Early Albumin Use in Septic Shock May Increase Risk of Renal Replacement Therapy and Mortality: Study

Researchers have determined that the use of early doses of albumin in patients presenting with septic shock and renal impairment may be linked to an increased incidence of renal replacement therapy (RRT) or in-hospital mortality. A recent study was published in the journal CHEST conducted by Asad E. and colleagues.

Septic shock is a life-threatening syndrome that frequently leads to multi-organ failure with acute kidney injury, significantly raising mortality rate and the need for RRT. Albumin infusions are given in nearly all the patients, as it is thought to have helped resuscitate blood volume, and thus better circulatory status. However, it is not well known what the renal effects of albumin would be in the context of septic shock with pre-existing impaired kidneys. To find out if early administration within 24 hours of admission reduces RRT or in-hospital mortality in this risk group, this study was performed. The analysis differentiated iso-oncotic (5%) and hyperoncotic (25%) albumin to determine if there were differences in risk profiles.

A retrospective, inverse probability-of-treatment weighted cohort study was conducted using 220 hospitals in geographically dispersed areas across the United States. The study population consisted of adult patients who were admitted with septic shock and had kidney impairment as evidenced by an eGFR measured at the time of hospital admission. The final cohort consisted of 9,988 patients classified as having received albumin within 24 hours of admission or not having received albumin at all during their hospital admission period.

Patients treated with albumin were further divided based on the solution of albumin they received-5% or 25%. The incidence of RRT or in-hospital death was the main composite endpoint of interest, and comparisons between groups were adjusted for confounding factors with inverse probability-of-treatment weighting.

Below are the key results reported by the authors on the impact of albumin use on outcomes in patients with septic shock and kidney impairment:

  • From 9,988 patients overall, albumin infusions were not administered to 7,929 (79.4%), whereas 2,059 (20.6%) received albumin within the first 24 h of admission.

  • The mean admission eGFR was 32 mL/min/1.73m², indicating severe impairment of the kidneys.

  • The composite endpoint of RRT or in-hospital mortality was present in 33.8% of the patients not receiving albumin compared with 39.7% of the patients receiving albumin (OR 1.29, 95% CI 1.14 – 1.47, p<0.001), with a significantly greater increase in risk associated with albumin use.

  • When analysed by albumin concentration, there was no significant difference in the composite outcome when iso-oncotic (5%) albumin was used (OR 1.07, 95% CI 0.84–1.37). The risk was significantly higher with hyperoncotic (25%) albumin (OR 1.43, 95% CI 1.16–1.76).

  • These results indicate that while albumin administration to septic shock patients with renal injury worsens their outcomes, the biggest increase in risk is observed with hyperoncotic albumin, which inflicts an even greater injurious insult on renal function and survival.

Early albumin administration has been associated with an increased need for RRT and in-hospital mortality in patients presenting with septic shock and impaired kidney function at admission. These findings indicate that in the setting of impaired renal function, the potential nefarious effects of hyperoncotic albumin on kidneys may outweigh the benefits, and caution should be exercised before administering albumin therapy in such patients afflicted with septic shock.

Reference:

Patanwala, A. E., Flannery, A. H., Mehta, H. B., Hills, T. E., McArthur, C. J., & Erstad, B. L. (2024). Comparative effectiveness of albumin versus no albumin on renal replacement therapy and mortality in patients with septic shock and renal impairment. Chest. https://doi.org/10.1016/j.chest.2024.10.012

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Low-dose isotretinoin to be effective against resistant rosacea, study finds

A new study published in the Journal of European Academy of Dermatology and Venerology showed that for individuals with resistant rosacea, low-dose isotretinoin (LDI) could be a safe and useful treatment. Rosacea is a chronic inflammatory skin disease that recurs frequently. With the possibility of ocular and extra-facial involvement, it often affects the centre face in a symmetrical distribution.

Rosacea affects 1% to 22% of individuals, with a preference for women and people with lighter skin phototypes. Because of its anti-inflammatory and sebum-reducing qualities, isotretinoin, which is a synthetic vitamin A analogue that is authorized for the treatment of acne vulgaris and has been investigated for rosacea in the past. Isotretinoin is still seldom used to treat rosacea, despite earlier research showing it can cause remissions in the condition. Therefore, this review and meta-analysis looked at the effectiveness and safety of low-dose isotretinoin for the four primary kinds of rosacea as erythematotelangiectatic, phymatous, papulopustular, and ocular rosacea.

Studies assessing LDI for rosacea, both randomized and non-randomized, were incorporated. Excluded studies included case reports, non-English research, and incomplete investigations. The Grading of Assessment, Recommendations, Development, and Evaluation scale was used to evaluate the quality of the study.

  • Nearly 16 studies with a total of 1445 patients were included out of 435 studies. LDI had a significant impact on erythema and lesion count reduction.
  • Isotretinoin reduced lesion count more than topical retinoids and topical antimicrobials (p = 0.03) with a moderate impact (SMD > 0.5).
  • At 16 weeks following the end of LDI, the mean lesion count and erythema remained lowered by 70% and 47%, respectively.
  • At 5.5 months after starting isotretinoin, the relapse rate was 35 percent, and 3 individuals (0.4%) noticed their rosacea get worse. Serious adverse effects were experienced by 3 patients (0.4%).

Overall, with acceptable tolerability and safety, LDI is a potentially useful therapy for moderate-to-severe or resistant rosacea, according to this combined systematic review and meta-analysis. Every study that used LDI for rosacea found that the condition improved with generally manageable, dose-dependent adverse effects.

Source:

King, A., Tan, M. G., Kirshen, C., & Tolkachjov, S. N. (2024). Low‐dose isotretinoin for the management of rosacea: A systematic review and meta‐analysis. In Journal of the European Academy of Dermatology and Venereology. Wiley. https://doi.org/10.1111/jdv.20315

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Study finds certain MS therapies may not slow disability progression

In people with primary progressive multiple sclerosis (MS), a new study has found no difference in the amount of time before disability worsened between people taking certain medications and those not receiving treatment. The study is published in the September 25, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.

With MS, the body’s immune system attacks myelin, the fatty, white substance that insulates and protects the nerves. People with primary progressive MS experience a steady decline in symptoms. About 10 to 15% of people with the disease have this type of MS.

The study looked at rituximab and ocrelizumab, anti-CD20 infusion therapies that target a protein called CD20 found on some white blood cells called B-cells. Removing these cells from the bloodstream is believed to reduce inflammation and damage that can occur to the myelin. Ocrelizumab is approved by the U.S. Food and Drug Administration (FDA) for primary progressive MS and for people with relapses, but rituximab is not. Rituximab is FDA approved for other diseases like rheumatoid arthritis and prescribed off label for MS.

“MS is a disabling disease, so treatments that slow the progression to worse disability are sorely needed,” said study author Laure Michel, MD, PhD, of Rennes University in France. “Anti-CD20 therapies are widely prescribed, in part because there are few alternate treatments. However, our study suggests they may not slow disability from worsening for people with primary progressive MS.”

The study involved 1,184 people with primary progressive MS who had an average age of 56. They did not take MS medications in the two years prior to the study. For the study, 295 people were treated with rituximab, 131 were treated with ocrelizumab and 728 were untreated. They were followed for an average of four years.

Participants’ level of disability was measured on a scale with scores ranging from zero, meaning no symptoms, to 10 points, meaning death due to MS. At the start of the study, all participants had a score of 6.5 or less.

Researchers then measured how long it took for people to advance to their first confirmed disability progression. For those whose score was less than 5.5 at the start of the study, advancing one point on the scale was considered progressing in disability. If their score was 5.5 or more, advancing 0.5 points on the scale was disability progression.

After adjusting for possible differences between the treated and untreated groups, researchers found there was no difference in the time it took to progress to the next level of disability between those taking a medication and those taking no medication.

“Medications for MS can be expensive and come with risks of side effects,” said Michel. “Our results indicate that there should be a constant evaluation of MS therapies to determine if the benefits outweigh the risks for people with primary progressive MS.”

A limitation of the study is that it was a look back in time and did not follow people in real time. Also, among those taking medications, most were taking rituximab with fewer people taking ocrelizumab. More research is needed in larger groups of people to confirm the findings.

Reference:

Hay, M., et al. (2024) Anti-CD20 Therapies in Drug-Naive Patients With Primary Progressive Multiple Sclerosis. A Multicenter Real-Life Study. Neurology. doi.org/10.1212/WNL.0000000000209886.

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AI-assisted colonoscopy increases polyp and adenoma detection in routine screening, finds research

A systematic review of randomized clinical trials (RCTs) comparing computer-aided detection (CADe) system-enhanced colonoscopy and conventional colonoscopy found that CADe (also known as artificial Intelligence- or AI-assisted) colonoscopies may increase overall detection of colonic polyps and adenomas, or precancerous growths, with a small increase in procedure time.

Equivocal results were found regarding detection of advanced colonic neoplasia (ACN), with a small increase in ACN detection rate but no difference in ACN detected per colonoscopy. The findings are published in Annals of Internal Medicine.

Researchers from Yale University and Mass General Brigham, Harvard School of Medicine comprehensively searched several large scientific research databases for RCTs comparing colonic lesion detection with standard colonoscopy versus AI-assisted colonoscopy with polyp detection (CADe) systems. The authors compared average adenoma per colonoscopy (APC) and ACN per colonoscopy for both screening methods. Secondarily, they compared adenoma detection rate (ADR), adenoma miss rate (AMR), and ACN detection rate between the two colonoscopy types.

They found that AI-assisted colonoscopy found more polyps and precancerous growths in the colon than conventional colonoscopy. However, AI-assisted colonoscopy detected marginally more serious growths (ACNs) than conventional colonoscopy but was no better than the conventional method at finding ACNs per colonoscopy.

The researchers note that there are no clear differences in benefit for detecting adenomas across different AI systems for CADe, and that there was an increase in benefit for providers with lower adenoma detection rate or those without a prior fecal immunochemical test result. They suggest that future studies focus on interval post colonoscopy colorectal cancer and may consider a study design that randomizes colonoscopists rather than patients.

Reference:

Saeed Soleymanjahi, Jack Huebner, Lina Elmansy, Niroop Rajashekar, Nando Lüdtke, BS, Rumzah Paracha, Rachel Thompson, Artificial Intelligence–Assisted Colonoscopy for Polyp Detection: A Systematic Review and Meta-analysis, Annals of Internal Medicine, https://doi.org/10.7326/ANNALS-24-00981

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Nasal Mupirocin fails to Prevent Symptom Recurrence After Sinus Surgery for Nasal Polyps: Study

Iran: A recent study has found that administering nasal mupirocin after endoscopic sinus surgery does not significantly reduce symptom recurrence in patients with chronic rhinosinusitis and nasal polyps. The findings were published online in the Iranian Journal of Otorhinolaryngology.

Chronic rhinosinusitis with nasal polyps is a prevalent condition that can lead to significant discomfort and impact quality of life. The surgical procedure aims to alleviate symptoms, but recurrence remains a challenge for many patients. Staphylococcus aureus has been recognized as a pathogen associated with the recurrence of symptoms in patients suffering from chronic rhinosinusitis with nasal polyps.

Against the above background, Alireza Mohebbi, NT and Head & Neck Research Center, Hazrat Rasoul Hospital/ The Five Health Senses Institute, Iran University of Medical Sciences, Tehran, Iran, and colleagues examined the effectiveness of mupirocin ointment applied to the nasal vestibule in reducing symptom recurrence and enhancing the outcomes of functional endoscopic sinus surgery.

For this purpose, the researchers included patients with chronic rhinosinusitis, nasal polyps, and a positive culture for Staphylococcus aureus in a clinical trial. The right nostril was designated as the intervention group, receiving mupirocin ointment, while the left nostril served as the control group, receiving vitamin A ointment. Lund-Mackay radiological scores and Lund-Kennedy endoscopic scores were assessed at diagnosis and again six months later.

The following were the key findings of the study:

  • Among 60 patients with chronic rhinosinusitis with nasal polyps, 91.6% were positive for nostril Staphylococcus aureus.
  • Comparing the average of the diagnostic radiological and endoscopic scores with the follow-up values in both groups indicated a significant improvement after surgery.
  • There was no significant difference in the radiological and endoscopic score improvements between the study and control groups.

The findings revealed that administering mupirocin ointment twice daily in the nostrils of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) does not significantly impact surgical outcomes following endoscopic nasal surgery. The researchers suggest that the use of mupirocin in these patients should be approached cautiously due to the potential for promoting the growth of gram-negative pathogenic bacteria.

The authors recommend conducting further studies with larger sample sizes to compare mupirocin with other topical antibiotics in preventing relapse in CRSwNP patients. Additionally, they propose evaluating the effects of combining mupirocin with other effective antibiotics targeting gram-negative bacteria.

“Future research should also explore different administration methods and dosages of mupirocin, comparing short-term, medium-term, and long-term results,” they concluded.

Reference:

Mohebbi AR, Mohsenian M, Elahi M, Minaeian S. Mupirocin Ointment Effect on Polyposis. Recurrence After Sinus Surgery. Iran J Otorhinolaryngol. 2024:36(5):573-580. Doi: 10.22038/ijorl.2024.70685.3405

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Early life childhood adverse experiences tied to childbirth comorbidities: Study

Japan: A recent nationwide online-based cross-sectional study has revealed significant associations between adverse childhood experiences (ACEs) and various pregnancy complications among women in Japan.

The findings, published in the Journal of Obstetrics and Gynaecology Research, revealed that adverse childhood experiences were linked to a higher likelihood of preterm birth, preeclampsia, and gestational diabetes mellitus (GDM) among the general population in Japan. However, no significant association was observed with small-for-gestational-age (SGA) births.

“In a study of 5,444 participants, women who reported four or more adverse childhood experiences had a threefold higher risk of developing preeclampsia. Additionally, those with two or three ACEs experienced a 42% to 61% greater likelihood of preterm birth,” the researchers reported. 

Preeclampsia is a condition characterized by high blood pressure and potential organ failure during pregnancy. This serious complication can endanger both the mother and the baby, making the implications of this study critical for public health. Takeo Fujiwara, Department of Public Health, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan, and colleagues aimed to investigate the relationship between adverse childhood experiences (ACEs) and pregnancy complications, such as preterm birth, GDM, preeclampsia, and SGA births within the general population in Japan.

For this purpose, the researchers utilized data from the JACSIS study, an online nationwide survey conducted in Japan from July to August 2021, involving 5,444 participants. The study defined ACEs as encompassing physical, sexual, and psychological abuse, neglect, childhood poverty, bullying victimization, domestic violence, parental death, and parental divorce.

Pregnancy complications, including PTB, gestational diabetes, preeclampsia, and small-for-gestational-age births, were assessed through participant questionnaires. A multivariable logistic regression model was employed to analyze the data.

The study led to the following findings:

  • Among the 5,444 women surveyed, 2,778 reported no adverse childhood experiences, while 374 experienced four or more ACEs.
  • A dose-response relationship was identified between total ACE scores and both preterm birth and preeclampsia.
  • Women with four or more ACEs exhibited a significantly higher risk of preeclampsia, with an adjusted odds ratio (aOR) of 3.06.
  • Additionally, those reporting two or three ACEs had increased risks of PTB, with aORs of 1.42 and 1.61, respectively.
  • Women with one ACE also showed a heightened risk of GDM, with an aOR of 1.34.
  • There was no association between ACEs and SGA births.

The findings highlight a concerning trend where early life traumas are linked to increased risks of pregnancy-related morbidities, such as preterm birth, preeclampsia, and gestational diabetes mellitus.

The implications of these findings extend beyond individual health, highlighting the need for comprehensive support systems for women with a history of ACEs. Public health initiatives could focus on early interventions and mental health support, potentially mitigating the long-term effects of childhood trauma.

“These insights could pave the way for improved maternal care and healthier pregnancies across Japan,” the researchers concluded.

Reference:

Maeda, Y., Tabuchi, T., & Fujiwara, T. Association between adverse childhood experiences and pregnancy morbidities: A nationwide online-based cross-sectional study. Journal of Obstetrics and Gynaecology Research. https://doi.org/10.1111/jog.16124

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T-tube for biliary drainage does not prevent postoperative complications in Parkinson’s patients, suggests study

A new study published in the journal of BMC Surgery found that the use of a T-tube in pancreaticoduodenectomy (PD) is not a practical way to avoid postoperative problems. Pancreaticoduodenectomy is usually used to treat malignant tumors of the distal bile ducts, ampulla, and pancreatic head. A few instances of chronic pancreatitis, benign ampullary tumors, and injury to the pancreatic head duodenum can also be treated with PD. With a reported incidence rate of 3-5% in prior research, biliary anastomotic stricture (BAS) is an uncommon long-term complication that follows Parkinson’s disease (PD) surgery.

Prior studies have indicated that the implementation of external T-tube biliary drainage may lower the incidence of postoperative problems related to Parkinson’s disease (PD), particularly the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF). Thus, this research was set out to assess whether T-tube biliary drainage after Parkinson’s disease (PD) was necessary and practical as it’s prophylactic impact on biliary anastomotic stricture has given special attention.

This research included patients who had pancreaticoduodenectomy performed at the facility between July 2016 and June 2020. The patients were separated into T-tube groupings and non-T-tube groups based on whether a T-tube was implanted during the procedure. the data gathered through an examination of the electronic health record system. Gender, age, BMI, length of stay after surgery (LOSAS), estimated blood loss (EBL), pathological diagnosis, size of mass, bile duct diameter, and postoperative complications (Bile leakage, postpancreatectomy hemorrhage (PPH), intra-abdominal infection (IAI), CR-POPF, and delayed gastric emptying) were the baseline data that were collected. Biliary anastomotic stricture (BAS) was the main goal of this study.

The findings of the study suggest that 330 individuals in all (Not-T-tube group = 226; T-tube group = 104) had PD. 222 participants were selected for further analysis using propensity score matching (Not-T-tube group =134, T-tube group = 88). The demographics of the patients in the matched groups were similar. The T-tube group had noticeably greater frequencies of clinically relevant postoperative pancreatic fistula (CR-POPF). Biliary anastomotic stricture (BAS) was observed in 3.15% of cases overall. Although the incidence of T-tube group was somewhat lower, there was no substantial difference. Overall, after PD, T-tube biliary drainage does not reduce the risk of developing BAS or postoperative sequelae. 

Source:

Luo, X., Zhuo, X., Lin, X., Lin, R., Yang, Y., Wang, C., Fang, H., Huang, H., & Lu, F. (2024). Whether T-tube biliary drainage is necessary after pancreaticoduodenectomy: a single-center retrospective study. In BMC Surgery (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12893-024-02570-5

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Methadone more effective than buprenorphine/naloxone for treatment retention of opioid use disorder: JAMA

People with opioid use disorder in British Columbia who received methadone had a 37-40 per cent lower rate of treatment discontinuation compared with those who received buprenorphine/naloxone.

The new research, published this week in the Journal of the American Medical Association, evaluated the risk of treatment discontinuation and mortality in people prescribed opioid agonist treatment (OAT) over a 10-year period.

“Reducing the risk of treatment discontinuation saves lives. With thousands of lives lost since the introduction of fentanyl into B.C.’s unregulated drug supply, it is important that we continue to evaluate the best available treatment options,” said Dr. Bohdan Nosyk, scientist at the Centre for Advancing Health Outcomes and a professor in the Faculty of Health Sciences at Simon Fraser University. “Comparative studies like this using high-quality health administrative data are one of the best sources of evidence we have to evaluate how our treatment options are performing as the toxic drug supply continues to evolve.”

The study, Buprenorphine/naloxone versus methadone for the treatment of opioid use disorder, was a collaboration between scientists and public health professionals from the Centre for Advancing Health Outcomes, Simon Fraser University, BC Centre on Substance Use, University of British Columbia (UBC), and McGill University in Canada, and universities and institutions in the United Kingdom, Austria, and across the United States.

This study included everyone in B.C. who received either methadone or buprenorphine/naloxone for opioid use disorders from Jan 1, 2010 to Mar 17, 2020 (30,891 people) and compared the impact of these medications on retention and all-cause mortality. Fentanyl was first detected in the drug supply in 2012 and became the primary driver of overdose mortality in 2016. The study period ended the day before BC declared a public health emergency for COVID-19. Just over 61 per cent of people in the cohort were prescribed methadone.

The study found that the risk of treatment discontinuation was lower among recipients of methadone compared with buprenorphine/naloxone. The risk of mortality was low during treatment and did not differ meaningfully between the two medications (0.13% vs. 0.08%). Importantly, these findings were consistent after the introduction of fentanyl and across patient subgroups, including youth (<24 years), people with severe mental disorders, and people with concurrent chronic pain.

“The benefits of these medications are only realized while people are using them. However, retention in OAT has steadily declined over the past 13 years,” said Dr. Paxton Bach, Clinical Assistant Professor in the Department of Medicine at UBC, Co-Medical Director for the BC Centre on Substance Use, and a co-author on the study. “Continuous evaluation and refinement of clinical guidance based on the strongest available evidence is vital in order to provide the best possible support to people with opioid use disorder in BC and around the world.”

Earlier research shows that mortality risk for people on OAT more than doubles after treatment discontinuation versus while on treatment.

The researchers noted that while this evidence suggests that methadone remains the treatment option with the strong evidence of effectiveness, decisions about medication choice must be made in collaboration with patients. Developing novel therapeutic regimens, like co-prescription of hydromorphone, is also an urgent priority. Additionally, there needs to be consideration the existing barriers to treatment retention, like urine drug screening and daily witnessed doses, and incorporation of strategies to improve retention, like engagement of peer support workers.

Reference:

Nosyk B, Min JE, Homayra F, et al. Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. Published online October 17, 2024. doi:10.1001/jama.2024.16954

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Experiences of parents and children born after preimplantation genetic testing largely positive, reports study

Little research has explored family experiences after
preimplantation genetic testing (PGT) for monogenic disorders (PGT-M) or PGT
for structural rearrangements (PGT-SR), particularly regarding how parents
discuss the condition with their children. The objective of this study was to
understand whether parents tell their children about PGT-M or PGT-SR and their
reflections on the advantages and disadvantages of the treatment.

A total of 47 parents with a child born after PGT-M or
PGT-SR completed a survey between December 2019 and May 2020. Parents were
asked open-ended questions about telling or not telling their children about
PGT, how their children understood and reacted to being conceived using PGT,
whether parents had any worries about their use of PGT, and parents’ general
reflections on the advantages and disadvantages of using PGT. The sample was
drawn from a previous study examining the obstetric and neonatal outcomes of
children born after PGT. The sample response rate was 47.19%. Children were aged
4–18 years. Data from the open-ended questions were analyzed using qualitative
content analysis and frequency counts and percentages were computed.
Illustrative Quotations are provided in the tables. The Danish Data Protection
Agency approved the data collection. Questionnaire studies do not require
approval from ethical committees or institutional review boards in Denmark.

Most parents told their children to be truthful, and they
saw no reason not to do so. For parents who had not yet told their child, this
was predominantly because the child was too young. Two respondents anticipated
that disclosure would be difficult. A total of 23 parents gave responses for
how their children responded to finding out about the use of PGT-M or PGT-SR.
The most common reaction was indifference, followed by feeling excited,
special, or curious. Most parents told their child to be truthful indifferent
about it at the time of the study.

For the 10 parents who said they worried about the child,
the reasons for their worry included whether the treatment will cause other
medical problems given that it is a relatively new treatment method (n = 5),
whether their child will have trouble conceiving in the future (n = 2), whether
the child will be able to access PGT when they need to (n = 2) and feeling
unsure of their decision to use it (n = 1). All parents stated that they would
recommend the treatment method to others. A total of 38 (80.9%) parents explained
why they would recommend PGT to others, with the most common reason being that
it enabled parents to have a genetically related child. In terms of the
advantages of PGT, the main advantage was the ability to have a healthy child.
Seven of the participants mentioned that PGT allowed them to have children
where they otherwise may have chosen not to. Other advantages included avoiding
miscarriage and being able to enjoy the pregnancy knowing that the infant was
healthy. The main disadvantage involved the adverse effect of the treatment,
specifically in response to the hormonal treatment received, and it is a
lengthy and invasive process that also took a toll on mental health

To author’s knowledge, this is the first study to examine
the experiences of parents raising a child born after PGT. The findings from
the study are reassuring and show that families who have used PGT have positive
experiences of the treatment, and children are reported to feel either neutral
or positive about having been born after the treatment.

Source: Vasanti Jadva, Ph.D.a,b Kate Shaw, B.A.b Bjørn Bay,
Ph.D.; Fertility Sterility;

https://doi.org/10.1016/j.fertnstert.2024.05.141

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Winter has no significant impact on symptoms including fatigue and pain in psoriatic arthritis patients: Study

A new study published in The Journal of Rheumatology found that the individuals with psoriatic arthritis (PsA) did not report a substantial change in their condition between the summer and winter months, despite mild changes observed.

Previous research has demonstrated that the cutaneous lesions of psoriasis patients may respond better to specific seasons, such as summer or winter. Nevertheless, there are extremely few PsA studies to date which evaluates the effect of weather fluctuation on disease activity. In order to enhance the quality of life for people with PsA, it might be beneficial to look at the relationship between DA, PROs, and weather variance. Also, people with psoriatic arthritis and other inflammatory articular disorders (IAD) describe seasonal variations in their symptoms. Thereby, this study by Maxine Joly-Chevrier and colleagues looked at the relationship between weather fluctuations, disease activity (DA), and patient-reported outcomes (PROs) in PsA patients.

From 2015 to 2020, Montreal (Environment Canada) provided hourly data of temperature, relative humidity, and pressure. These values were matched with the DA and PROs of PsA patients who were registered in RHUMADATATM. This study closely looked at the variations in mean DA and PROs between the winter and summer seasons. The clinical profile and meteorological parameters were correlated using Pearson correlation coefficients.

The study found a total of 858 PsA patients to have 2665 PROs collected from them. Wintertime saw reduced CDAI (p=0.001) and SDAI (p<0.001). Over the summer, it was shown that there were negative relationships between temperature and HAQ-DI and positive correlations between humidity and symptoms (PtGA, weariness, pain, BASDAI, CRP, BASFI). The outcomes found favorable relationships in the winter months between discomfort, weariness, and temperature. The weather could explain for less than 1% of the fluctuation in PROs, which may represent disease activity, according to optimum regression models constructed based on Akaike’s Information Criteria, which the study discovered to have strong relationships with gender, age, and illness duration.

Overall, this work adds to the expanding body of data which directly links between meteorological conditions and IAD symptomatology, which are complex disorders impacted by a variety of variables. The data indicate that weather-related factors have a little impact in the variability of PsA symptoms at the group level, and that other factors may have a greater influence. 

Reference:

Joly-Chevrier, M., Coupal, L., Sauvageau, L. C., Movahedi, M., & Choquette, D. (2024). A Real-World Analysis on Weather Variation Disease Activity and Patient Reported Outcomes in Psoriatic Arthritis. In The Journal of Rheumatology (p. jrheum.2024-0520). The Journal of Rheumatology. https://doi.org/10.3899/jrheum.2024-0520

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