Nurse drugged, raped by director in UP Hospital

Kanpur: A 22-year-old nurse was allegedly intoxicated and raped by the director after being held hostage inside a private hospital, police said on Monday. An FIR has been registered, and the accused has been arrested.

It is suspected that the nurse was given a soft drink laced with intoxicants before the assault took place.

According to the PTI report, Kalyanpur’s Assistant Commissioner of Police (ACP) Abhishek Pandey said the woman has been working as a nurse at a private hospital in Kalyanpur for the last couple of months.  

Also Read:Ratnagiri horror: Nursing student drugged, raped by autorickshaw driver on way home from hospital

On Sunday evening, she attended a party thrown by the director in the hospital. The accused asked her to stay at the hospital during night hours on the pretext of official work, he said. Around midnight he called her to his room and forcefully pulled her inside and locked the door, the ACP said.

The director took the nurse hostage and allegedly raped her, said another official requesting anonymity.

The accused also threatened the nurse to kill her if she reported the incident to anyone, the official added, news agency PTI reported.

The police have not yet disclosed the identity of the accused.

He was produced before the court following the arrest, the official said the victim’s medical examination would be conducted and she would be produced before the court to record her statement before the magistrate, the police added.

Also Read:Nurse on night duty allegedly raped by doctor at Moradabad Hospital, 3 arrested

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Electric Fans Ineffective for lowering core body temperatures of elderly in Extreme Heat: JAMA

Researchers have established that electric fans did not reduce core body temperatures of elderly individuals under extreme heat indoors, especially as temperature increased to 33°C and beyond. A recent study was published in the journal JAMA Network by Fergus K. and colleagues.

Electric fans have been suggested as an inexpensive means to reduce heat stress among very elderly individuals aged 65 and older, especially based on earlier biophysical modeling and works in younger adults. This study was designed to determine the effect of exposure to an electric fan on core temperature and heart rate in older adults who were exposed to indoor temperatures similar to those during recent North American deadly heat waves.

The subjects (≥65 years) were exposed to high indoor temperatures of more than 33°C, simulating conditions that are usually experienced during a heat wave. The core temperature and heart rate of the participants were recorded throughout the exposure period while measuring the impact of electric fans use. This would measure if fans can limit the rise in core body temperature and provide cardiovascular relief under such extreme conditions.

The experiment reported a lack of effective cooling by electric fans on peak core temperatures in older individuals exposed to high indoor heat:

  • Peak core temperature was unaltered by fan use, meaning that it showed inefficient reduction of dangerous heat accumulation in the elderly.

  • Besides end-exposure core temperature and heart rate declines, these decreases were small and below thresholds for clinical significance.

  • However, the core temperature and heart rate reduction both were small, without question not more than a marginal effect among subjects, and therefore of no biomedical significance.

  • These findings are in keeping with previous biophysical models which suggested that cooling by fans had little role to play in reducing body temperature in older individuals at ambient temperatures above 33-35°C.

Thus, electric fans alone cannot be used as a cooling intervention, especially when temperatures rise above 33°C in extreme indoor heat environments. These findings further indicate the alternative cooling solution urgently needed for older adults in a world with rising global temperatures and deadly heat waves.

Reference:

O’Connor, F. K., Meade, R. D., Wagar, K. E., Harris-Mostert, R. C., Tetzlaff, E. J., McCormick, J. J., & Kenny, G. P. (2024). Effect of electric fans on body core temperature in older adults exposed to extreme indoor heat. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2024.19457

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Treating severe calcification with atherectomy device fails to improve PCI outcomes, study finds

Routine use of an orbital atherectomy device to remove calcium from severely blocked coronary arteries before patients undergo cardiac stenting procedures does not improve outcomes, a Mount Sinai-led study has found.

The results of the ECLIPSE study were announced during a late-breaking trial presentation at the Transcatheter Cardiovascular Therapeutics Annual Meeting on Tuesday, October 29. This is the first large-scale study to study this specific device in severely calcified lesions, and the results support reserving its use for extreme cases.

“Operators across the United States currently have different thresholds for using atherectomy or other advanced lesion preparation techniques when treating severely calcified lesions. While these devices are essential to treat the most extreme cases prior to implanting a stent, it was unknown before this study whether their routine upfront use in patients with severely calcified lesions that are less than extreme would safely improve outcomes after drug-eluting stent implantation,” says study chair Gregg W. Stone, MD, Director of Academic Affairs for the Mount Sinai Health System and Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai. “The large-scale, multicenter ECLIPSE trial has shown that the routine use of orbital atherectomy did not lead to greater stent expansion or improve one-year patient outcomes compared to routine balloon angioplasty prior to stenting. Therefore, the use of orbital atherectomy may be reserved for the most extreme cases for which the operator does not believe that balloon angioplasty would be likely to safely cross or pre-dilate the calcified lesion.”

Patients with coronary artery disease-plaque buildup inside the arteries that leads to chest pain, shortness of breath, and heart attack—often undergo percutaneous coronary intervention (PCI), a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. Cardiologists first put a balloon through the artery to make the opening big enough for the stent to fit in permanently.

Heavily calcified blockages are more challenging to open with balloon angioplasty, which may lead to stent complications including heart attacks. One option cardiologists use to avoid this in severely calcified lesions is orbital atherectomy-a device from Abbott Vascular, in Santa Clara, California, approved by the Food and Drug Administration for this purpose that fractures and sands the calcium, allowing balloons and stents to better expand. Atherectomy devices (orbital or other types) are used in more than 10,000 patients per year undergoing PCI in the United States, and in up to 10 percent of PCI cases at some hospitals.

Investigators launched the ECLIPSE study to figure out whether routinely using the orbital atherectomy device in severely calcified lesions that might be adequately expanded by balloons only would allow the stent to better expand and improve clinical outcomes. They enrolled 2,005 cardiac patients with 2,492 lesions at 104 sites across the United States and randomized roughly half to receive orbital atherectomy and half to balloon angioplasty; both groups then underwent PCI with drug-eluting stents. The primary endpoints were stent expansion and one-year clinical outcomes.

Researchers used optical coherence tomography (OCT) imaging to assess the stent area in both groups. At the end of the procedure, the stent area was not greater in the atherectomy group compared with the balloon angioplasty group. The minimal stent area at the site of maximal calcification was 7.67 ± 2.27 mm2 in the orbital atherectomy group and 7.42 ± 2.54 mm2 in the balloon angioplasty group, a difference that was not statistically significant. Additionally, orbital atherectomy did not reduce the one-year rate of target vessel failure, which is a combination of cardiac death or myocardial infarction or repeat intervention attributable to the treated vessel. In the orbital atherectomy group, 114 patients (11.6 percent) had target vessel failure, compared with 95 patients in the balloon angioplasty group (9.8 percent), also a non-significant difference.

Among secondary outcomes, there were more cardiac deaths at 30 days after PCI in the orbital atherectomy group compared with the balloon group (eight versus zero). Cardiac death within one year occurred in 30 patients (4.0 percent) compared to 26 patient (2.7 percent) in the balloon angioplasty group, a non-significant difference. There were no significant differences in other major safety outcomes, including vessel perforation or heart attack.

“In this trial, the atherectomy procedure was longer and required use of more guide wires and other interventional devices, more contrast, and more radiation compared with procedures using balloons only for lesion preparation. Given the absence of clear benefit, these results support reserving use of orbital atherectomy for the most extreme cases that the operator does not believe would be safely crossed or dilated with a balloon. Such cases were not included in the present trial,” added Dr. Stone “It is important to note that the event rates were lower in both the balloon and atherectomy groups of patients in whom OCT was used to guide the procedure, consistent with the results from other studies that have shown that intravascular imaging use improves PCI outcomes in complex lesions. Finally, these results apply to lesion preparation with orbital atherectomy only. Whether the routine use of other advanced lesion preparation techniques in severely calcified lesions, including rotational atherectomy or intravascular lithotripsy, would improve stent expansion and clinical outcomes after PCI is unknown.”

Reference:

Treating severe calcification with an atherectomy device does not improve cardiac stenting outcomes, study finds, The Mount Sinai Hospital / Mount Sinai School of Medicine, Meeting: TCT 2024: Transcatheter Cardiovascular Therapeutics.

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Study Reveals Association Between Cardiac Arrhythmias and Macular Degeneration Risk

USA: A recent study presented at the annual meeting of the American Academy of Ophthalmology, which took place from October 18 to 21 in Chicago, found that cardiac arrhythmias, including myocardial infarction and atrial fibrillation, are linked to age-related macular degeneration (AMD). 

Significant cardiovascular conditions, such as myocardial infarction, cardiac valve disease, and ischemic stroke, have been linked to age-related macular degeneration and subretinal drusenoid deposits (SDDs). In light of this, R. Theodore Smith, M.D., Ph.D., of the Icahn School of Medicine at Mount Sinai, and colleagues examined the relationship between cardiac arrhythmias and SDDs and the impact of heart failure on cardiac index (CI). 

For this purpose, the researchers conducted a study involving 55 cardiac patients aged 49 to 91 at Mount Sinai Hospital. The patients underwent spectral domain optical coherence tomography scans to assess the presence of subretinal drusenoid deposits. Patient charts were then reviewed for cardiac index and arrhythmias.

The following were the key findings of the study:

  • Cardiac arrhythmias may contribute to developing subretinal drusenoid deposits through ocular hypoperfusion. Among the 30 patients with arrhythmias, 15 were found to have SDDs, compared to only five out of 25 patients without arrhythmias.
  • The mean cardiac index was significantly lower in patients with SDDs (1.95 ± 0.60 L/min/m²) than those without (2.71 ± 0.73 L/min/m²).

“Patients with common arrhythmias, such as atrial fibrillation, or those with serious cardiovascular conditions like myocardial infarction and stroke should undergo immediate optical coherence tomography of the macula to check for subretinal drusenoid deposits. If SDDs are detected, a retinal referral is warranted,” Smith stated to Elsevier’s PracticeUpdate.

He continued, “A large cohort of age-related macular degeneration patients with SDDs and/or typical drusen should be evaluated for cardiovascular disease through electrocardiograms to check for arrhythmias, as well as cardiac and carotid ultrasound tests for other serious vascular issues. This approach will clarify the true risk associated with SDDs compared to drusen regarding CVD and help identify previously undetected cardiovascular problems, particularly among Black, Hispanic, and female populations, where underdiagnosed CVD is a significant public health concern.”

“Cardiac arrhythmias, such as atrial fibrillation, are linked to subretinal drusenoid deposits in age-related macular degeneration. These arrhythmias can lead to heart failure by disrupting the relationship between ventricular output and filling, potentially contributing to SDDs through ocular hypoperfusion. The observed decrease in cardiac index in patients with SDDs supports this mechanism. Furthermore, SDDs may serve as a biomarker for serious heart disease, highlighting a critical concern for underserved populations and women,” the researchers concluded.

Reference: https://aao.apprisor.org/apsSession.cfm

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Hybrid closed-loop insulin therapy prevents low night-time blood glucose levels among breastfeeding mothers with type 1 diabetes: Study

Hybrid closed-loop insulin therapy prevents low night-time blood glucose levels among breastfeeding mothers with type 1 diabetes suggests a study published in the Diabetologia.

This study aimed to describe the relationship between breastfeeding episodes and maternal glucose levels, and to assess whether this differs with closed-loop vs open-loop (sensor-augmented pump) insulin therapy. Infant-feeding diaries were collected at 6 weeks, 12 weeks and 24 weeks postpartum in the trial of postpartum closed-loop use in 18 women with type 1 diabetes.

Continuous glucose monitoring (CGM) data were used to identify maternal glucose patterns within the 3 h of breastfeeding episodes. Generalised mixed models adjusted for breastfeeding episodes in the same woman, repeat breastfeeding episodes, carbohydrate intake, infant age at time of feeding and early pregnancy HbA1c. Results: CGM glucose remained above 3.9 mmol/l in the 3 h post-breastfeeding for 93% (397/427) of breastfeeding episodes.

There was an overall decrease in glucose at nighttime within 3 h of breastfeeding (1.1 mmol l−1 h−1 decrease on average; p=0.009). A decrease in nighttime glucose was observed with open-loop therapy (1.2 ± 0.5 mmol/l) but was blunted with closed-loop therapy (0.4 ± 0.3 mmol/l; p<0.01, open-loop vs closed-loop). There is a small decrease in glucose after nighttime breastfeeding that usually does not result in maternal hypoglycaemia; this appears to be blunted with the use of closed-loop therapy.

Reference:

Donovan, L.E., Bell, R.C., Feig, D.S. et al. Glycaemic patterns during breastfeeding with postpartum use of closed-loop insulin delivery in women with type 1 diabetes. Diabetologia 67, 2154–2159 (2024). https://doi.org/10.1007/s00125-024-06227-z

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Periodontal Disease Linked to ASCVD due to shared pathways: Study

A trailblazing review proposed
that poor oral health particularly periodontal disease can cause atherosclerotic
cardiovascular disease (ASCVD) due to shared biological pathways like inflammation,
immune response, and bacterial translocation. The study titled ‘Oral Health and
Atherosclerotic Cardiovascular Disease: A Review’ was published in the American
Journal of Preventive Cardiology.

Periodontal disease (PD) is a
prevalent chronic infection of the gums and the surrounding bone seen in older
adults that begins with the accumulation of dental plaque leading to gingivitis.
Gingivitis, an inflammatory response can progress to PD potentially causing
bone loss and tooth damage due to deeper penetration of the bacteria. Risk factors
like smoking, diabetes, and poor oral hygiene many of which are also atherosclerotic
cardiovascular risk factors may worsen the progression of PD. Additionally, an
imbalance in oral flora (dysbiosis) can lead to bacteremia, the spread of
bacteria in the bloodstream, prompting systemic inflammation that might link PD
to ASCVD.

Also Read: Seizures among children swallowing medications or illegal substances doubled over 15-year period: Study

Mechanisms by which PD can lead
to ASCVD:

  • Direct translocation of bacteria like
    porphyromonas gingivalis into the bloodstream or through inflammatory or immune
    responses can affect cardiovascular health as periodontal bacteria have also
    been detected in the atheromatous plaques.
  • Triggering of immune responses or inflammatory
    diseases by bacteria causing PD like the P.gingivals can activate immune cells
    like macrophages, T-cells, and B-cells which are in turn linked to
    atherosclerosis progression.
  • PD can lead to increased platelet activity which
    can in turn cause thrombus formation and transient ischemic attacks increasing
    the risk of atherosclerotic cardiovascular disease.
  • Impaired endothelial function leading to reduced
    vascular flexibility and increased oxidative stress can be caused by
    periodontal disease. Improved endothelial health was seen due to improved periodontal
    condition.
  • Diabetes, smoking, dyslipidemia, hypertension,
    obesity, and poor diet are some of the common and shared risk factors that can
    increase the risk of ASCVD in poor periodontal health.
  • Shared inflammatory pathways and biomarkers suggest
    a strong biological link between PD and ASCVD.
Also Read: Nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions tied to favourable outcomes: Study

Supporting Data:

Literature in the past has also
observed a positive association between PD and ASCVD with PD doubling the risk
of myocardial infarction, peripheral arterial disease, and ischemic stroke. Oral
health can have a long-term impact on vascular health as pediatric Oral
infections are linked to increased carotid artery thickness in adulthood.

Thus, the researchers highlight that
poor periodontal health can increase the risk of cardiovascular diseases. The
authors call for increased awareness and preventive measures, especially in
lower socio-economic areas where the risk of PD causing ASCVD is higher. Further
research is needed to justify the etiology and the potential benefits of
periodontal treatment in reducing cardiovascular diseases.

Further reading: Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol. 2021;7:100179. Published 2021 Apr 5. doi:10.1016/j.ajpc.2021.100179

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MRI can save rectal cancer patients from surgery, study suggests

Magnetic resonance imaging (MRI) can spare many patients with rectal cancer from invasive surgery that can carry lifelong side effects, new research indicates.

The findings, from UVA Cancer Center’s Arun Krishnaraj, MD, MPH, and collaborators, indicate that MRI can predict patient outcomes and the risk of the tumor reccurring or spreading for patients who have undergone chemotherapy and radiation.

That information could be extremely useful in determining the best course of treatment and deciding whether a patient can avoid surgery in favor of a “watch and wait” approach, the researchers say. In watch-and-wait, doctors continue to monitor patients for cancer reccurrence or spread, holding off on surgery but potentially leaving them uncertain and anxious about the future.

The information MRI can provide would be both useful for doctors and comforting for patients, the new findings suggest.

“After undergoing chemotherapy and radiation for rectal cancer, patients are understandably concerned whether their cancer is gone or whether there may be some leftover disease. Using newer MRI techniques, we are now able to predict much better than in the past whether any cancer remains and, if so, whether it will come back and spread,” said Krishnaraj, a radiologist and imaging expert who is director of UVA Health’s Division of Body Imaging, among other leadership positions. “No one wants to get surgery if they can avoid it. Now we have a powerful tool to help patients and their doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery.”

Better Care for Rectal Cancer

Colorectal cancer is increasing among younger adults-those under 50-even as it has been decreasing among older people. It’s estimated that the disease will strike approximately 1 in 23 men and 1 in 25 women, according to the American Cancer Society.

Rectal cancer is typically treated at first with radiation and chemotherapy, but some patients require what is known as “total mesorectal excision” – the removal of a substantial portion of their bowel. This can be lifesaving but it can also be life-changing: Side effects can include the need for a permanent colostomy bag and sexual dysfunction.

To help patients make the best choices and get the best outcomes, Krishnaraj and his collaborators wanted to see if MRI could serve as a crystal ball for the effects of watch-and-wait. To do this, they analyzed the results of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial to see how MRI results aligned with patient outcomes. In total, they reviewed outcomes from 277 patients, with an average age of 58, who had the stage of their rectal cancer determined by MRI. The average length of the follow-up period was slightly more than 4 years.

After crunching the numbers, the researchers determined MRI was an effective tool for predicting the patients’ overall survival, the risk of their cancer returning and their chances for keeping their bowel intact.

The promising MRI crystal ball can likely be made even more effective by combining it with data from endoscopies (visual inspections) after treatment, the OPRA Consortium researchers say. They are urging additional research on the potential of the combination, which they believe could offer doctors and patients a powerful new tool.

“I am optimistic that continued advancement in MRI and other tools like endoscopy will provide better information about future outcomes,” Krishnaraj said. “Ultimately, I would love to get close to 99% predictive probability in better informing our patients about their potential risk for recurrence or spread of their cancers following treatment. We may not be there quite yet, but that is our goal.”

Developing new ways to improve patient care is an essential mission for UVA Cancer Center, one of only 57 cancer centers designated as “comprehensive” by the National Cancer Institute. The designation honors elite cancer centers with the finest cancer care and research programs in the nation.

Reference:

Hannah Williams, Dana M. Omer, Hannah M. Thompson, Sabrina T. Lin, Floris S. Verheij, Joao Miranda, MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer, Radiology,https://doi.org/10.1148/radiol.232748.

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New AHA Guidelines Highlight Strategies to Prevent First Strokes: Emphasis on Lifestyle Changes, Screening

USA: In a significant update, the American Heart Association (AHA) and American Stroke Association (ASA) have released the 2024 Guideline for the Primary Prevention of Stroke, the first major revision in a decade. The new guideline replaces the 2014 version and aims to provide healthcare professionals with the latest strategies for preventing strokes in individuals with no prior history of the condition. The guideline emphasizes the importance of lifestyle management, risk factor control, and primary care screening.

According to the guidelines, adopting healthy lifestyle behaviors—such as maintaining good nutrition, quitting smoking, and staying physically active—can significantly reduce the risk of having a first stroke. Alongside these lifestyle changes, regular health screenings and effective management of cardiovascular disease and stroke risk factors through medication are crucial. Ideally, screening for stroke risk and educating individuals on how to lower their chances of experiencing a stroke should start with their primary care provider and incorporate evidence-based recommendations.

The guidelines, published in the journal Stroke, highlight that over 500,000 Americans experience their first stroke each year, with up to 80% of strokes being preventable. “This guideline is crucial because new evidence has emerged since the last update, allowing us to better identify individuals at risk for their first stroke,” said Dr. Cheryl D. Bushnell, chair of the writing group and a professor at Wake Forest University School of Medicine, said in a press release. The guideline aligns with the AHA’s “Life’s Essential 8,” a framework for promoting cardiovascular health.

One of the notable additions is the recommendation for glucagon-like peptide 1 receptor agonists (GLP-1s), which have shown strong evidence for reducing stroke risk in patients with diabetes and high cardiovascular risk. These medications, which include semaglutide (Ozempic or Wegovy), are recognized for their dual benefits in managing diabetes and promoting weight loss. However, the guideline stresses the need for further studies to confirm their efficacy in stroke prevention when used solely for weight management.

The updated guidelines also underscore the significance of addressing social determinants of health—factors such as education, economic stability, and access to care—that can influence stroke risk. The authors advocate for screening these determinants in clinical settings, recommending evidence-based interventions to tackle their adverse effects. Such measures include ensuring patient education is accessible and relevant, advocating for effective medications, and connecting patients to community resources to address health-related needs like food and housing insecurity.

In addition, the guideline introduces specific recommendations for women’s health. It highlights the need for screening for stroke risks associated with oral contraceptives, endometriosis, and early-onset menopause. The authors emphasize the importance of managing hypertensive disorders during pregnancy to prevent maternal intracerebral hemorrhage.

Blood pressure management is another critical focus. The guidelines recommend that most patients requiring antihypertensive medications for stroke prevention should be prescribed at least two medications, as studies have shown that a single medication is often insufficient.

The guidelines also recognize the increased stroke risk among transgender individuals undergoing estrogen therapy and call for careful evaluation and modification of their risk factors.

Dr. Bushnell noted that implementing these recommendations could substantially reduce the incidence of first strokes and even lower the risk of dementia, another serious condition associated with vascular health. As clinicians adopt these guidelines, the hope is to see a marked decline in stroke incidence, paving the way for healthier communities.

Reference:

Bushnell C, et al “2024 guideline for the primary prevention of stroke: a guideline from the American Heart Association/American Stroke Association” Stroke 2024; DOI: 10.1161/STR.0000000000000475.

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Model predicts number of MII oocytes needed to obtain at least one euploid blastocyst: Study

Female age is significantly and directly related to embryo
aneuploidy rates. The current delay in motherhood has led to a large proportion
of women of advanced maternal age seeking infertility treatment, thus
presenting significantly higher embryo aneuploidy rates. Consequently, these
patients are characterized by lower chances of success in in vitro
fertilization (IVF) treatments with their own oocytes and many of them are
finally encouraged to enter the oocyte donation program.

In the assumption of the statement ‘‘the older the patient,
the lower the number of euploid blastocysts,’’ there is a frequently asked
question in the day-to-day operations of an infertility clinic: how many
oocytes each of our patients’ needs, according to female age, to have the
highest chances of obtaining at least one euploid blastocyst in their IVF
treatment cycles? The answer to this question would constitute useful
information for both the clinician and the patient. On the one hand, the
clinician may be able to better assess each patient’s possibilities and the
feasibility of their treatment cycle because it will be easier to explain the
patient’s options. On the other hand, the patient will understand this
information more easily, helping her to cope emotionally with treatment. This
is nowadays feasible because predicting ovarian response with high precision
before starting treatment has become possible with the use of novel biomarkers,
such as antimullerian hormone levels and/or antral follicle count.

The aim of the present study by Cristina Rodríguez-Varela et
al was to design a similar tool to determine the number of metaphase II (MII)
oocytes needed to obtain at least one euploid blastocyst regarding female age
in IVF treatment cycles, considering our own data from the last 5 years using
next-generation sequencing (NGS) on TE biopsies. This information will help to decide
the best strategy for each patient and her individual situation.

Eligible patients were undergoing their first IVF-PGT-A
treatment cycle, in which at least one MII oocyte was obtained, regardless of
oocyte and semen origin. Oocyte donation cycles were included in the donor
group (≤34
years old). Treatment cycles from women with their own oocytes were selected only
when the oocytes were aged ≥35 years (patient group). Only
trophoectoderm biopsies performed on days 5 or 6 of development and analyzed using
next-generation sequencing were included. Preimplantational genetic testing for
aneuploidy cycles because of a known abnormal karyotype were excluded.

A total of 2,660 IVF-PGT-A treatment cycles were performed
in the study period in the eligible population (patients group = 2,462; donors
group =198). The mean number of MII oocytes needed to obtain one euploid
blastocyst increased with age, as did the number of treatment cycles that did
not get at least one euploid blastocyst. An adjusted multivariate binary
regression model was designed using 80% of the patient group sample (n = 2,462;
training set). A calculator for the probability of obtaining at least one
euploid blastocyst was created using this model. The validation of this model
in the remaining 20% of the patient group sample (n = 493; validation set)
showed that it could estimate the event of having at least one euploid
blastocyst with an accuracy of 72.0%

The minimum number of MII oocytes needed to have high
chances of obtaining at least one euploid blastocyst increases with increasing
maternal age. Study model estimates with an accuracy of 74% the probability of
having at least one euploid blastocyst, considering oocyte age and the number
of MII oocytes. This model has been created with the largest database of
IVF-PGT-A treatment cycles ever used for this purpose, including only PGT-A
treatment cycles using NGS on TE biopsies. Once this model has been validated
prospectively and in multicenter studies, it may be useful for both the
clinician and the patient coming to an infertility clinic, whether or not a
PGT-A analysis is performed. The clinician may use this data to propose the
best strategy for each patient, whereas the patient may use this information to
better understand the likelihood of obtaining an euploid blastocyst, helping
her to cope emotionally with IVF treatment. Nevertheless, to this day, this
model has limited clinical value. It should be further validated and optimized
to use it as a clinical support tool, in our own clinic and in many others.

Source: Cristina Rodríguez-Varela, M.Sc.,a Juan Manuel
Mascaros, M.Sc., a Elena Labarta; Fertil
Steril® Vol. 122, No. 4, October 2024

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Air pollution linked to peanut allergy during childhood, unravels study

Exposure to higher levels of air pollution as a baby is linked to having a peanut allergy throughout childhood, according to a new study. And policies aimed at tackling poor air quality could potentially reduce the prevalence and persistence of peanut allergies, it stated.

The research, led by Murdoch Children’s Research Institute (MCRI) and the University of Melbourne, found being exposed to higher levels of air pollution from infancy was associated with increased odds of developing a peanut allergy and having the allergy persist across the first 10 years of life. However, the same association was not seen for egg allergy or eczema.

Published in the Journal of Allergy and Clinical Immunology, the study is the first to explore the link between air pollution and challenge-proven food allergy over the first decade of life.

The research involved 5,276 children in Melbourne from the HealthNuts study, recruited at age one and followed-up at four, six and 10 years. The research team used estimates of the annual average concentration of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) at each participant’s residential address at the time of each follow up.

MCRI Associate Professor Rachel Peters said the study found that higher levels of air pollution was a risk factor for the development and persistence of peanut allergies. And this was despite Melbourne having generally good air quality compared to our international counterparts, she said.

“The rise in allergy prevalence has occurred at a similar time to increased urbanisation, leading to the belief that environmental factors may be contributing to high allergy rates,” Associate Professor Peters said.

“Eczema and food allergy most often develop in infancy. Both immune conditions can naturally resolve over time, but for some they can persist throughout adolescence and into adulthood.”

“This is the first study to use an oral food challenge, the gold-standard of food allergy diagnosis, to investigate the relationship between food allergy and air pollution.”

University of Melbourne’s Dr Diego Lopez said the co-exposure of peanut allergens in the environment and air pollutants could be increasing the allergy risk.

“Air pollutants have an irritant and inflammatory effect that may boost the immune systems pro-allergic response, potentially triggering the development of food allergies,” he said.

“However, the underlying mechanisms of how air pollution increases the risk of a peanut allergy, and why eczema and egg allergy aren’t impacted in the same way, need to be explored further.”

Allergic disease is one of Australia’s greatest public health challenges, with one in 10 developing a food allergy in their first year of life.

Associate Professor Peters said policies aimed at tackling air pollution could potentially reduce the development and persistence of peanut allergy.

“The research highlights the importance of early-life interventions aimed at reducing exposure to air pollution, which could potentially prevent peanut allergies and other poor child health outcomes,” she said.

“Improving city design to support greater air quality regulation, better promoting public transport and switching to non-combustion fuels may help turn the tide on peanut allergy.”

Mae, 8, was diagnosed with peanut, diary and egg allergies at 8 months old after an allergic reaction saw her breakout in hives across her entire body. She has since gone onto have several anaphylaxis reactions.

Her mum, Eleanor Jenkin, said the most severe episode occurred five years ago during a food challenge at The Royal Children’s Hospital to check Mae’s tolerance for adding egg back into her diet.

“She was eating cupcakes as part of the challenge until she started to refuse to eat anymore,” she said. We thought she was just being fussy, but she began vomiting and lost consciousness. It was her first anaphylaxis and while it was scary, she returned to her normal self a few minutes after being given an adrenaline shot.”

Since then, Mae has carried an EpiPen with her at all times.

“We were hopeful she would grow out of the food allergies but now we have come to accept that Mae will be living with serious and ongoing allergies,” Eleanor said.

“Her allergies are always going to be in the back of her mind, influencing the decisions that she makes every time she eats at a restaurant, orders takeaway or goes to a birthday party. As a family we are learning to manage this new normal as best we can.”

Living in Melbourne’s west, Eleanor said the new MCRI research showed why it was important to tackle air pollution.

“There is a whole suite of reasons why we should be addressing air pollution and its link with peanut allergy just adds to that,” she said.

“Multiple factors are behind the allergy epidemic and if higher levels of air pollution are impacting the prevalence and persistence then that’s an important discovery for families.

“We want to see the quality of life improve for children living with allergies as well as fewer children having to go through what Mae has experienced. The more we know about how to prevent allergies the better.”

The GenV study, tracking the health and wellbeing of Victorians from birth to old age, is also starting to look at the impact of air pollution and climate change on children’s health. GenV has gathered data from more than 120,000 participants, including 48,000 babies.

MCRI researchers are linking information on heat vulnerability with perinatal and child health data from the GenV cohort and are seeking to include temperature extremes and climate related disaster evidence in the future.

Associate Professor Suzanne Mavoa said this would improve our understanding of how climate change impacts the health of children and families, identify those most at risk and test policies and interventions to better protect against severe weather events.

Reference:

Diego J. Lopez, Caroline J. Lodge, Dinh S. Bui, Nilakshi T.Waidyatillake, John C.Su, Luke D. Knibbs, Rushani Wijesuriya, Kirsten P Perrett, Jennifer J Koplin, Victoria X Soriano, Kate Lycett, Yichao Wang, Suzanne Mavoa, Shyamali C. Dharmage, Adrian J. Lowe and Rachel L. Peters. ‘Early life air pollution is associated with persistent peanut, but not egg allergy, across the first ten years,’ Journal of Allergy and Clinical Immunology: In Practice. DOI: 10.1016/j.jaci.2024.08.018,

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