BPD, survival rates, and cerebral palsy at diagnosis. The interventions were systemic dexamethasone and hydrocortisone; nearly half of the studies began treatment within the first week of life.

BPD Risk and Treatment Outcomes:

  • Dexamethasone showed improved survival free of cerebral palsy in infants with a BPD risk greater than 70%.

  • Harmful effects were observed in infants with a BPD risk lower than 30%.

  • For every 10% point increase in BPD risk, dexamethasone improved survival rates without cerebral palsy by 3.74% (95% CI: 1.54-5.93%; p= 0.002).

Corticosteroid Comparison:

  • 69% of studies focused on dexamethasone, while 31% analyzed hydrocortisone.

  • Evidence for the benefit of hydrocortisone was weaker, with significant effects only in neonates at 30% or less risk for BPD.

Timing of Treatment:

  • 46% of studies started corticosteroid therapy in the first week after birth.

  • There was no strong evidence that differences in timing affected the outcomes of dexamethasone (interaction coefficient: 0.13; 95% CI: −0.04 to 0.30; p =0.14).

Dexamethasone reduces the risk of subsequent cerebral palsy but increases mortality in high-risk preterm infants without cerebral palsy, a fact for which it should not be used in low-risk patients due to the potential for harm. The studies highlight the requirement for stratifying risks before utilizing corticosteroids in neonates.

Reference:

Doyle, L. W., Mainzer, R., & Cheong, J. L. Y. (2024). Systemic postnatal corticosteroids, bronchopulmonary dysplasia, and survival free of cerebral palsy. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.4575

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E-Cigarette Residue Exposure in Utero Shows Lasting Effects on Immune Response

Results from a new animal study found that maternal exposure to e-cigarette residues, with or without nicotine, affected offspring’s immune response later in life. The study findings are published in the American Journal of Physiology-Lung Cellular and Molecular Physiology. The study has been chosen as an APSselect for November.

When e-cigarettes are used inside a building or vehicle, the vapor condenses on surfaces forming a thick oily layer. Despite growing evidence that direct and second-hand e-cigarette exposure is harmful, less is known about the potential effects of exposure to these vaping residues—known as third-hand exposure.

To find out how maternal third-hand e-cigarette exposure might affect a developing fetus, researchers conducted an experiment examining how this exposure in pregnant mice affects immune response and susceptibility to infections in their offspring later in life.

The researchers mimicked third-hand exposure by using low or high-power e-cigarette settings to deposit e-vapor residues with and without nicotine on to towels, which were changed daily. Mice were exposed to these towels or towels with no e-cigarette residue before, during and after pregnancy.

Once the offspring grew to adulthood, the researchers assessed various markers of immune system functioning. Some of the male adult offspring were also infected with mouse-adapted influenza A virus, and lung and bone marrow immune cell responses were assessed seven days after infection.

The researchers found that maternal third-hand exposure to low- or high-power e-vapor in the presence or absence of nicotine was associated with changes in both the innate and adaptive immune cell responses in offspring. Innate immune cells provide immediate, non-specific defense against pathogens while adaptive immune cells like B and T cells develop a specific and lasting response to specific pathogens.

The flu-infected offspring from the nicotine-exposed groups showed fewer lung alveolar macrophages, cells that play a critical role in the immune response to respiratory infections. These offspring also had more pronounced increases in neutrophils in the bone marrow, which could potentially hinder recovery from infections. Importantly, the e-vapor exposure led to lower activation of the CD4+ T cells and CD8+ T cells in the lungs of the flu-infected offspring, which could potentially compromise the ability to mount an effective immune response.

The researchers said that the study “shows that maternal third-hand exposure to e-vapor, irrespective of the presence of nicotine, exerts long-lasting, potentially detrimental, effects on the immune response of offspring in later life.”

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Induction therapy with infliximab effective against severe Behçet’s syndrome

A recent groundbreaking phase 2 trial compared the induction therapies for severe Behçet’s syndrome revealed that infliximab is both effective and safe than cyclophosphamide. This randomized controlled trial was conducted between May 2018 and April 2021 focused on patients with major vascular and central nervous system involvement who were particularly a high-risk group within Behçet’s disease spectrum.

The study included a total of 52 patients who met the criteria for Behçet’s syndrome of International Study Group. The participants were randomly assigned to receive either intravenous infliximab (5 mg/kg at weeks 0, 2, 6, 12, and 18) or cyclophosphamide (0.7 g/m² at weeks 0, 4, 8, 12, 16, and 20, with a maximum dose of 1.2 g per infusion). All participants were administered a uniform glucocorticoid regimen throughout the trial.

Infliximab demonstrated a significantly higher rate of complete response which was defined as clinical, biological, and radiological remission coupled with a prednisone dose ≤0.1 mg/kg daily by week 22. Also, 22 out of 27 patients (81%) treated with infliximab achieved complete response when compared to 14 out of 25 patients (56%) in the cyclophosphamide group. The estimated difference was 29.8 percentage points, with a 95% credible interval of 6.6 to 51.7. The posterior probability that at least 70% of infliximab-treated individuals would achieve complete response was 97.4%, while the probability of cyclophosphamide stood at only 6.0%. 

Infliximab also demonstrated a more favorable safety profile. Adverse events were reported in 29.6% (8 out of 27) of patients in the infliximab group compared with 64% (16 out of 25) in the cyclophosphamide group. This resulted in an estimated difference of −32.3 percentage points, with a 95% credible interval ranging from −55.2 to −6.6. The rate of serious adverse events was comparable between the two groups, recorded at 15% for infliximab and 12% for cyclophosphamide.

These findings underline the potential of infliximab as a superior induction therapy for patients with severe forms of Behçet’s syndrome, particularly those with vascular or neurological complications. The higher efficacy rate and fewer adverse events suggest that infliximab could be a preferable option over the traditionally used cyclophosphamide, which had a higher burden of side effects. Overall, the study provides strong evidence to favor infliximab as a first-line treatment for severe Behçet’s syndrome.

Source:

Saadoun, D., Maalouf, G., Vieira, M., Trad, S., Lazaro, E., Sacre, K., Plessier, A., Sené, T., Koné-Paut, I., Noel, N., Mekinian, A., Lambert, M., Ribeiro, E., Mirault, T., Mele, N., Dellal, A., Fain, O., Melki, I., Chiche, L., … Cacoub, P. (2024). Infliximab versus Cyclophosphamide for Severe Behçet’s Syndrome. In NEJM Evidence (Vol. 3, Issue 11). Massachusetts Medical Society. https://doi.org/10.1056/evidoa2300354

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Zinc deficiency promotes Acinetobacter lung infection, suggests study

Dietary zinc deficiency promotes lung infection by Acinetobacter baumannii bacteria – a leading cause of ventilator-associated pneumonia, according to a new study published Nov. 15 in the journal Nature Microbiology.

A Vanderbilt University Medical Center-led team of researchers discovered an unexpected link between the pro-inflammatory cytokine interleukin-13 (IL-13) and A. baumannii lung infection, and they demonstrated that blocking IL-13 prevented infection-associated death in an animal model.

The findings suggest that anti-IL-13 antibodies, which are FDA-approved for use in humans, may protect against bacterial pneumonia in patients with zinc deficiency.

“To our knowledge, this is the first study showing that neutralization of IL-13 could prevent mortality from a bacterial infection,” said Eric Skaar, PhD, MPH, the Ernest W. Goodpasture Professor of Pathology and director of the Vanderbilt Institute for Infection, Immunology and Inflammation. “This discovery points to the possibility of using anti-IL-13 therapy in patients with zinc deficiency and A. baumannii pneumonia as part of a personalized therapy approach.”

Nearly 20% of the world’s population is at risk for zinc deficiency, which can impair immune function and is a major risk factor for pneumonia. The World Health Organization considers zinc deficiency a leading contributor to disease and death.

Patients at risk for zinc deficiency, particularly critically ill and elderly patients, are also at risk for A. baumannii infection. Patients in health care settings have the highest risk for infection, especially those who are on ventilators, have devices such as catheters, are in intensive care units, or have prolonged hospital stays. A. baumannii is becoming increasingly resistant to antimicrobial treatments, making it a critical public health threat, Skaar said.

To explore whether and how dietary zinc deficiency contributes to A. baumannii pathogenesis, the researchers established a mouse model of dietary zinc deficiency and acute A. baumannii pneumonia. Lauren Palmer, PhD, a former postdoctoral fellow at VUMC who is now assistant professor of Microbiology and Immunology at the University of Illinois, Chicago, led the studies.

The researchers found that zinc-deficient mice had increased A. baumannii bacterial burden in the lungs, spread of bacteria to the spleen, and higher mortality compared to mice with adequate dietary zinc consumption. They showed that the zinc-deficient mice produce more IL-13 during infection and that administration of IL-13 to mice with sufficient zinc promoted spread of A. baumannii to the spleen. Anti-IL-13 antibody treatment protected zinc-deficient mice from A. baumannii-induced death.

The findings add to a growing set of studies showing that certain nutrient deficiencies are associated with IL-13 production and a “type 2” immune response.

“IL-13 may be an important risk factor for health care-associated and opportunistic lung infections, further supporting exploration of IL-13 as a target for treatment,” Skaar noted.

FDA-approved anti-IL-13 antibodies (lebrikizumab and tralokinumab) have been extensively investigated as potential therapies for uncontrolled severe asthma. Although they were not found to be effective for that indication, the clinical trials demonstrated their safety. 

References: Lauren D. Palmer, Kacie A. Traina, Lillian J. Juttukonda, Zachery R. Lonergan, Dziedzom A. Bansah, Xiaomei Ren, John H. Geary, Christopher Pinelli, Kelli L. Boyd, Tzushan S. Yang & Eric P. Skaar Nature Microbiology (2024)Cite this article Metrics

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Early Intratracheal Budesonide Treatment Has Minimal Effect on BPD-Free Survival in Preterm Infants: PLUSS Trial

Australia: In extremely preterm infants treated with surfactant for respiratory distress syndrome, early administration of intratracheal budesonide may have minimal to no impact on survival without bronchopulmonary dysplasia (BPD), PLUSS trial has shown. The findings were published online in the Journal of the American Medical Association (JAMA). 

The clinical trial explored whether combining intratracheal budesonide, a steroid, with surfactant therapy can improve outcomes for extremely preterm infants facing respiratory distress syndrome (RDS). The study, known as the PLUSS (Prevention of Lung Injury with Surfactant and Steroid) trial, specifically targeted infants born at 23 to 28 weeks of gestation—one of the most vulnerable groups for developing bronchopulmonary dysplasia, a chronic lung condition that often arises in premature babies due to prolonged ventilation and oxygen therapy.

Bronchopulmonary dysplasia is a frequent and serious complication in extremely preterm infants born at less than 28 weeks gestation. While systemic corticosteroids reduce the risk of BPD, they may carry potential risks of adverse effects. In contrast, administering corticosteroids directly into the lungs could offer a more targeted approach with fewer side effects. With this in mind, Brett J. Manley, Newborn Research, The Royal Women’s Hospital, Melbourne, Victoria, Australia, and colleagues aimed to assess the effectiveness of early intratracheal corticosteroid treatment in improving survival rates free of BPD in extremely preterm infants.

For this purpose, the researchers conducted a double-blind, randomized clinical trial across 21 neonatal units in four countries (Australia, New Zealand, Canada, and Singapore). The study enrolled infants born at less than 28 weeks gestation, aged under 48 hours, and requiring respiratory support, including those treated with surfactant. From January 2018 to March 2023, infants were randomly assigned to receive either intratracheal budesonide mixed with surfactant or surfactant alone.

The primary outcome was survival free of bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age, and 15 secondary and safety outcomes were assessed.

The study led to the following findings:

  • The primary analysis included 1,059 infants: 524 in the budesonide and surfactant group and 535 in the surfactant-only group.
  • The mean gestational age was 25.6 weeks, and the mean birth weight was 775 g; 55.3% of infants were male.
  • Survival free of BPD occurred in 25.6% of infants in the budesonide and surfactant group, compared to 22.6% in the surfactant-only group (adjusted risk difference, 2.7%).
  • At 36 weeks postmenstrual age, 83.2% of infants in the budesonide and surfactant group and 80.6% in the surfactant-only group were alive.
  • Among those alive, 69.3% in the budesonide and surfactant group and 71.9% in the surfactant-only group were diagnosed with BPD.

The findings revealed that in extremely preterm infants with respiratory distress syndrome who received surfactant, early intratracheal budesonide may not significantly affect the chances of surviving without bronchopulmonary dysplasia at 36 weeks postmenstrual age.

“Long-term results from this trial at 2 years, along with findings from similar large studies, will be crucial to better understand the effectiveness and safety of intratracheal budesonide and its potential role in treatment,” the researchers concluded.

Reference:

Manley BJ, Kamlin COF, Donath SM, et al. Intratracheal Budesonide Mixed With Surfactant for Extremely Preterm Infants: The PLUSS Randomized Clinical Trial. JAMA. Published online November 11, 2024. doi:10.1001/jama.2024.17380

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Hybrid technique effective alternative to bag-mask ventilation to enhance ventilation efficiency, suggests study

Effective bag-mask ventilation (BMV) is crucial for managing the airway and preventing irreversible hypoxia, making it essential for all healthcare providers, including new trainees, to be proficient in efficient BMV techniques. Proper patient positioning, airway patency, and a secure mask seal are vital for successful BMV. Studies have identified various factors, such as edentulous patients, beard presence, advanced age, high BMI, history of snoring, and incorrectly sized masks, as predictors of difficult BMV, which can be addressed by using a two-handed BMV technique with an appropriately fitting mask. Recent randomized controlled study compared the effectiveness of two different bag-mask ventilation (BMV) techniques performed by novice airway providers. One group received BMV using the conventional double-handed CE technique, while the other group used a hybrid technique with the dominant hand in the CE grip and the non-dominant hand on the thenar eminence.

The primary outcome was the 2-minute (24 breaths) mean exhaled tidal volume between the two groups. The secondary outcomes were the number of failed breaths (no exhaled tidal volume) and the comfort level of the airway providers using a 5-point Likert scale.

The study found that the mean exhaled tidal volume was significantly higher in the group using the hybrid technique (476.71 mL) compared to the group using the traditional CE technique (377.51 mL). The mean end-tidal carbon dioxide was also significantly higher in the hybrid technique group (30.42 mmHg) versus the CE technique group (28.83 mmHg). The number of failed breaths was comparable between the two groups, with 4 patients experiencing 2 failed breaths each. The comfort level of the airway providers was also similar, with over 50% finding both techniques very comfortable or comfortable.

Conclusion

The results suggest that the dominant-hand CE and non-dominant-hand thenar eminence hybrid technique provides higher exhaled tidal volumes and end-tidal carbon dioxide levels compared to the traditional CE technique, with similar provider comfort levels. This hybrid technique may be considered an effective alternative BMV method, especially for novice airway providers. The study highlights the potential benefits of combining established BMV techniques to enhance ventilation efficiency, particularly when performed by less experienced clinicians. Further research is warranted to validate these findings and explore the utility of hybrid BMV approaches in various clinical settings.

Key Points

1. The study compared the effectiveness of two different bag-mask ventilation (BMV) techniques – the conventional double-handed CE technique and a hybrid technique using the dominant hand in the CE grip and the non-dominant hand on the thenar eminence.

2. The primary outcome was the 2-minute mean exhaled tidal volume between the two groups, while the secondary outcomes were the number of failed breaths and the comfort level of the airway providers.

3. The results showed that the mean exhaled tidal volume and end-tidal carbon dioxide were significantly higher in the group using the hybrid technique compared to the group using the traditional CE technique.

4. The number of failed breaths was similar between the two groups, with 4 patients experiencing 2 failed breaths each. The comfort level of the airway providers was also comparable, with over 50% finding both techniques very comfortable or comfortable.

5. The study suggests that the dominant-hand CE and non-dominant-hand thenar eminence hybrid technique may be considered an effective alternative BMV method, especially for novice airway providers.

6. The study highlights the potential benefits of combining established BMV techniques to enhance ventilation efficiency, and further research is warranted to validate these findings and explore the utility of hybrid BMV approaches in various clinical settings.

Reference –

Saroye N, Kaur G, Singh U, Grewal A, Khanna A, Nayyar R. Evaluation of efficacy of two bag‑mask ventilation techniques by novice airway providers: Two‑handed CE versus dominant‑hand CE–non‑dominant‑hand thenar eminence techniques – A randomised controlled trial. Indian J Anaesth 2024;68:1010‑5

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Glucagon-like peptide-1 receptor Agonists can effectively control Alcohol Use Disorder, finds study

A recent study found that glucagon-like peptide-1 receptor
(GLP-1) agonists like semaglutide and liraglutide are effective in reducing
hospitalization due to alcohol use disorder (AUD) as per a trial that was
published in the journal JAMA Psychiatry.

Harmful use of alcohol is a global burden both economically
and healthcare-wise. Psychological treatments are the main line of management
of this. However, pharmacological management can also be used to reduce the
harmful usage of alcohol. Research shows that Glucagon-like peptide-1 receptor
(GLP-1) agonists that are used to treat diabetes and obesity can also be used to
treat alcohol use disorder. Hence researchers conducted a study to investigate
the potential of GLP-1 agonists as a treatment for reducing alcohol-related
harms.

Also Read: Marijuana use during pregnancy on the rise, 6% of pregnant women report using marijuana in new research

This observational cohort study used real-world data from
Swedish registries. The data was collected from registers of inpatient care,
specialized outpatient care, sickness absence, and disability pension.
Participants were all residents aged 16 to 64 with a diagnosis of AUD. A cohort
of 227 886 individuals were followed up from AUD diagnosis to death,
emigration, or end of data linkage. The main exposure was GLP-1 agonists, which
were exenatide, liraglutide, dulaglutide, and semaglutide. The secondary
exposure was the use of AUD medications. Hospitalization due to AUD was the
primary outcome of measurement while hospitalization due to substance use
disorder, somatic reasons, and suicide attempts was the secondary outcome of
measurement. Cox regression models with fixed effects were used to calculate
the within-individual risk of an outcome associated with use vs nonuse of
pharmacotherapies.

Findings:

  • The cohort included 227 866 individuals with AUD
    of which 144 714 (63.5%) were male and the remaining (36.5%) were female.
  • The cohort’s mean (SD) age was 40.0 (15.7)
    years, and the median (IQR) follow-up time was 8.8 (4.0-13.3) years.
  • A total of 133 210 individuals (58.5%)
    experienced AUD hospitalization.
  • Semaglutide (4321 users) and liraglutide (2509
    users) were associated with the lowest risk of both AUD and SUD
    hospitalization.
  • AUD medications were associated with a modestly
    decreased risk.
  • Semaglutide and liraglutide use were also
    associated with a decreased risk of somatic hospitalizations but not associated
    with suicide attempts.
Also Read: Patients with major depressive disorder may have significantly high Triglyceride levels and CVD risk: Study

Thus, the study concluded that semaglutide and liraglutide
were associated with a substantially decreased risk of hospitalization due to
AUD and can be effectively used in the management of alcohol use disorder.

Further reading: Lähteenvuo M, Tiihonen J, Solismaa
A, Tanskanen A, Mittendorfer-Rutz E, Taipale H. Repurposing
Semaglutide and Liraglutide for Alcohol Use Disorder. JAMA Psychiatry. Published
online November 13, 2024. doi:10.1001/jamapsychiatry.2024.3599

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Serum lactate level potential predictor for ICU admissions in patients presenting with seizure at ED: Study

A recent study published in the journal of Internal and Emergency Medicine highlighted the significance of serum lactate levels as a potential predictor for intensive care unit (ICU) admission in patients presenting with seizures at the emergency department (ED). This retrospective cohort study looked forward to fill a gap in existing research by assessing if serum lactate could help foresee the need for ICU care in these patients.

The study analyzed the records of 288 adult patients, all aged 18 or older, who were diagnosed with seizures or convulsive status epilepticus at the ED and had their serum venous lactate levels tested. Out of this group, 45 patients (15.63%) required admission to the ICU. The primary goal was to identify clinical factors that were independently predictive of such admissions.

The research employed logistic regression analysis to assess the data and identify predictors. 2 main factors were found to be significant indicators for ICU admission:

  • Convulsive Status Epilepticus: The patients presenting with this severe form of seizure were found to be at notably higher risk for ICU admission, with an adjusted odds ratio of 4.793 (95% confidence interval: 2.119, 10.844).
  • Serum Lactate Levels: Elevated serum lactate levels also correlated with increased likelihood of ICU admission. For every 1 mg/dL increase in serum lactate, the adjusted odds ratio was 1.008 (95% confidence interval: 1.001, 1.016).

The study determined that a serum lactate threshold of over 63 mg/dL provided a specificity of 80.25% for predicting ICU admissions, despite the sensitivity being lower at 35.56%. The area under the receiver operating characteristic (ROC) curve was calculated at 63.30% (with a 95% confidence interval ranging from 54.77% to 71.84%) which indicated moderate predictive performance.

These findings suggest that serum lactate could serve as a practical, early marker for evaluating the need for more intensive monitoring and treatment in seizure patients at the ED. The high specificity associated with a lactate level over 63 mg/dL meant that while the marker is less sensitive and it is reliable in ruling in the need for ICU care when elevated. Also, convulsive status epilepticus remains a significant factor necessitating critical intervention. Overall, the results from this study highlight the utility of serum lactate as part of the broader assessment strategy for ED patients who were presenting with seizures.

Reference:

Phungoen, P., Khamsai, S., Chotmongkol, V., Daungjunchot, R., Sawanyawisuth, K., & Tangpaisarn, T. (2024). Serum lactate is associated with an ICU admission in patients presenting with seizure at the emergency department. In Internal and Emergency Medicine. Springer Science and Business Media LLC. https://doi.org/10.1007/s11739-024-03806-1

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Trans-epithelial phototherapeutic keratectomy safe and effective procedure for Recurrent Corneal Erosion Syndrome: Study

A recent groundbreaking study
revealed that trans-epithelial phototherapeutic keratectomy (TE-PTK) is safe
and efficient for the treatment of recurrent corneal erosion syndrome (RCES)
and resistant RCES cases as per a study that was published in the journal Graefe’s
Archive for Clinical and Experimental Ophthalmology.

Recurrent corneal erosion
syndrome (RCES) is a painful eye condition frequently caused by mechanical
trauma and characterized by abnormal epithelial adhesion to the underlying
basal lamina. This condition leads to recurrent epithelial breakdown and
impairs vision causing severe pain. Conservative treatments include the use of topical
lubricants, topical hypertonic saline, and/or bandage contact lenses while
invasive approaches include mechanical debridement, alcohol delamination of the
epithelium, and excimer laser phototherapeutic keratectomy (PTK). As there is
ambiguity in the various treatment approaches for the management of RCES and
the use of phototherapeutic keratectomy (PTK), researchers conducted a retrospective
study to examine the long-term safety and efficacy of transepithelial PTK for
the management of RCES that is resistant to conservative management.

Also Read: Phentolamine Ophthalmic Solution Reverses Mydriasis Faster, suggests study
A retrospective study was carried
out on 593 consecutive eyes in individuals resistant to conservative
measures. Individuals who received TE-PTK treatment and failed at 3 or
more conventional treatments like
Topical lubricants, Topical hypertonic saline, Topical steroid eye drops, Oral
doxycycline for ≥ 3 months, and Bandage contact lenses for ≥ 2 weeks
were included. A telephone survey was used to gather the required information
by using questionnaires for basic demographic information and PTK therapies. Preoperative
assessment was done by using the Corrected distance visual acuity (CDVA). The
surgical procedure was carried out by using The SCHWIND Custom Ablation Manager
(SCHWIND eye-tech solutions GmbH, Kleinostheim, Germany) set in transepithelial
PTK mode. The protocol included ablating 50 microns for epithelial removal and
15 microns of subepithelial treatment. Standard post-operative follow-up was
carried out. The Kaplan–Meier survival analysis was done to calculate the
cumulative recurrence-free survival after treatment.

Findings:

  • This study included 593 eyes of 555 patients
    (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK.
  • The leading identified causes of RCES were
    trauma (45.7%) and anterior basement membrane dystrophy (44.2%).
  • The most common pre-PTK interventions were
    ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact
    lenses (50.9%).
  • Thirty-six eyes had undergone surgical
    interventions such as stromal puncture, epithelial debridement, or diamond burr
    polishing.
  • Post-PTK, 78% of patients did not require any
    subsequent therapies and 20% required ongoing drops.
  • Six patients (1.1%) reported no symptom
    improvement and were required to repeat TE-PTK for ongoing RCES symptoms after the
    initial TE-PTK.
  • All 6 eyes were successfully retreated with
    TE-PTK (average time to retreatment was 11.3 ± 14.9 months).
  • There was no significant difference in best
    corrected visual acuity pre- vs. post-operatively. The mean postoperative
    follow-up was 60.5 months (range: 5–127 months).
Also Read: Capsular Tension Rings Reduce IOL Decentration in Highly Myopic Eyes Over 30 mm, claims JAMA study

Thus, the researchers concluded
that TE-PTK showed a high efficacy and safety profile and can be used as
a preferred treatment option for patients with RCES resistant to standard
treatments. The treatment showed a low recurrence rate and low rates of
retreatments. The researchers also suggested that TE-PTK can be considered for
broader application in resistant RCES based on cost-effectiveness and patient
satisfaction.

Further reading: Bizrah M,
Shunmugam M, Ching G, et al. Transepithelial phototherapeutic keratectomy for
treatment-resistant recurrent corneal erosion syndrome. Graefes Arch
Clin Exp Ophthalmol. 2024;262(10):3253-3260. doi:10.1007/s00417-024-06482-1

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Nanohydroxyapatite serum effective remineralizing agent after interproximal reduction, reports study

A study published in the American Journal of Orthodontics and Dentofacial Orthopedics reported that nanohydroxyapatite serum is an effective remineralizing agent after interproximal reduction.

Interproximal reduction (IPR) damages the caries’ protective superficial layer of the enamel, making the enamel surface prone to caries because of the increase in surface roughness. Remineralizing solutions can help in preventing these undesirable side effects. Therefore, this study aimed to compare the effect of nanohydroxyapatite (nHAp) and sodium fluoride (NaF) application on enamel remineralization after IPR and to evaluate changes in surface roughness, composition, and microhardness of the treated enamel. A total of 25 patients with Angle’s Class I malocclusion, requiring 4 premolar extractions, were selected and randomly divided into 5 groups (n = 5). Group 1 served as the control. In group 2, the extraction of premolars was done immediately after IPR, and in group 3, the extraction of premolars was done 3 months after IPR. In group 4, the extraction of premolars was performed 3 months after IPR with weekly application of nHAp serum. In group 5, the extraction of premolars was performed 3 months after IPR, along with once-a-month application of NaF varnish. The proximal reduction of premolars in all the groups was done using Strauss IPR burs (Strauss Diamond Instruments, Palm Coast, Fla). The extracted teeth were sectioned, and the enamel surfaces were subjected to energy-dispersive X-ray spectroscopy to evaluate elemental composition. Vicker’s microhardness test was used to evaluate enamel hardness and atomic force microscopy for enamel surface roughness. Descriptive statistics were calculated for the 5 groups using a 1-way analysis of variance, and Tukey’s multiple post-hoc test was used for intergroup comparison. Results: Calcium-to-phosphorous ratio, enamel microhardness, and surface roughness were found to be closest to untouched enamel in patients treated with nHAp, followed by patients who were treated with NaF. A lower calcium-to-phosphorous ratio and weakened and roughest enamel surface was seen in teeth, which were extracted immediately after IPR. Among the remineralizing agents tested, nHAp serum can be recommended for better remineralization of enamel surfaces after IPR.

Reference:

Dussa S, C S, Kiran Kumar P, Saritha T. Qualitative and quantitative evaluation of enamel surface roughness and remineralization after interproximal reduction: An in vivo study. Am J Orthod Dentofacial Orthop. 2024 Jun 8:S0889-5406(24)00200-2. doi: 10.1016/j.ajodo.2024.05.009. Epub ahead of print. PMID: 38852104.

Keywords:

Nanohydroxyapatite, serum, effective, remineralizing, agent, after, interproximal, reduction, reports, study, Dussa S, C S, Kiran Kumar P, Saritha T, American Journal of Orthodontics and Dentofacial Orthopedics

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