Older Patients of epilepsy more likely to develop cardiovascular events: JAMA

A new study published in the recent edition of Journal of American Medical Association suggests that when providing enzyme-inducing antiseizure medications (EIASMs) to elderly patients who have epilepsy, doctors should use caution if there are additional cardiovascular risk factors present.

In their lifetime, one in 10 persons will experience at least one epileptic episode. Although epilepsy frequently strikes younger people, adults 60 years of age and beyond account for the majority of persons with epilepsy (PWE), both new onset and long-standing. There is a robust cross-sectional correlation between cardiovascular disease (CVD) and epilepsy. Also, a number of studies have demonstrated that there is a significant risk of developing cerebrovascular disease even in individuals whose epilepsy is not caused by it. Thereby, Jimmy Li and his team conducted this study to investigate the probabilities of new-onset cardiovascular events (CVEs) in patients with and without epilepsy during a 6-year period. Also, the mediation effects of EIASM usage and conventional cardiovascular risk factors (CVRFs) on this connection was investigated, with the goal of determining respective contribution of each factor to CVD risk in epilepsy.

This prospective cohort research utilized the whole cohort of the Canadian Longitudinal research on Ageing (CLSA) with a 6-year follow-up. The CLSA was a continuous, nationwide research project that recruited a total of 51,338 Canadian individuals between the ages of 45 and 85 at baseline. 30,097 people who reside close to one of the 11 data gathering centers make up the comprehensive cohort. A voluntary 45% of people took part in the CLSA. The people who had no prior history of CVEs at baseline were not included in the comprehensive cohort. There were no further exclusion standards used and 86% percent of participants finished the follow-up.

Of the 30,097 participants included in the comprehensive cohort, 27,230 had a history of epilepsy, 431 of whom were included in the total. Epilepsy patients had a 2.20 adjusted risk ratio for new-onset CVEs. Each of the following factors that mediated a different proportion of the effect of epilepsy on new-onset CVEs were;

  • strong EIASM usage (24.6%)
  • weak EIASM use (4.0%)
  • Framingham score (1.4%)
  • PASE score (3.3%)
  • waist to hip ratio (1.6%).

Overall, the findings of this study found a correlation between epilepsy and newly diagnosed CVEs.

Source:

Li, J., Shlobin, N. A., Thijs, R. D., Sylvestre, M.-P., Josephson, C. B., Deacon, C., & Keezer, M. R. (2024). Antiseizure Medications and Cardiovascular Events in Older People With Epilepsy. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2024.3210

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T2R activation by polyphenols could modulate glucose metabolism and control appetite

A recent research published in the Food Bioscience journal highlighted an critical connection between Type 2 taste receptors (T2Rs) and the regulation of appetite and blood glucose levels. While these receptors are traditionally associated with taste buds that perceive bitter flavors, they are also expressed in the gastrointestinal (GI) tract, where they play a significant role in homeostatic regulation.

The T2Rs of GI tract are activated by various ligands, including the bioactive compounds known as polyphenols, which are commonly found in plant-based foods. When these receptors are activated, they trigger the release of gastrointestinal hormones such as cholecystokinin (CCK) and incretin hormones like glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). These hormones have profound effects on appetite regulation, GI motility, and blood glucose homeostasis.

Cholecystokinin (CCK) and GLP-1 are peptides that play critical roles in managing food intake and appetite. CCK slows down gastric emptying, which prolongs the feeling of fullness after a meal, while GLP-1 improves insulin secretion in response to glucose, thereby helping in blood glucose control. Incretins like GLP-1 and GIP are particularly important as they stimulate insulin release by contributing to the maintenance of blood glucose levels within a healthy range.

One of the major insights from the research is the role of polyphenols, which are known for their strong bitter taste, are not well absorbed in the upper digestive tract. But, they travel through the digestive system to the colon, where they are excreted. However, during their journey through the GI tract, polyphenols interact with T2Rs, particularly in the GI tract, where they appear to trigger beneficial effects.

Epidemiological and intervention studies have consistently shown a negative correlation between polyphenol intake and the risk of developing diabetes. The proposed mechanism behind this protective effect involves the activation of T2Rs by polyphenols, which in turn leads to improved glucose tolerance and better regulation of appetite and intestinal motility.

The review suggests that the activation of T2Rs by polyphenols could be an important factor with their ability to modulate glucose metabolism and control appetite by offering a potential pathway for dietary interventions to prevent metabolic disorders like diabetes. Overall, the findings illuminate the importance of considering the bitter components of our diet, like polyphenols, not just for their nutritional value but also for their potential role in regulating key physiological processes.

Source:

Osakabe, N., Ohmoto, M., Shimizu, T., Iida, N., Fushimi, T., Fujii, Y., Abe, K., & Calabrese, V. (2024). Gastrointestinal hormone-mediated beneficial bioactivities of bitter polyphenols. In Food Bioscience (Vol. 61, p. 104550). Elsevier BV. https://doi.org/10.1016/j.fbio.2024.104550

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Age, Gender, and Steroid Use Linked to Ocular Issues in Herpes Zoster Ophthalmicus, Study Finds

USA: A recent study in the American Journal of Ophthalmology has shed light on the risk factors associated with ocular complications in patients suffering from herpes zoster ophthalmicus (HZO) and the concerning rates of shingles vaccination within a large urban health system.

The researchers identified several key factors associated with the development of ocular complications in HZO, including age, female gender, use of steroids at the initial visit, and the presence of stromal keratitis. Additionally, they noted that shingles vaccination rates were low among the study population. The study stated that recognizing these risk factors and the low vaccination uptake can help pinpoint at-risk groups, ultimately aiding disease prevention efforts.

“The study involving urban patients with herpes zoster ophthalmicus found that corneal scarring was the most prevalent complication, occurring in 70% of cases,” the researchers reported.

Ann-Marie Lobo-Chan, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, and colleagues aimed to analyze the epidemiology of herpes zoster (HZ) and HZO within an urban hospital system, focusing on identifying risk factors for ocular complications in HZO. They also sought to report the shingles vaccination rates and instances of HZ reactivation following vaccination in this population.

For this purpose, the research team conducted a retrospective cohort study involving patients treated at the University of Illinois Hospital system between January 1, 2010, and December 1, 2021, who were diagnosed with HZ and HZO based on diagnosis codes. They reviewed the medical records of HZO patients who had been seen within one year of their diagnosis. Using multivariable logistic regression analysis, they identified factors linked to the development of ocular complications in HZO.

Based on the study, the researchers reported the following findings:

  • During the study period, 3283 patients had HZ; the mean age of onset was 52.3 years, 61.6% were female, and 37% were Black.
  • HZO with ocular involvement was present in 3.4% of patients.
  • Ocular complications developed in 436.4% of patients; the most common complication was corneal scarring (70%).
  • Age (odds ratio [OR] 1.04), female gender (OR 2.86), steroids at initial visit (4.46), and stromal keratitis (OR 3.45) were associated with developing ocular complications.
  • Of eligible populations, 1.5% received shingles vaccination; 43 patients developed reactivation of HZ following vaccination.

As the authors highlight, the study emphasizes the interplay between demographic factors, clinical characteristics, and vaccination rates, calling for increased vigilance and action to protect at-risk populations from the debilitating effects of herpes zoster ophthalmicus. Enhanced awareness and vaccination initiatives, as suggested by the research, may be crucial in mitigating risks and improving overall health outcomes for this vulnerable group.

Reference:

Lobo-Chan, A., Song, A., Kadakia, A., & Mehta, S. D. (2024). Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus and Zoster Vaccine Utilization in a Large, Urban Health System. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2024.09.028

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Zoledronic acid improves outcomes for osteoporotic hip fractures, finds Study

A new study published in the Journal of Bone and Mineral Research found that when older patients with osteoporotic hip fractures are given zoledronic acid during their initial hospital stay, it greatly lowers their all-cause mortality and future vertebral fractures.

High 1-year death rates are linked to osteoporotic hip fractures, around 20% to 25% in women and 33% to 35% in men. Only 8% to 10% of patients receive zoledronic acid within a year following a fracture, despite the proven ability of this medication to lower fracture and death risks. This study evaluated the impact of zoledronic acid inpatient therapy on death rates and the risk of recurrent fractures in patients who were admitted for a first hip fracture.

Between January 1, 2016 and March 15, 2023 individuals with acute fragility hip fractures admitted to Massachusetts General Brigham facilities were identified. At the time of the fracture, the patients included had normal calcium levels, no postoperative renal damage, and were not actively using antiosteoporosis medicine. Propensity score matching was performed in a 1:1:3 ratio between patients who got zoledronic acid and the patients who did not get antiosteoporosis medication within the first year following their initial fracture. All-cause mortality and recurrent vertebral, nonvertebral, or contralateral hip fractures for a maximum of 24 months after the index fracture were the main research outcomes.

  • A total of 652 patients were given zoledronic acid and matched with 1926 people who got no antiosteoporosis medication. The patients who received zoledronic acid had a considerably reduced all-cause death rate than the ones who received no treatment.
  • Subgroup analysis revealed that women in the zoledronic acid group had much lower mortality than males in the untreated group, despite the difference between the two groups being not significant.
  • Furthermore, patients under the age of 90 who got zoledronic acid had considerably decreased mortality, regardless of the differences between groups above the age of 90 being not significant.
  • The rates of future spinal compression fractures were reduced in the zoledronic acid group. There were no significant differences between groups in the incidence of new contralateral hip fractures or nonvertebral fractures.
  • When it came to unfavorable outcomes, the rates of nonunion were comparable in the treated and untreated groups, and the zoledronic acid group did not see any incidences of atypical femoral fractures or osteonecrosis of the jaw.

Overall, the outcomes of this study support that zoledronic acid given inpatient is advantageous for osteoporotic hip fractures.

Reference:

Fan, W., Sun, X., Leder, B. Z., Lee, H., Ly, T. V., Pu, C. T., Franco-Garcia, E., & Bolster, M. B. (2024). Zoledronic acid for hip fracture during initial hospitalization. In Journal of Bone and Mineral Research. Oxford University Press (OUP). https://doi.org/10.1093/jbmr/zjae101

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Pre-Existing Diabetes Linked to Over Threefold Increase in Stillbirth and Perinatal Mortality Risk: Study

A systematic review and meta-analysis by researchers found that pre-existing diabetes tripled the risk of stillbirth and perinatal mortality. This study was published in the Obstetrics and Gynecology journal by Blankstein A. and colleagues. Data from 91 studies of people with pre-existing diabetes were combined, and the summary estimate revealed that people with type 2 diabetes have a significantly higher risk of adverse pregnancy outcome compared to those with type 1 diabetes.

Diabetes mellitus, in particular that pre-existing before pregnancy, has been considered an established risk factor for adverse pregnancy outcomes including stillbirth and perinatal mortality. However, the strength of association across populations and relative risk across type 1 versus type 2 diabetes has been less clear. This current study will quantify the association of pre-existing diabetes with the risk of stillbirth and perinatal mortality, and identify predictive risk factors that could inform clinical practice and patient care.

The review and meta-analysis were conducted in accordance with data from MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials from inception up to April 2022. Cohort and randomized controlled trial studies were identified in this review as studies targeting an association between pre-existing diabetes and stillbirth or perinatal mortality. To address the heterogeneity among studies, a random-effects model was applied. A total of 7777 citations were identified through the title and abstract screening, and 91 full-text articles were on the list of potentially eligible articles.

Key Findings

Association with Stillbirth

  • The pooled OR for stillbirth was 3.74 (95% CI, 3.17–4.41) when used with pre-existing diabetes. This pooled estimate was based on data from 37 studies, with noted heterogeneity of I2 = 82.5%.

Association with Perinatal Mortality:

  • The overall risk of perinatal mortality associated with pre-existing diabetes was increased, with a pooled OR of 3.22 (95% CI, 2.54–4.07) from 14 studies, with similar heterogeneity of I2=82.7%.

Type 1 versus Type 2 Diabetes:

  • Women with type 1 diabetes have a lower risk of stillbirth (pooled OR 0.81, 95% CI, 0.68–0.95) and perinatal mortality (pooled OR 0.73, 95% CI, 0.61–0.87), compared to women with type 2 diabetes, with no statistical heterogeneity present in these comparisons (I2=0%).

Impact of Prenatal and Prepregnancy Care:

  • The study emphasized the protective effect of prenatal care and prepregnancy diabetes management. These interventions, indeed, had significantly lower odds for stillbirth, with an OR of 0.26 (95% CI, 0.11–0.62, I2=87.0%), and for perinatal mortality, with an OR of 0.41 (95% CI, 0.29–0.59, I2=0%).

This systematic review and meta-analysis affirm that pre-existing diabetes carries an increased risk of stillbirth and perinatal mortality and that the risk with maternal type 2 diabetes is higher than that with type 1 diabetes. Prenatal and preconception care play crucial roles in mitigation, while at the same time offering pathways to achieving better outcomes for both the mother and child.

Reference:

Blankstein, A. R., Sigurdson, S. M., Frehlich, L., Raizman, Z., Donovan, L. E., Lemieux, P., Pylypjuk, C., Benham, J. L., & Yamamoto, J. M. (2024). Pre-existing diabetes and stillbirth or perinatal mortality: A systematic review and meta-analysis. Obstetrics and Gynecology, 10.1097/AOG.0000000000005682. https://doi.org/10.1097/aog.0000000000005682

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Trueness of shade matching with intraoral scanners low compared to spectrophotometers, finds study

Researchers have found in a new study that trueness of shade matching with intraoral scanners was low compared to spectrophotometers.Therefore Shade determination with intraoral scanners is not recommended. The study has been published in the Journal of Esthetic and restorative Dentistry.

This systematic review and meta-analysis compared the accuracy of intraoral scanners and spectrophotometers in determining tooth shade. An electronic search of five databases (PubMed, Scopus, Embase, Web of Science, CENTRAL) was conducted on October 19, 2023. A total of 163 studies were identified from the databases, of which 23 articles were eligible for inclusion. In vivo and in vitro quasi-experimental studies were included. After data extraction, a quantitative analysis was performed to determine the accuracy of the intraoral scanner in subgroups using four outcomes: trueness and precision with different measurement locations. A random-effects model was used to pool effect sizes. The pooled proportion with a 95% confidence interval (CI) was used for the effect size measure.Results: Eleven articles were included in the meta-analysis. Trueness with the intraoral scanner was between 0.28 (CI: 0.09–0.60) and 0.38 (CI: 0.24–0.53). Repeatability was between 0.81 (CI: 0.64–0.91) and 0.85 (CI: 0.74–0.92). Trueness showed low, and precision had moderate certainty of evidence. The trueness of shade matching with intraoral scanners is low compared to spectrophotometers, although the precision is considered high and is similar to spectrophotometers.

Reference:

Vitai, V., Németh, A., Teutsch, B., Kelemen, K., Fazekas, A., Hegyi, P., Németh, O., Kerémi, B. and Borbély, J. (2024), Color Comparison Between Intraoral Scanner and Spectrophotometer Shade Matching: A Systematic Review and Meta-Analysis. J Esthet Restor Dent. https://doi.org/10.1111/jerd.13309

Keywords:

Trueness, shade, matching, intraoral, scanners, low ,compared , spectro, photometers, finds, study, Vitai, V., Németh, A., Teutsch, B., Kelemen, K., Fazekas, A., Hegyi, P., Németh, O., Kerémi, B. and Borbély, J.

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Study Reveals High Prevalence of Sexual Dysfunction in Sarcoidosis Patients

Netherlands: Sexual dysfunction is a significant yet often overlooked issue in patients with chronic inflammatory diseases, and a recent study has shed light on its prevalence among those with sarcoidosis.

The new research, published in CHEST, highlights that sexual dysfunction is notably prevalent among patients with sarcoidosis, revealing that this issue affects a significant portion of the population suffering from the disease. The study emphasizes that sexual dysfunction in sarcoidosis patients is not just a matter of personal distress but is also intertwined with broader markers of quality of life.

This study, conducted by Catharina C. Moor, Department of Respiratory Medicine, Sarcoidosis Center of Excellence, Erasmus Medical Center, Rotterdam, and colleagues, is the first to evaluate the prevalence of sexual dysfunction in patients with sarcoidosis.

“Two-thirds of women with sarcoidosis experienced sexual dysfunction, while nearly 40% of men reported erectile dysfunction. Additionally, over 70% of patients indicated low overall sexual satisfaction. The study also found significant correlations between sexual health and health-related quality of life (HRQoL), as well as depressive symptoms and fatigue,” the researchers reported.

Sarcoidosis, a multisystem disease causing granulomatous inflammation, leads to symptoms like fatigue, cognitive dysfunction, and pain, significantly affecting health-related quality of life. Sexual dysfunction, often linked to chronic inflammatory conditions, may be exacerbated by sarcoidosis and its treatments. However, its prevalence in sarcoidosis has not been studied. Considering this, Dr. Moor and colleagues sought to assess the prevalence of sexual dysfunction in both men and women with sarcoidosis and to investigate how sexual dysfunction correlates with HRQoL, anxiety, depressive symptoms, and fatigue.

For this purpose, the researchers conducted a single-center cross-sectional study comprising data from 93 patients with sarcoidosis who completed validated surveys to determine the prevalence of sexual dysfunction.

Out of 150 outpatients, 101 agreed to participate, and 93 completed the questionnaires. The average FSFI score was 20.33, with 66.7% of women experiencing sexual dysfunction.

The study led to the following findings:

  • Among men, 39.2% had erectile dysfunction (10.7% severe), and 71.5% reported low overall satisfaction.
  • There were significant correlations between sexual dysfunction and health-related quality of life (HRQoL), anxiety, depression, and fatigue.
  • The FSFI score moderately correlated with the KSQ score (r = 0.36).
  • In men, the KSQ score correlated with erectile dysfunction (r = 0.37) but not with overall satisfaction (r = 0.25).
  • Depressive symptoms correlated with sexual dysfunction in women (r = –0.49), erectile dysfunction (r = –0.44), and overall satisfaction in men (r = –0.33).
  • Anxiety had a moderate negative correlation with erectile dysfunction (r = –0.31) but not with FSFI.
  • Fatigue correlated with sexual dysfunction in women (r = –0.42) but not in men.

“The higher rates of sexual dysfunction in both male and female patients with sarcoidosis underscore the importance of raising awareness among healthcare professionals who treat these individuals,” the researchers wrote.

“Clinicians are encouraged to routinely evaluate sexual health, address any contributing factors, and, when necessary, refer patients for psychosexual counseling,” they concluded.

Reference:

Moor CC, Gur-Demirel Y, Koudstaal T, Miedema JR, Sexual dysfunction in patients with sarcoidosis, CHEST (2024), doi: https://doi.org/10.1016/j.chest.2024.07.159.

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Babies born after fertility treatment have higher risk of heart defects, suggests research

The risk of being born with a major heart defect is 36% higher in babies who were conceived after assisted reproductive technology, such as in vitro fertilisation (IVF), according to results of a very large study published in the European Heart Journal.

Researchers say the finding is important since congenital heart defects are the most common form of birth defects, and some of them are associated with life threatening complications.

The study also shows that the increase in risk is particularly associated with multiple births which are more common in assisted reproduction.

The study was led by Professor Ulla-Britt Wennerholm from the University of Gothenburg in Sweden. She said: “Previous research shows that there are increased risks for babies conceived with the help of assisted reproductive technology. These include preterm birth and low birth weight. We wanted to investigate whether the risk of heart defects was higher for babies born following assisted reproduction.”

The research included all liveborn children born in Denmark between 1994 and 2014, all children born in Finland between 1990 and 2014, those born in Norway between 1984 and 2015 and those born in Sweden from 1987 to 2015; more than 7.7 million in total.

Researchers compared data on babies born following assisted reproduction, including IVF, intracytoplasmic sperm injection (ICSI) and embryo freezing, with data on babies conceived naturally.

They assessed how many liveborn children in each group were diagnosed with a major heart defect or with a serious heart defect either in the womb or in the first year of life. They took into account other factors that can increase the risk of congenital heart defects, such as child’s year of birth, country of birth, mother’s age at delivery, if the mother smoked during pregnancy, or if the mother had diabetes or heart defects.

This showed that heart defects were around 36% more common in babies born after assisted reproduction, compared to babies conceived without such treatment (absolute risk 1.84% versus 1.15%). This risk was similar regardless of the type of assisted reproduction used (IVF or ICSI, fresh or frozen embryos). However, the risk was greater for multiple births following assisted reproduction compared to singleton births following assisted reproduction (2.47% versus 1.62%).

Professor Wennerholm said: “We already know that babies born after assisted reproductive technology have a higher risk of birth defects in general however, we have found a higher risk also in congenital heart defects, the most common major birth defect.

“The fact that the risk of heart defects is similar regardless of the type of assisted reproduction used may indicate that there is some common factor underlying infertility in parents and congenital heart disease in their babies.

“Congenital heart defects can be extremely serious requiring specialist surgery when babies are very young, so knowing which babies are at the greatest risk can help us diagnose heart defects as early as possible and ensure the right care and treatment are given. More and more people are conceiving with the help of assisted reproductive technology, so we might expect to see increases in cases of congenital heart defects worldwide.”

In an accompanying editorial [2] Dr Nathalie Auger from University of Montreal Hospital Research Centre in Canada and colleagues said: “Assisted reproductive technology is a popular intervention in reproductive medicine, with these procedures accounting for 2% to 8% of births depending on the country. While most neonates born after assisted reproductive technology are healthy, these procedures are not without risks.

“In one of the largest studies to date, the researchers found that assisted reproductive technology was associated with the risk of major heart defects diagnosed prenatally or up to one year of age.

“Patients who use assisted reproductive technology tend to differ from the general population. These patients may have underlying morbidities that affect both fertility and the risk of heart defects.”

Reference:

Nona Sargisian, Max Petzold, Eva Furenäs, Mika Gissler, Anne Lærke Spangmose, Sara Malchau Lauesgaard, Signe Opdahl, Anja Pinborg, Anna-Karina A Henningsen, Kjersti Westvik-Johari, Kristiina Rönö, Christina Bergh, Ulla-Britt Wennerholm, Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study, European Heart Journal, 2024;, ehae572, https://doi.org/10.1093/eurheartj/ehae572.

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Electrolyte imbalances in individuals with eating disorder may increase mortality risk, reveals study

The results of a new study published in The Lancet Psychiatry journal highlighted the need for routinely checking electrolyte levels in individuals with eating disorders and acting quickly to address any abnormalities discovered in order to lower the risk of complications and early death.

Eating disorders (ED) have a significant role in extensive organ failure, including kidney function issues. Abnormal kidney function and electrolyte abnormalities are common in ED patients, involving chronic kidney disease (CKD) and acute kidney injury (AKI), which are most commonly associated with persistent hypokalaemia and volume depletion. Electrolyte imbalances are more common in individuals with eating disorder than in the general population. This study was carried out by Marco Solmi and team to determine if electrolyte imbalances in individuals with eating disorder were linked to physical health outcomes and death.

In Ontario, individuals who were 13 years of age or older who had an eating disorder and had an outpatient electrolyte measure within a year (between January 1, 2008 and June 30, 2019) were included in this retrospective population-based cohort research. Hypokalaemia, hyperkalaemia, hypernatraemia, hyponatraemia, hypomagnesaemia, metabolic acidosis, hypophosphataemia, or metabolic alkalosis were all considered electrolyte abnormalities. Death from all causes was the main outcome. Hospitalization, a cardiac episode, infection, acute or chronic renal illness, fracture, and bowel obstruction were the secondary outcomes. This study also looked at a younger cohort (less than 25 years old) and people who had no secondary outcome diagnosis prior to this.

A total of 6163 patients with an eating disorder and an electrolyte measure within a year of diagnosis were included. The study found no accessible ethnicity statistics. Hypokalaemia (994/1987 [50·0%]), hyponatraemia (752/1987 [37·8%]), and hypernatraemia (420/1987 [21·1%]) were the most prevalent electrolyte abnormalities. In all, 234/4176 (5·6%) of individuals without an electrolyte abnormality and 311/1987 (15·7%) of the ones with one experienced fatality.

An electrolyte imbalance was linked to hospitalization, acute renal damage, chronic kidney disease, bone fracture, and bowel obstruction, but not to infection or a cardiovascular event. The results were similar across eating disorder types, sexes, and young people (less than 25) without secondary outcomes at baseline. Overall, abnormalities in electrolytes have been linked to mortality and poor physical health outcomes, which emphasizes the need for monitoring and potential treatments to avoid negative consequences.

Source:

Solmi, M., Fabiano, N., Clarke, A. E., Fung, S. G., Tanuseputro, P., Knoll, G., Myran, D. T., Bugeja, A., Sood, M. M., & Hundemer, G. L. (2024). Adverse outcomes and mortality in individuals with eating disorder-related electrolyte abnormalities in Ontario, Canada: a population-based cohort study. In The Lancet Psychiatry (Vol. 11, Issue 10, pp. 818–827). Elsevier BV. https://doi.org/10.1016/s2215-0366(24)00244-x

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Anti-BP180 Autoantibody Levels Linked to Bullous Pemphigoid Disease Severity: JAMA

Researchers reported that levels of anti-BP180 autoantibodies may be the best marker for monitoring the disease activity of bullous pemphigoid (BP). BP is an autoimmune skin disorder in which autoantibodies attack parts of the skin, specifically the BP180 and BP230 proteins. A recent study was published in JAMA Dermatology by Po-Yi Chou and colleagues. This study aimed to evaluate the relationship over time between the titers of anti-BP180 and anti-BP230 antibodies in patients with BP disease, concerning their severity.

The systematic review of studies searched databases from their inception up to and including April 11, 2024 for the Cochrane Central Register of Controlled Trials, Embase, and PubMed to identify studies that had measured the association of levels of anti-BP180 and anti-BP230 IgG antibodies with disease severity in BP. The Autoimmune Bullous Skin Disorder Intensity Score, or ABSIS, and the BP Disease Area Index, or BPDAI, assessed intralesional and lesional severity. About 0.4% of the studies retrieved were included in the final analysis.

Altogether, 14 studies were included in this metaanalysis with 1,226 patients. For data extraction and cross-validation, the services of two independent researchers were sought. In case of discrepancies, a third researcher resolved them. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for assessment of bias. Random-effects model was utilized while conducting the meta-analysis. Subgroup analyses were conducted according to the manufacturers of ELISA kits that were used in different studies.

The meta-analysis of the studies had several important findings:

Anti-BP180 Correlation with Disease Severity:

  • There was at baseline a moderate correlation between anti-BP180 antibody levels and BPDAI scores (r = 0.56, 95% CI: 0.46-0.64), and ABSIS scores (r = 0.52, 95% CI: 0.39-0.62).

  • Correlation became stronger during the 3rd-month follow-up, with significant associations between anti-BP180 and BPDAI (r = 0.63, 95% CI: 0.39-0.79), and between anti-BP180 and ABSIS (r = 0.62, 95% CI: 0.39-0.79).

  • At 6-month follow-up, moderate correlations were retained (BPDAI: r = 0.53, 95% CI: 0.25-0.72; ABSIS: r = 0.53, 95% CI: 0.25-0.72).

  • Anti-BP230 Antibody Levels and Disease Severity: Anti-BP230 antibody levels did not correlate with disease severity at baseline or follow-up by either BPDAI or ABSIS, so the levels are of no utility for BP monitoring.

In conclusion, this systematic review and meta-analysis provides strong evidence for the use of anti-BP180 autoantibody levels as an adjunctive tool in the monitoring of BP disease severity. In this way, the good correlation with scores of BP at various time points suggests that these biomarkers may guide the treatment of the patient with BP.

Reference:

Chou, P.-Y., Yu, C.-L., Wen, C.-N., Tu, Y.-K., & Chi, C.-C. (2024). Bullous pemphigoid severity and levels of antibodies to BP180 and BP230: A systematic review and meta-analysis. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2024.3425

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