Adenoidectomy combied with tympanostomy tube insertion may significantly reduce repeat procedures and oral antibiotic use in kids: JAMA

Adenoidectomy combined with tympanostomy tube insertion may significantly reduce repeat procedures and oral antibiotic use in kids suggests a study published in the JAMA.

The benefit of adenoidectomy on otologic outcomes after tympanostomy tube (TT) insertion is unclear. Results from prior work are challenging to interpret due to small sample sizes, heterogeneous study designs, and varying outcome measures. A study was done to evaluate the association between adenoidectomy and otologic outcomes using a US population-level sample of children who received TTs, producing generalizable results for widespread clinical application. A matched cohort study was conducted using claims data from the Merative MarketScan Research Databases. The study included 601 848 children who received TTs between January 1, 2007, and December 31, 2021. Children who received adenoidectomy and TTs simultaneously (Ad+TT) were identified irrespective of the number of prior TTs. Control participants who received TTs without adenoidectomy were matched based on sex, age at the time of the procedure, and the number of prior TT procedures. The primary outcomes were repeat TT insertion and subsequent oral antibiotic prescriptions after TT insertions. Multivariable logistic regression was used to quantify the effects of adenoidectomy and covariates on each outcome. Stratified analyses were performed in children younger than 4 years and 4 years or older. Results Overall, 601 848 children (median [IQR] age, 2 [1-4] years; range, 0-11 years; 351 078 [58.3%] male) who received TTs were identified. The Ad+TT cohort included 201 932 children, with an equal number in the matched cohort. In children younger than 4 years, Ad+TT was common and was associated with lower odds of subsequent oral antibiotics (odds ratio [OR], 0.59; 95% CI, 0.58-0.60) but higher odds of repeat TT insertions (OR, 1.24; 95% CI, 1.22-1.27). In children 4 years or older, Ad+TT was associated with lower odds of repeat TT insertions (OR, 0.78; 95% CI, 0.75-0.81) and subsequent oral antibiotics (OR, 0.63; 95% CI, 0.62-0.65). This study found that in children younger than 4 years, Ad+TT was commonly performed and may have had a secondary benefit of reducing subsequent oral antibiotic courses; however, it was not associated with a reduction in the risks of repeat TT insertions. In children 4 years or older, Ad+TT was associated with a reduction in the risk of repeat TT insertions and subsequent oral antibiotics. Given these findings, Ad+TT may be offered in children 4 years or older to improve otologic outcomes.

Reference:

Qian ZJ, Truong MT, Alyono JC, Valdez T, Chang K. Tympanostomy Tube Insertion With and Without Adenoidectomy. JAMA Otolaryngol Head Neck Surg. Published online October 17, 2024. doi:10.1001/jamaoto.2024.3584

Keywords:

Adenoidectomy, combined, tympanostomy, tube, insertion, may, significantly, reduce, repeat, procedures, oral, antibiotic, use, kids, JAMA, Qian ZJ, Truong MT, Alyono JC, Valdez T, Chang K

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Preventive use of landiolol beneficial for patients undergoing bimaxillary surgery, suggests study

The difficulty in bimaxillary surgery is the considerable bleeding during the surgery, leading to the exploration of different methods to reduce blood loss. Recent study aimed to assess the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, particularly regarding their impact on intraoperative bleeding and cardiac function. The research found that the combined use of hypotensive anesthesia and piezosurgical instruments significantly reduced intraoperative bleeding, but was associated with a higher incidence of tachycardia, especially when using nicardipine. The combination also significantly lengthened the duration of the surgery and may have increased the burden on cardiac function. The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

Reducing Blood Loss in Bimaxillary Surgery

Bimaxillary surgery, which combines mandibular and maxillary osteotomies, involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. Hypotensive anesthesia, a technique in which blood pressure is intentionally lowered during surgery to reduce bleeding, has been recognized for its potential in reducing intraoperative bleeding, but concerns regarding vital organ hypoperfusion during hypotensive anesthesia have been raised in other studies. The use of piezosurgical instruments in bimaxillary surgery provides an alternative strategy for bleeding management, albeit with potential challenges such as prolonged surgical duration. The study collected and analyzed data from the medical records of 30 patients who underwent bimaxillary surgery between 2015 and 2023. The results indicated that the combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss. However, it was observed that tachycardia may occur during hypotensive anesthesia, especially when nicardipine is used, which may lead to a strain on cardiac function. The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that the preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

Challenges and Limitations of Combined Approach

The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the potential confounding variables associated with variations in anesthesia methods and hypotensive techniques. Additionally, the study indicated the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Key Points

– The study assessed the risks and benefits of using hypotensive anesthesia and piezosurgical instruments in bimaxillary surgery, aiming to reduce intraoperative bleeding and strain on cardiac function. – The combined use of hypotensive anesthesia and piezosurgical instruments was found to significantly reduce intraoperative bleeding, but it was associated with a higher incidence of tachycardia, particularly when using nicardipine. The combination also led to a significant lengthening of the surgical duration and potential increased burden on cardiac function.

– The study suggested that proactive preparation and preventive small-dose administration of landiolol could be beneficial in managing the potential occurrence of tachycardia when employing hypotensive anesthesia.

– Bimaxillary surgery involves significant intraoperative bleeding and the need for transfusion, making it crucial to explore alternative measures with minimal adverse effects to reduce blood loss. The combination of hypotensive anesthesia and piezosurgical instruments effectively reduced blood loss, but concerns regarding tachycardia during hypotensive anesthesia, especially when nicardipine is used, highlight the need for careful management of cardiac function.

– The study demonstrated the effectiveness of landiolol in managing tachycardia and suggested that proactive preparation and preventive use of landiolol may be beneficial for patients undergoing bimaxillary surgery.

– The study also highlighted the challenges and limitations involved in the combined use of hypotensive anesthesia and piezosurgical instruments, including the inability to discern the individual impacts of each method and the need for further research and larger scale studies in this area to better understand the risks and benefits of the combined approach in bimaxillary surgery.

Reference –

Yamamura K, Murakami K, Hirata Y, et al. (August 21, 2024) Assessing the Risks and Benefits of Hypotensive Anesthesia and Piezosurgical Instruments in Bimaxillary Surgery. Cureus 16(8): e67394. DOI 10.7759/cureus.67394

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Cone-beam computed tomography superior to periapical radiography for detection of vertical root fractures: Study

A new study published in the journal BMC Medical Imaging showed that Cone-beam computed tomography (CBCT) had a greater sensitivity than periapical radiography (PA) in diagnosing vertical root fractures (VRF). An entire or partial root surface may be affected by a vertical root fracture, which is characterized as a longitudinal fracture in the root that starts in the root canal and continues towards the apical periodontium. Tooth extraction is sometimes the only treatment option for fractured teeth, which has a poor or disastrous prognosis.

Accurate VRF identification is crucial to avoid incorrect diagnosis and the extraction of a tooth that might be treated and kept. The most common diagnostic techniques for identifying VRFs include radiography, clinical examination, and invasive procedures like exploratory surgery. It is controversial to use two-dimensional radiography techniques to detect VRFs. In contrast to PA radiography, CBCT is three-dimensional. Recent research has shown that improved understanding of VRF detection, together with the introduction of more sophisticated CBCT scanners and software, has increased diagnostic accuracy. In order to compile the existing data comparing the diagnostic accuracy of PA and CBCT for the diagnosis of vertical root fractures, Abbas Shokri and team carried out this study to do a systematic review and meta-analysis.

A search for published literature about all kinds of human teeth was done using PubMed, Scopus, and Web of Science. The Comprehensive Meta-Analysis statistical software V3 was used to examine the data. The heterogeneity of the studies were examined using the I2 statistic. The requirements for inclusion in the systematic review and meta-analysis were fulfilled by 23 and 16 papers, respectively. For PA radiography, the sensitivity and specificity for VRF detection were determined to be 0.51 and 0.87, respectively, whereas for CBCT, they were 0.70 and 0.84, respectively.

Although CBCT offers benefits like high-resolution 3D images and avoids the drawbacks of traditional radiography modalities like superimposing anatomical structures, it should be remembered that CBCT still carries a higher radiation dose and should not be used as a first radiography technique until after a thorough clinical examination to look for any signs of a fracture line. According to the current findings, CBCT generally had a much greater overall sensitivity than PA radiography for the identification of VRFs; however, there was no discernible difference in the two methods’ specificity.

Source:

Shokri, A., Salemi, F., Taherpour, T., Karkehabadi, H., Ramezani, K., Zahedi, F., & Farhadian, M. (2024). Is cone-beam computed tomography more accurate than periapical radiography for detection of vertical root fractures? A systematic review and meta-analysis. In BMC Medical Imaging (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12880-024-01472-5

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Nano nano-hydroxyapatite effective conservative alternative to fluoride for remineralizing White spot lesions, suggests study

Nano nano-hydroxyapatite effective conservative alternative to fluoride for remineralizing White spot lesions suggests a study published in the Journal of Dentistry.

A study was done to assess the effect of nano-hydroxyapatite (nano-HAP) either with or without fluoride on white spot lesions (WSLs) in terms of remineralisation and colour change. An electronic search was carried out in MEDLINE via PubMed, Scopus, Web of Science, LILACS, Embase, Cochrane Library, Google Scholar, Grey literature, and hand search. There were no limitations in terms of language and date (till August 2024) and all studies meeting the inclusion criteria were included. The outcome variables were enamel surface microhardness, enamel remineralisation rate, mineral content, and colour change. Different risk of bias tools were employed according to the study design. The level of evidence was graded using the GRADE profiler. A total of 14 out of 422 studies met the inclusion criteria. Three out of 14 studies were in vivo, one was in situ, while ten of them were in vitro. All 14 studies investigated the nano-HAP effects on WSLs. Following the full-text reviews and statistical analysis, 12 out of 14 studies were only included in the meta-analysis, since the remaining two studies lacked comparable data (mean±SD). Results: Different forms of delivery for nano-HAP were reported in the included studies. Pure nano-HAP showed promising effects on enamel surface microhardness (MD = 9.29, 95 % CI [7.74, 10.84], p < 0.00001), and mineral gain (MD = 0.09, 95 % CI [0.05, 0.13], P < 0.0001) when compared to fluoride alone. In addition, nano-HAP and fluoride demonstrated similar remineralisation abilities based on the DIAGNOdent™ readings (MD=0.09, 95 % CI [0.05, 0.13], p < 0.0001) There were no colour improvements within the WSLs following the application of nano-HAP (MD = -2.76, 95 % CI [-6.79, 1.27], p = 0.18). The intervention containing pure nano-HAP showed a promising remineralisation effect on WSLs in comparison to fluoride alone. However, there were no colour changes within WSLs following the use of nano-HAP. Limited number of clinical studies, high risk of bias, quality of the available studies, and relatively short follow-up periods failed to result in concrete evidence. The intervention containing pure nano-HAP showed a promising remineralisation effect in comparison to fluoride alone. Therefore, it might be an effective alternative to fluoride-containing agents.

Reference:

S Alajlan, Baysan A. The effect of nano-hydroxyapatite on white spot lesions: A systematic review and meta-analysis, Journal of Dentistry, Volume 151, 2024, 105402, ISSN 0300-5712. https://doi.org/10.1016/j.jdent.2024.105402.

(https://www.sciencedirect.com/science/article/pii/S0300571224005724)

Keywords:

Nano, nano-hydroxyapatite, effective, conservative, alternative, fluoride, remineralising, White spot lesions, study, Journal of Dentistry, S Alajlan, Baysan A

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

A new study from the University of Georgia College of Public Health found that about 6% of pregnant women reported using marijuana during the last month, and many did not associate it with health risks. The study highlights the importance of education surrounding marijuana use during pregnancy, said lead researcher Mohammad Rifat Haider.

Published in The American Journal on Addictions, the study utilized responses from the National Survey on Drug Use and Health. Among 4,338 pregnant mothers, 5.7% reported using marijuana during the last month.

Within that group, 70.9% perceived little to no risk associated with marijuana use during pregnancy, even though it has been associated with low birth weight, premature birth and neurodevelopmental effects.

While other substances, like alcohol or illegal drugs, have clearly identified adverse effects, marijuana has some conflicting perceptions, said Haider, an assistant professor in health policy and management. It can be seen as helpful in reference to cancer patients seeking to minimize nausea, but studies have also shown harmful side effects of continued use.

During pregnancy, however, the evidence clearly points to negative effects, Haider said.

2 of 3 pregnant women who used pot live in states where medical marijuana is legal

Marijuana use is legal for recreational use in 25 states and or medical purposes in 14 more. Two-thirds of the pregnant women who reported using marijuana lived in a state where medical marijuana was legal at the time of the survey.

Most of the pregnant women who used marijuana were also in their first trimester, and use decreased as the pregnancy progressed. Women in their first trimester may have seen medical marijuana as a way to combat morning sickness, Haider said.

“Marijuana is seen as a cure for nausea, but that’s not the way it should be dealt with in pregnancy because it is harmful for the mother and the fetus,” Haider said.

Women should consult physician to combat nausea, not turn to marijuana

Rather than turn to medical marijuana, women should talk to their OBGYN about prescription drugs that can limit nausea and vomiting, Haider said.

And doctors should be prepared to address misconceptions about how marijuana can affect these symptoms during pregnancy.

“When medical marijuana is available, when it is legal, it is available in the pharmacy. It is widely available,” he said. “So we need to be extra cautious in those states and make solid policy that helps make pregnant women aware of the detrimental effects or marijuana use.”

Improved education around pot use in pregnancy crucial

Another factor associated with marijuana use was mental health disorders or major depressive episodes. This is seen with many other substances, Haider said, where if there are unmet health needs, individuals are more likely to experience a substance use disorder.

All of these numbers highlight a need for improved education efforts around marijuana use in pregnancy. Doctors should be prepared to screen individuals for past substance use including regular marijuana use, and they should provide information on potential adverse effects of marijuana, especially in states where medical marijuana is legal.

“Long story short, this is a very vulnerable population, and evidence shows that during pregnancy, marijuana use is detrimental for both mother and child,” Haider said. “There needs to be policy direction from the state to have these discussions.”

Reference:

Haider MR, Karim S, Jayawardhana J, Hansen NB, Haile ZT. Association between state-level medical marijuana legalization and marijuana use during pregnancy: A population-based study. Am J Addict. 2024 Sep 29. doi: 10.1111/ajad.13651.

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Study reveals links between many pesticides and prostate cancer

Researchers have identified 22 pesticides consistently associated with the incidence of prostate cancer in the United States, with four of the pesticides also linked with prostate cancer mortality. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

To assess county-level associations of 295 pesticides with prostate cancer across counties in the United States, investigators conducted an environment-wide association study, using a lag period between exposure and prostate cancer incidence of 10–18 years to account for the slow-growing nature of most prostate cancers. The years 1997–2001 were assessed for pesticide use and 2011–2015 for prostate cancer outcomes. Similarly, 2002–2006 were analyzed for pesticide use and 2016–2020 for outcomes.

Among the 22 pesticides showing consistent direct associations with prostate cancer incidence across both time-based analyses were three that had previously been linked to prostate cancer, including 2,4-D, one of the most frequently used pesticides in the United States. The 19 candidate pesticides not previously linked to prostate cancer included 10 herbicides, several fungicides and insecticides, and a soil fumigant.

Four pesticides that were linked to prostate cancer incidence were also associated with prostate cancer mortality: three herbicides (trifluralin, cloransulam-methyl, and diflufenzopyr) and one insecticide (thiamethoxam). Only trifluralin is classed by the Environmental Protection Agency as a “possible human carcinogen,” whereas the other three are considered “not likely to be carcinogenic” or have evidence of “non-carcinogenicity.”

“This research demonstrates the importance of studying environmental exposures, such as pesticide use, to potentially explain some of the geographic variation we observe in prostate cancer incidence and deaths across the United States,” said lead author Simon John Christoph Soerensen, MD, of Stanford University School of Medicine. “By building on these findings, we can advance our efforts to pinpoint risk factors for prostate cancer and work towards reducing the number of men affected by this disease.”

Reference:

Simon John Christoph Soerensen, Pesticides and prostate cancer incidence and mortality: An environment-wide association study, Cancer, https://doi.org/10.1002/cncr.35572

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Turmeric compound may reduce risk of age-related macular degeneration: JAMA

Curcuma-based nutritional supplements (CBNS) have been scientifically established to possess antioxidant and anti-inflammatory properties. These could possibly decrease the onset and progression of age-related macular degeneration (AMD), which is the most common cause of vision loss among the elderly. AMD, especially its advanced forms, causes blindness and requires treatments like intravitreal anti–vascular endothelial growth factor (VEGF) therapy. A recent study was published in JAMA Ophthalmology by Alsoudi A. and colleagues.

The study involved data from more than 1.8 million participants, including 66,804 patients who had been exposed to CBNS and 1,809,440 patients who had not. All participants were at the age of 50 or older and had no diagnosis of AMD before the inception of the study. The demographic factors and comorbidities were adjusted to reduce possible bias by applying propensity score matching (PSM). In secondary analysis, patients with early nonexudative AMD were also included, in order to assess the role of CBNS in developing advanced forms of AMD from early nonexudative AMD.

The participants were stratified by the use of CBNS and then assessed to determine the relative risk for the development of different forms of AMD; nonexudative AMD, exudative AMD, advanced nonexudative AMD, and geographic atrophy (GA). Other secondary results have been incorporated, namely blindness and intravitreal anti-VEGF therapy.

  • In patients 50 years of age or older with no prior diagnosis of AMD, use of CBNS was associated with reduced relative risk (RR) of developing nonexudative AMD (RR, 0.23; 95% CI, 0.21-0.26; P < 0.001), exudative AMD (RR, 0.28; 95% CI, 0.24-0.32; P < 0.001), and advanced nonexudative AMD or GA (RR, 0.11; 95% CI, 0.07-0.17; P < 0.001).

  • CBNS use was associated with roughly half the risk of blindness (RR, 0.46; 95% CI, 0.36-0.59; P < 0.001) than among those who did not use CBNS.

  • The risk of intravitreal anti-VEGF therapy was considerably lower in CBNS users (RR, 0.15; 95% CI, 0.13-0.17; P < 0.001).

  • These associations were also consistent across age-specific subgroups, including patients at 60 and 70 and older.

  • CBNS was related to a lower progression to advanced nonexudative AMD or GA among those with early nonexudative AMD (RR, 0.58; 95% CI, 0.41-0.81; P < 0.001).

The findings indicate a good association between CBNS and reduced risk in the incidence and progression to the late stages of AMD. Outcomes show additive potential on reducing AMD risk for subjects already at some increased level of risk. Future research would be justified, not only in monitoring long-term safety measures but also gaining a better understanding of how CBNS mechanisms prevent the onset of AMD.

Reference:

Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., & Rahimy, E. (2024). Curcuma-based nutritional supplements and risk of age-related macular degeneration. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.4400

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An old drug with new tricks: Exploring the cancer-fighting promise and limitations of hydroxychloroquine

As the hunt for effective cancer therapies intensifies, some scientists are turning back to look at old drugs in a new light. The anti-malarial hydroxychloroquine is one such drug that has been “repurposed” to fight cancer. Despite its effectiveness at blocking the resupply of needed resources to cancer cells, clinical trial results have been disappointing, in part because cancer cells eventually become resistant to the drug.

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Medicaid funding for addiction treatment hasn’t curbed overdose deaths, study finds

For generations, the federal government has largely refrained from paying for mental health and substance use treatment in large residential facilities.

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Exposure to flame-retardant chemicals during pregnancy associated with varying childhood obesity risks

Exposure to organophosphate esters (OPEs)—chemicals found in everyday products that use plastics and flame retardants—during pregnancy may have varying effects on the risks of childhood obesity, according to a new study.

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