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There is a lack of knowledge about the effect of flavanols-rich dark chocolate intake on the anatomy and functionality of retinal vessels. The aim of this study prospective, randomized, blind, crossover clinical trial (ClinicalTrials.gov Identifier: NCT05227248, 07/02/2022) was to evaluate the effect of dark-chocolate intake on the functionality and anatomy of the retinal vessels in healthy subjects using dynamic vessel analyzer (DVA) and optical coherence tomography angiography (OCT-A). Twenty eyes of 20 healthy subjects (mean age, 24.4 ± 1.6 years; 12 females) were enrolled. Participants were randomized to consume 20 g of dark chocolate or 7.5 g of milk chocolate. Visual function, DVA and OCT-A parameters were evaluated before chocolate consumption and two hours later. One week later, the same participants were tested before and after consuming the opposite chocolate. Using OCT-A, no differences were disclosed in terms of perfusion density changes after dark-chocolate and milk-chocolate intake analyzing all chorioretinal plexuses (p > 0.09 in all analyses). Using DVA, a significant increase in the arterial dilation percentage after flicker stimulation was disclosed comparing baseline (2.750 ± 2.054%) with values after the dark chocolate intake (4.145 ± 3.055%, p = 0.016). This difference was not disclosed after the milk chocolate intake (p = 0.465). We disclosed that a reasonable amount of flavanols-rich chocolate in healthy subjects has benefic functional short-term effects in retinal vessels measured with DVA. This suggests a potential role of dark chocolate intake on retinal vessels. Further studies with long-term follow-up are warranted to show if the chronic assumption of dark chocolate could play a favorable role in the prevention of retinal diseases.

Reference:

Sacconi, R., Pezzella, M., Ribarich, N. et al. Benefits of dark chocolate intake on retinal vessels functionality: a randomized, blind, crossover clinical trial. Sci Rep 14, 20203 (2024). https://doi.org/10.1038/s41598-024-70289-7

Keywords:

Long term, consumption, dark chocolate, beneficial, preventing, retinal, vascular, disease, reveals, research, Scientific Reports, Sacconi, R., Pezzella, M., Ribarich, N.

This study aimed to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, ‘In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favourable clinical result?’ The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and periods evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; two studies reported the soft tissue changes: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and the pink esthetic score showed favouritism for the test group but without statistical significance. This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Reference:

Campi M, Leitão-Almeida B, Pereira M, Shibli JA, Levin L, Fernandes JCH, Fernandes GVO, Borges T. Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials. Quintessence Int. 2024 Oct 1;0(0):0. doi: 10.3290/j.qi.b5768294. Epub ahead of print. PMID: 39351790.

Keywords:

Outcomes, Immediate, implant, placement, damaged, extraction, sockets, comparable, conventional, implant, placement, finds, study, Campi M, Leitão-Almeida B, Pereira M, Shibli JA, Levin L, Fernandes JCH, Fernandes GVO, Borges T, Buccal bone defect; Compromised extraction sockets; Dental implants; Fresh sockets; Immediate implant placement.

The study found that mini-PCNL is safe and achieves a high stone-free rate, making it an appealing choice for patients and healthcare providers.

“In patients with stones larger than 15 mm, the stone-free rate was 87.01%, comparable to the 88.57% observed in adults. Although adults experienced a slightly greater drop in hemoglobin levels, there were no significant differences in complications, including blood transfusions, postoperative fever, or the need for additional interventions,” the researchers wrote.

Mini-PCNL is a refined version of traditional percutaneous nephrolithotomy (PCNL), designed specifically for children. It employs smaller instruments and accesses the kidney through a tiny incision, reducing tissue damage and recovery time. Waleed N. Jaffal, College of Medicine, University of Anbar, Ramadi, Al Anbar, Iraq, and colleagues aimed to evaluate the safety and efficacy of mini-PCNL for treating renal stones in children.

For this purpose, the researchers enrolled 77 patients under the age of 15 with renal stones larger than 15 mm in a prospective case-controlled study conducted at Al-Ramadi Teaching Hospital, Ar Razi Private Hospital, and Ghazi Al-Hariri Hospital for Surgical Specialties in Anbar and Baghdad, Iraq, from January 2020 to January 2024. This group, referred to as group A, was compared to a control group (group B) comprising 70 adult patients aged 18 to 60. Both groups underwent mini-PCNL procedures.

The study compared various factors, including gender, stone size, and location, operation time, stone-free rate, hemoglobin drop, need for blood transfusion, incidence of postoperative fever, any associated visceral injuries, and the requirement for further interventions such as extracorporeal shock wave lithotripsy or flexible ureteroscopy (ESWL or FURS).

The following were the key findings of the study:

• The ages of patients in group A ranged from 8 months to 15 years, with a mean of 4.30 ± 3.16 years, while group B included adults aged 18 to 60 years, with a mean age of 36.3 ± 12.0 years.
• There were no significant differences in gender distribution, stone size, or location.
• The stone-free rate was 87.01% for group A and 88.57% for group B, showing no statistical difference.
• The average hemoglobin drop was 1.096 ± 0.412 in group A and 1.195 ± 0.110 in group B.
• Blood transfusions were required in one case from each group, with no significant difference.
• There were three cases in group A and two in group B needing ESWL, with no statistical difference between the groups.
• FURS was required in four cases in group A and three in group B.
• The operative time ranged from 30 to 125 minutes for group A and from 34 to 129 minutes for group B.
• Postoperative fever occurred in 23 cases in group A and 21 cases in group B (p-value 0.986).
• Minor liver injuries were reported in one case from each group.

“The findings indicate that mini-PCNL is a safe and effective method for treating renal stones in children, with a low rate of significant complications and a high stone-free rate,” the researchers concluded.

Reference:

Jaffal, W.N., Al-Timimi, H.F.H., Hassan, O.A. et al. The safety and efficacy of miniaturized percutaneous nephrolithotomy in children. Urolithiasis 52, 142 (2024). https://doi.org/10.1007/s00240-024-01643-7

The researchers noted, “Although there was a gradual decrease in the initiation of benzodiazepine prescriptions from 2013 to 2021, the findings revealed an excessive supply of these medications following discharge after an acute ischemic stroke. This situation highlights the urgent need for better prescribing policies.”

The findings were published online on October 17, 2024, in Stroke, the official journal of the American Heart Association (AHA).

Benzodiazepines are commonly prescribed for anxiety, insomnia, and other conditions, but they come with risks, particularly for older adults and those recovering from significant medical events like a stroke. The potential for dependency, increased risk of falls, and cognitive impairment are particularly concerning in stroke survivors, who may already face challenges related to mobility and mental health. While guidelines recommend against prescribing to individuals aged 65 and older, there is limited knowledge about national prescription patterns in this demographic.

To fill this knowledge gap, Julianne D. Brooks, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues aimed to analyze the patterns of benzodiazepine prescriptions among ischemic stroke survivors, particularly focusing on the prevalence of excessive supply following discharge and examining longitudinal trends in usage, especially in patients aged 65 and older, where guidelines recommend against such prescriptions.

For this purpose, the researchers analyzed a 20% sample of Medicare claims from April 1, 2013, to September 30, 2021. They focused on beneficiaries aged 65 and older who were discharged alive after an acute ischemic stroke and had traditional Medicare coverage, along with six months of prior enrollment in Parts A (hospital insurance), B (medical insurance), and D (drug coverage).

Individuals with prior benzodiazepine prescriptions, those who self-discharged, or those discharged to skilled nursing facilities were excluded from the study. The researchers analyzed demographics, comorbidities, the duration of initial prescription supplies, and the cumulative incidence of benzodiazepine fills within 90 days after discharge. They also analyzed geographic and yearly trends.

The study led to the following findings:

• The study included 126,050 beneficiaries with a mean age of 78 years (SD, 8), of whom 54% were female and 82% were White.
• Within 90 days post-discharge, 6,127 individuals (4.9%) started a benzodiazepine.
• Among the new prescriptions, lorazepam (40%) and alprazolam (33%) were the most commonly prescribed.
• Most initial fills (76%) were supplied of more than 7 days, with 55% offering between 15 and 30 days.
• The initiation rates were higher for females (5.5%) than males (3.8%).
• Geographically, initiation rates were highest in the Southeast (5.1%) and lowest in the Midwest (4.0%), with a modest decline in nationwide initiation rates from 2013 to 2021 (cumulative incidence difference of 1.6%).

“While the number of new prescriptions decreased over the study period, the total supply of benzodiazepines remained disproportionately high. This discrepancy suggests that many patients continue to receive these medications even when they may not be clinically justified,” the researchers concluded.

Reference:

Lomachinsky Torres V, et al “Benzodiazepine utilization in ischemic stroke survivors: analyzing initial excess supply and longitudinal trends” Stroke 2024; DOI: 10.1161/STROKEAHA.124.047257.