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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Hemodiafiltration may reduce mortality in maintenance hemodialysis patients compared to conventional hemodialysis: Study

Researchers have discovered that a significant reduction in mortality occurs in patients with end-stage renal disease (ESRD) when hemodiafiltration (HDF), is used instead of conventional hemodialysis. A recent study was conducted by Yifan and colleagues published in BMC Nephrology.

In ESRD, a patient always requires dialysis for the removal of the waste products and excess fluids from the blood. Standard treatment is conventional hemodialysis, but in the last few years, HDF has been investigated concerning its apparent advantages regarding mortality as it is a modified form of dialysis that increases toxin removal by combining diffusion and convection.

The researchers systematically searched PubMed, Embase, and the Cochrane Library for RCTs comparing HDF with conventional HD up until January 14, 2024, to collect credible evidence. A total of 10 randomized controlled trials involving 4654 patients were included. The analysis was performed using Review Manager 5.3 software, enabling the assessment of relevant data and the quality of the evidence. The study results focused on four main outcomes: all-cause mortality, cardiovascular mortality, sudden death, and infection-related mortality.

Key Findings

The meta-analysis led to several key findings regarding the impact of HDF compared to conventional HD

  • All-cause mortality: The all-cause mortality was lower with HDF than with HD by 16%, (RR 0.84, 95% CI 0.72–0.99, P = 0.04).

  • Cardiovascular mortality: HDF decreased cardiovascular mortality by 26%, (RR 0.74, 95% CI 0.61–0.90, P = 0.002).

  • Sudden death: The risk of sudden death was not significantly different between the groups (RR 0.92, 95% CI 0.64–1.34, P = 0.68).

  • Death from infection: While the point estimate indicated a reduction in infection-related mortality with HDF, the change was not significant (RR 0.70, 95% CI 0.47–1.03, P = 0.07).

  • HDF had significant superiority to high-flux HD for all-cause mortality (RR 0.81, 95% CI 0.69–0.96, P = 0.01), but not over low-flux HD (RR 0.93, 95% CI 0.77–1.12, P = 0.44).

  • Convective volume: HDF with a convective volume of 22 L or more was superior to the control in lowering both all-cause mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002) and cardiovascular mortality (RR 0.73, 95% CI 0.54–0.94, P = 0.01).

The meta-analysis supports the fact that HDF significantly decreases mortality in ESRD patients compared to the conventional method of hemodialysis, with higher volumes of convection. Such preliminary evidence may eventually lead to increased adoption of HDF as a more regular procedure in the treatment of ESRD patients.

Reference:

Zhu, Y., Li, J., Lu, H., Shi, Z., & Wang, X. (2024). Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis. BMC Nephrology, 25(1). https://doi.org/10.1186/s12882-024-03810-9

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23-Fold Increase in Heart Attack Risk among Women with Gestational Diabetes and Hypertension, reveals research

France: A recent nationwide cross-sectional cohort study has highlighted alarming insights into the long-term cardiovascular risks faced by women who experience gestational diabetes mellitus (GDM) and gestational hypertension (GH) during pregnancy. The findings were published online in the European Journal of Obstetrics & Gynecology and Reproductive Biology. 

The findings were striking: women with a history of both GDM and GH were found to have a staggering 23-fold increased risk of experiencing a myocardial infarction within the first 5 years of their postnatal lives.

Cardiovascular disease ranks as the leading cause of death among women globally. While the connection between a history of hypertensive disorders during pregnancy or gestational diabetes (GDM) and subsequent cardiovascular events is well documented, the implications of experiencing both gestational hypertension (GH) and GDM together are less clearly understood. To address this gap, Laurent Fauchier, Service de Cardiologie, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France, and colleagues examined the relationship between GDM and GH, evaluating their individual and combined effects on future cardiovascular risks. 

For this purpose, the researchers identified all female patients discharged from French hospitals in 2013 who had complete follow-ups for five years. These patients were categorized based on their history of gestational diabetes, gestational hypertension, both conditions, or neither. After applying propensity score matching, those with GDM and/or GH were matched 1:1 with patients who had no history of these conditions. The analysis adjusted hazard ratios (HR) for cardiovascular events during the follow-up period, accounting for the patient’s age at baseline.

The study led to the following findings:

  • Women with a history of gestational hypertension exhibited a significantly increased risk of cardiovascular death, with a hazard ratio (HR) of 5.46.
  • Women with a history of gestational diabetes mellitus did not show a significant difference in the risk of cardiovascular events:
    • Myocardial infarction risk (HR 0.88) was not significantly elevated.
    • Cardiovascular death risk (HR 1.25) was also not significantly different.
  • Women with a history of both GDM and GH faced a markedly higher risk of myocardial infarction, with a hazard ratio of 23.33.

In the largest contemporary analysis of hospitalized female patients to date, we present the first findings on the combined cardiovascular risk associated with gestational diabetes mellitus and gestational hypertension within five years postpartum.

“Our results indicate that women with a history of both conditions face a staggering 23-fold increased risk of myocardial infarction. Therefore, those who experience both GDM and GH during pregnancy should be referred for specialized ongoing cardiology care and classified as high risk when presenting with acute symptoms indicative of potential cardiac ischemia,” the researchers concluded. 

Reference:

Bullough, S., Lip, G. Y., Fauchier, G., Herbert, J., Sharp, A., Bisson, A., Ducluzeau, P. H., & Fauchier, L. (2024). The impact of gestational diabetes and gestational hypertension on future cardiovascular events: A nationwide cross-sectional cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 301, 216-221. https://doi.org/10.1016/j.ejogrb.2024.08.021

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Prophylactic infusion of norepinephrine may prevent hypotension during vertebroplasty, reports research

Prophylactic infusion of norepinephrine may prevent hypotension during vertebroplasty, reports research published in the BMC Surgery.

Transient hypotension is a common occurrence during the implantation of bone cement. This placebo-controlled randomized clinical trial study investigated the effect of prophylactic infusion of norepinephrine on the incidence of hypotension in senior patients who underwent vertebroplasty. The trial recruited patients who were greater than or equal to 65 years of age, had an American Society of Anesthesiologist physical status classification of I to III, and underwent vertebroplasty from August 2020 to August 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine in China. The patients were randomly grouped according to whether they received either a norepinephrine infusion of 0.05 µg/kg/min or an equivalent volume of saline 10 min before implantation of bone cement. Intraoperative hemodynamics were monitored continuously by the MostCare system at the following 7 time points: 10 min before implantation of bone cement and immediately, 30 s, 1, 3, 5, and 10 min after implantation of bone cement. We also recorded the number of hypotensive episodes and the total number of vasopressors after implantation of bone cement. Multivariable logistic regression was used to assess the risk factors associated with hypotension after implantation of bone cement. Results: A total of 63 patients were randomized to the control group (n = 31; median [IQR] age, 74 [69–79] years) and the norepinephrine group (n = 32; median [IQR] age, 75 [71–79] years). The incidence of hypotension in the norepinephrine group was significantly lower than that in the control group after implantation of bone cement (12.5% vs. 45.2%; relative risk [RR], 3.61 [95% CI, 1.13–15.07]; P = 0.005). Moreover, the median (IQR) number of hypotensive episodes (0 [0–0] vs. 0 [0–2]; P = 0.005) and the total number of vasopressors (0 [0–0] vs. 0 [0–1]; P = 0.004) in the norepinephrine group were significantly lower than those in the control group. Furthermore, compared with the baseline, the MAP significantly decreased at 1 min (P = 0.007) and 3 min (P < 0.001) after bone cement implantation in the control group. However, the MAP at 3 min in the norepinephrine group was significantly higher than that in the control group (P < 0.001). The incidence of complications was not different between the groups. In multivariable logistic regression, the FRAIL score (OR, 2.29; 95% CI, 1.21–4.31) was identified as a risk factor associated with hypotension. Prophylactic infusion of norepinephrine before bone cement implantation can stabilize hemodynamics and reduce the incidence of hypotension after implantation of bone cement.

Reference:

Fu, Q., Liu, S., Sun, Y. et al. Effect of prophylactic infusion of norepinephrine on the prevention of hypotension during vertebroplasty: a randomized clinical trial. BMC Surg 24, 333 (2024). https://doi.org/10.1186/s12893-024-02640-8

Keywords:

Prophylactic, infusion, norepinephrine, may, prevent, hypotension, during, vertebroplasty, reports, research, Fu, Q., Liu, S., Sun, Y, Hypotension, Norepinephrine, Vertebroplasty, Hemodynamics, Bone cement implantation

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Study Reveals ABO Blood Group Incongruence Linked to Lower Risk of Newborn Infections After 90 Days

Canada: A recent cohort study published in JAMA Network Open has examined the relationship between maternal-newborn ABO blood group incongruence and the risk of bacterial infections in newborns.

The study found no link between maternal-newborn ABO blood group mismatches and the risk of bacterial infections in newborns during the first 30 and 7 days after birth. However, such mismatches were associated with a reduced risk of bacterial infection within the first 90 days of life.

Newborn immunity is primarily dependent on the transfer of antibodies from mother to fetus during pregnancy. While mismatches in ABO blood groups between mothers and their infants may offer some protection against serious infections, there is a lack of specific data regarding bacterial infections in newborns. To address this gap, Emily Ana Butler, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada, and colleagues aimed to explore the relationship between maternal-newborn ABO blood group incongruence and a reduced risk of bacterial infections in newborns.

For this purpose, the researchers conducted a cohort study using linked patient-level datasets of all singleton live births in Ontario, Canada, from January 1, 2014, to December 31, 2020. The study focused on maternal-newborn pairs with known ABO blood groups. Data analysis occurred between February and May 2024.

The primary outcome measured was bacterial infection in newborns within 30 days of birth, with secondary outcomes at 7 and 90 days. Modified Poisson regression was used to calculate adjusted relative risks, accounting for neonatal sex and preterm birth.

A total of 138,207 maternal-newborn pairs were analyzed. The findings include:

  • Maternal Age: Average age was 31.8 years for those with ABO blood group incongruence and 31.5 years for those with congruence.
  • Newborn Gestational Age: Average gestational age was 38.5 weeks for the incongruent group and 38.4 weeks for the congruent group.
  • Gender Distribution: 51.3% of males in the incongruent group and 51.9% in the congruent group.
  • ABO Blood Group Distribution: 37,953 pairs (27.5%) had ABO blood group incongruence, while 100,254 pairs (72.5%) had congruency.
  • Bacterial Infections Within 30 Days:
    • Incongruent group: 328 infections (8.6 per 1,000).
    • Congruent group: 1,029 infections (10.3 per 1,000).
    • Adjusted relative risk (ARR) for infection: 0.91.
  • ARRs for Bacterial Infections:
    • Within 7 days: 0.89.
    • Within 90 days: 0.86.

“The findings showed that maternal-newborn ABO blood group incongruence did not correlate with a reduced risk of infection within the first 30 or 7 days after birth. However, there was a noted association indicating that incongruence was linked to a lower risk of bacterial infection in infants within 90 days of birth,” the researchers concluded.

Reference:

Butler EA, Ray JG, Cohen E. Maternal-Newborn ABO Blood Groups and Risk of Bacterial Infection in Newborns. JAMA Netw Open. 2024;7(10):e2442227. doi:10.1001/jamanetworkopen.2024.42227

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Methotrexate first line, viable treatment option for effective mycosis fungoides, finds study

A new study published in the Journal of the European Academy of Dermatology and Venereology found that methotrexate (MTX) has a favorable benefit/risk ratio and is a good therapy choice for Mycosis fungoides (MF) when administered as a first-line treatment. A uncommon and varied subtype of non-Hodgkin lymphomas, cutaneous T-cell lymphomas (CTCLs) are distinguished by their distinct T-cell phenotype and clinical presentation.

The two most common main CTCL subtypes are Sézary syndrome (SS) and Mycosis fungoides. As a folate antagonist, methotrexate (MTX) works by blocking the enzyme dihydrofolate reductase, which is necessary for DNA synthesis. It is one of the most common chemotherapeutic options used to treat a variety of cancers, including CTCLs. This study by Vasiliki Nikolaou and colleagues was set out with the intention of summarizing and reporting the clinical experience of MF patients treated with low-dose MTX in tertiary experienced centers in Greece.

MF participants from 5 Greek cutaneous lymphoma referral centers participated in this retrospective multicenter investigation. Information about safety and efficacy was examined. The median (IQR) age of diagnosis for the 211 MF patients who were enrolled (68.3% of whom were male) was 68.3 (56–75) years.

There were 124 individuals with late-stage (IIB-IVB) illness (59.3%). 112 (53.1%) patients received MTX monotherapy, whereas 99 patients received combination regimens that included phototherapy, interferon, and retinoids. In 103 patients, MTX was the first-line treatment (48.9%). There was a 55.5% overall response rate (ORR), with 29.9% of patients providing full answers.

With no discernible differences between monotherapy and combination therapy, MTX showed higher efficacy as a first-line treatment than in later usage. 3.8 months (IQR 2.3–9.9 months) was the median time to greatest response. The individuals with erythrodermic disease (Stage III) had improved ORRs when compared to the ones with tumor stage disease (Stage II).

The median progression-free survival (PFS) for early-stage disease was 17.1 months, for Stage IIB disease it was 5.7 months, for Stage III it was 46 months, and for Stage IV it was 9.6 months (0.7-.). Also, 14 (6.7%) of the individuals had serious adverse (Grade 3) events that resulted in treatment termination. A weekly median dosage of 15 mg of oral MTX was administered to all patients once a week. Overall, this study provides important insights into the real-world response rates of MF patients treated with MTX.

Source:

Nikolaou, V., Panou, E., Tsimpidakis, A., Koumprentziotis, I., Patsatsi, A., Siakantaris, M., Kruger‐Krasagakis, S., Marinos, L., Georgiou, E., Lampadaki, K., Velissari, A., Daponte, A., Doxastaki, A., Kaliampou, S., Vaiopoulos, A., Konstandinou, I., Koumourtzis, M., Lakiotaki, E., Pappa, V., … Papadavid, E. (2024). Effectiveness and safety of methotrexate in the treatment of mycosis fungoides: Real‐world data from a multicentre study. In Journal of the European Academy of Dermatology and Venereology. Wiley. https://doi.org/10.1111/jdv.20350

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Semaglutide 2.4 mg may significantly improve liver fibrosis and resolve MASH in ESSENCE trial

According to Headline results from part 1 of the phase 3 ESSENCE trial,  Semaglutide 2.4 mg may significantly improve  liver fibrosis and lead to  resolution of steatohepatitis in MASH patients compared to placebo.

The results from part 1 of the ongoing ESSENCE trial, a pivotal phase 3, 240-week, double-blinded trial in 1,200 adults with metabolic dysfunction-associated steatohepatitis (MASH) and moderate to advanced liver fibrosis (stage 2 or 3) have been announced by Novo Nordisk. Part 1 of the ESSENCE trial evaluated the effect of once-weekly semaglutide 2.4 mg on liver tissue (histology) compared to placebo on top of standard of care for the first 800 randomised people at 72 weeks.

The trial achieved its primary endpoints by demonstrating a statistically significant and superior improvement in liver fibrosis with no worsening of steatohepatitis, as well as resolution of steatohepatitis with no worsening of liver fibrosis with semaglutide 2.4 mg compared to placebo. At week 72, 37.0% of people treated with semaglutide 2.4 mg achieved improvement in liver fibrosis with no worsening of steatohepatitis compared to 22.5% on placebo. 62.9% of people treated with semaglutide 2.4 mg achieved resolution of steatohepatitis3 with no worsening of liver fibrosis compared to 34.1% on placebo.

In the trial, semaglutide 2.4 mg appeared to have a safe and well-tolerated profile in line with previous semaglutide 2.4 mg trials.

“We are very pleased about the ESSENCE clinical trial results and the potential of semaglutide to help people living with MASH” said Martin Holst Lange, executive vice president and head of Development at Novo Nordisk. “Among people with overweight or obesity, one in three live with MASH. This has a serious impact on their health and represents a significant unmet need.”

Novo Nordisk expects to file for regulatory approvals in the US and EU in the first half of 2025. The detailed results from ESSENCE will be presented at a scientific conference in 2024. Part 2 of the ESSENCE trial will continue with expected readout in 2029.

About MASH

Metabolic dysfunction-associated steatohepatitis (MASH) is a serious, progressive, metabolic disease affecting the liver, which can be fatal if not properly managed. More than 250 million people live with MASH and the number of individuals in advanced stages of the disease is expected to double by 2030. Of those who are currently overweight or living with obesity, more than one in three are also living with MASH. People living with MASH often experience few or no specific symptoms in the early stages of the disease, which often results in delayed diagnosis. The risk of progression to advanced liver disease, including liver cancer, is higher in people living with MASH than in the general population.

About the ESSENCE trial

ESSENCE is a phase 3 trial evaluating the effect of once-weekly subcutaneous semaglutide 2.4 mg in adults with metabolic dysfunction-associated steatohepatitis with moderate to advanced liver fibrosis (stage 2 or 3). ESSENCE is a two-part trial where 1,200 planned participants were randomised 2:1 to receive semaglutide 2.4 mg or placebo, on top of standard of care for 240 weeks. In part 1, the objective was to demonstrate that treatment with semaglutide 2.4 mg improves liver histology at 72 weeks based on biopsy sampling from the first 800 randomised patients. In part 2, the objective is to demonstrate that treatment with semaglutide 2.4 mg lowers the risk of liver-related clinical events compared to placebo in adults with MASH and moderate to advanced liver fibrosis at 240 weeks.

About semaglutide 2.4 mg

Once-weekly subcutaneous semaglutide 2.4 mg is a GLP-1 receptor agonist marketed under the brand name Wegovy®. Wegovy® is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with a BMI of 30 kg/m2 or greater (obesity), adults with a BMI of 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition and paediatric patients aged 12 years and older with an initial BMI at the 95th percentile or greater for age and gender (obesity).

In the US, Wegovy® is indicated in combination with a reduced calorie diet and increased physical activity to reduce the risk of MACE in adults with established cardiovascular disease and either obesity or overweight, as well as to reduce excess body weight and maintain weight reduction long term in adults and paediatric patients aged 12 years and older with obesity and in adults with overweight in the presence of at least one weight-related comorbid condition.

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Sleep apnea contributes to dementia among elderly women

A common yet underdiagnosed sleep disorder contributes to the development of dementia among adults-particularly women, a Michigan Medicine study suggests.

Investigators uncovered this by examining survey and cognitive screening data from more than 18,500 adults to determine the potential effect of known or suspected obstructive sleep apnea on the risk for dementia.

Obstructive sleep apnea is a chronic sleep disorder characterized by episodes disrupted or restricted breathing during sleep.

For all adults age 50 and older, having known obstructive sleep apnea or its symptoms-as people often do not know they have the problem-was associated with a higher chance of having signs or a diagnosis of dementia in coming years.

While the overall difference in those dementia diagnoses never rose above 5%, the association remained statistically significant even after researchers accounted for many other factors that can affect dementia risk, such as race and education.

At every age level, women with known or suspected sleep apnea were more likely than men to be diagnosed with dementia.

In fact, the rate of dementia diagnosis decreased among the men and grew larger for the women as they aged.

The results are published in SLEEP Advances.

“Our findings offer new insight into the role of a treatable sleep disorder on long-term cognitive health at the population level for both women and men,” said first author Tiffany J. Braley, M.D., M.S., neurologist, director of the Multiple Sclerosis/Neuroimmunology Division and co-founder of the Multidisciplinary MS Fatigue and Sleep Clinic at University of Michigan Health.

Reasons for the sex-specific differences in dementia diagnosis by sleep apnea status, researchers say, are not yet known. However, they pose several possible explanations.

Women with moderate sleep apnea may have a greater risk of cardiovascular disease and are more likely to have insomnia, both of which can negatively impact cognitive function.

“Estrogen starts to decline as women transition to menopause, which can impact their brains,” said co-author Galit Levi Dunietz, Ph.D., M.P.H., an associate professor in the University of Michigan Department of Neurology and Division of Sleep Medicine.

“During that time, they are more prone to memory, sleep and mood changes that may lead to cognitive decline. Sleep apnea increases significantly post-menopause yet remains underdiagnosed. We need more epidemiologic studies to better understand how sleep disorders in women impact their cognitive health.”

Six million Americans have been officially diagnosed with sleep apnea, yet the disorder is believed to affect closer to 30 million people.

In a 2024 report, a Lancet Commission identified several modifiable risk factors that together account for around 40% of global dementia.

While sleep was not included as an official risk factor, the commission noted that sleep apnea “might be associated with dementia” and to consider adding screening questions about dementia for people with the sleep disorder.

Other modifiable risk factors for dementia include cardiovascular disease and mental health problems, both of which may be exacerbated by untreated sleep apnea.

“These potential harms caused by sleep apnea, many of which threaten cognitive performance and decline, highlight the importance of early diagnosis and treatment,” Braley said.

“Obstructive sleep apnea and resultant sleep deprivation and fragmentation are also associated with inflammatory changes in the brain that may contribute to cognitive impairment.”

The Michigan Medicine study used existing data from the Health and Retirement Study, an ongoing survey that is representative of Americans aged 50 and older.

“This study design cannot fully prove that sleep apnea causes dementia-that would likely require a randomized trial, over many years, to compare effects of sleep apnea treatment to the effects of no treatment,” said co-author Ronald D. Chervin, M.D., M.S., director of the Division of Sleep Medicine in the Department of Neurology at U-M Health.

“As it may be a long time if ever until such a trial occurs, backward-looking analyses such as ours, within large databases, may be among the most informative for years to come. In the meantime, the results provide new evidence that clinicians and patients, when making decisions about testing for sleep apnea and treating it, should consider the possibility that untreated sleep apnea causes or exacerbates dementia.” 

Reference:

Tiffany J Braley, Xiru Lyu, Galit Levi Dunietz, Paul C Schulz, Riley Bove, Ronald D Chervin, Henry L Paulson, Kerby Shedden, Sex-specific SLEEP Advancesdementia risk in known or suspected obstructive sleep apnea: A 10-year longitudinal population-based study, SLEEP Advances, 2024;, zpae077, https://doi.org/10.1093/sleepadvances/zpae077

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Adalimumab and corticosteroids may reduce uveitis recurrence among patients with Behçet’s disease: Lancet

A new study published in The Lancet Rheumatology showed that adalimumab and corticosteroids resulted in a noticeably decreased risk of recurrence in Behçet’s disease uveitis when compared to ciclosporine with corticosteroids. There is a lack of information about head-to-head studies of immunomodulatory treatments for Behçet’s disease. In order to avoid uveitis recurrence in patients with severe Behçet’s disease, this study examined the safety and effectiveness of ciclosporin, interferon alfa-2a, and adalimumab when used in combination with corticosteroids. Thus, Zhong and colleagues carried out this study to evaluate the safety and effectiveness of ciclosporin, interferon alfa-2a, and adalimumab (Humira, AbbVie) when used in conjunction with corticosteroids.

This large, randomized study was conducted in specialized uveitis center in Chongqing, China. Eligible patients were the ones who were 18 years of age or older, using corticosteroids for severe Behçet’s disease uveitis, and had never used anti-TNF medication. The patients received a tapering dosage of corticosteroids with subsequent dose modifications, and were randomly allocated in a 1:1:1 ratio to either ciclosporin, interferon alfa-2a, or adalimumab. The annualized recurrence rate of uveitis, as determined by the whole data set, was the main outcome. For the main endpoint, the non-inferiority margin of difference between the adalimumab and interferon alfa-2a groups was established at 1·0. Every patient who got at least one dosage of the trial medications had their safety evaluated. The conception and execution of the trial involved people who had firsthand experience with Behçet’s illness uveitis.

A total of 270 individuals were randomized to receive interferon alfa-2a, ciclosporin, or adalimumab between May 12, 2020 and February 22, 2022; 261 patients made up the whole analysis set. The least-squares mean for the main outcome was 0·95 for adalimumab, 1·84 for ciclosporin and 1·44 for interferon alfa-2a. The patients on ciclosporin had a considerably greater annualized recurrence rate than those on adalimumab. Non-inferiority criterion were not met by the 0·50 least-squares mean difference between interferon alfa-2a and adalimumab. Ciclosporin and interferon alfa-2a did not significantly vary in the main result. 12 (13%) out of 90 patients receiving ciclosporin plus corticosteroids, 8 (9%) out of 90 patients receiving interferon alfa-2a plus corticosteroids, and 7 (8%) out of 90 patients receiving adalimumab plus corticosteroids experienced serious side effects. Overall, the combined protocol of adalimumab plus corticosteroids was better to that of ciclosporine plus corticosteroids for Behçet’s disease uveitis on corticosteroid treatment.

Source:

Zhong, Z., Deng, D., Gao, Y., Bu, Q., Dai, L., Feng, X., Tang, C., Luo, X., Wang, Y., Zhou, C., Su, G., & Yang, P. (2024). Combinations of immunomodulatory agents for prevention of uveitis relapse in patients with severe Behçet’s disease already on corticosteroid therapy: a randomised, open-label, head-to-head trial. In The Lancet Rheumatology (Vol. 6, Issue 11, pp. e780–e790). Elsevier BV. https://doi.org/10.1016/s2665-9913(24)00194-2

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Use of Ovulation Tracking Wearables and Devices on the Rise, unravels study

The industry of Fertility tracking devices and wearables is rapidly expanding. These track ovulation and guide the conception. Researchers from the Northwestern University Feinberg School of Medicine Chicago have provided a narrative review of various products that are available in the present market and discussed on innovation of new technologies that tailor the ovulation in women. The review was published in the American Journal of Obstetrics & Gynecology.

The rapid growth of the Femtech industry focuses on technologies like apps and devices that help to improve women’s health. Females of reproductive age use this technology to track their fertility and pregnancy. Despite the presence of multiple novel products in the market that track fertility, they are not backed up by scientific research. Hence, researchers conducted a narrative review of various products to help these products help those in need.

The study identified and categorized fertility-tracking wearables and devices that help to track a woman’s fertile window till ovulation using sensors that collect data and send it to other smartphones. The researchers focused on technologies that went beyond calendar or symptom tracking and included technologies that monitor specific biomarkers by using wearable devices or tools. By using terms like ‘fertility tracker’, ‘hormone’, ‘urinary’, ‘device’, and ‘wearable’ the researchers reviewed the first 100 results in each category.

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They grouped the fertility trackers into two categories. They include wearables and devices. Wearables are tools worn for long periods that are in contact with the body for a long time. Devices are tools that analyze the bodily fluids and for a short duration. The researchers later searched scientific databases to validate the tools and compared the performance of these technologies.

These technologies help women track their fertile window which is the six-day up to ovulation. Most of the two tools the wearables and the devices work on the principle of raising the basal body temperature (BBT) after ovulation and the surge of luteinizing hormone before ovulation.

Wearables: These track the rise in BBT1-2 days after ovulation to identify the fertile window. They come in different forms like rings, wristbands, vaginal inserts, and skin patches. They measure temperature precisely, non-invasively, and sync data with the smartphone. Oura ring and Apple watches can sync with FDA-approved fertility tracking apps like the Natural Cycle.

Devices: These measure various biomarkers like oral temperature or urinary hormones including LH and metabolites of estradiol and progesterone. These use Bluetooth or smartphone apps to interpret the hormone levels and give feedback. Devices like Mira, Inito, and Proov use actual hormone levels whereas others like Premom and Femometer just indicate if the individual is in a fertile window.

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These fertility trackers are promising but have a significant gap in validation for women with irregular cycles and a diversified population. As there is inconsistency in how these devices are tested, it is necessary to critically evaluate the findings.

Even though some fertility trackers have FDA clearance and are promising, there is a high necessity for independent research to check their validation. They lack evidence on outcomes like pregnancy or birth rates. Fertility tracking needs more innovation and not just commercialized products at higher prices. Further research is needed that focuses on cost-effectiveness, accessibility, personalization, and continuous monitoring.

Further reading: Cromack SC, Walter JR. Consumer wearables and personal devices for tracking the fertile window. Am J Obstet Gynecol. 2024;231(5):516-523. doi:10.1016/j.ajog.2024.05.028

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