Thoracic endovascular aortic repair may decrease mortality rate of TBAD versus medical treatment: Study

New research found that thoracic endovascular aortic repair (TEVAR) was productive and has reduced patients’ in-hospital stay or 30-day mortality rate with Type B aortic dissections (TBADs) compared to the medical treatment group. The study results were published in the journal BMC Surgery. Better treatment results were seen in old-age patients, and those with uncomplicated TBADs with TEVAR than with medical treatment.

Endovascular therapy techniques have advanced significantly, offering a promising alternative to traditional medical treatment for patients with Type B aortic dissections (TBADs). Type B aortic dissections occur when the inner layer of the aorta tears, allowing blood to flow between layers of the aortic wall, which can lead to severe complications. The main treatment options include best medical therapy (BMT), aimed at managing blood pressure and other risk factors, and thoracic endovascular aortic repair (TEVAR), which involves inserting a stent to support the aorta and prevent further damage. As research showed that both techniques have been effective researchers conducted a meta-analysis to compare mortality rates and overall complications between TEVAR and BMT in patients with TBADs. The goal was to determine whether TEVAR provides better outcomes than BMT alone, particularly in terms of reducing early mortality and complications.

Also Read: Thoracic aortic aneurysm managed successfully by TEVAR with periscope graft technique: case report

The analysis included randomized controlled trials and prospective or retrospective cohort studies comparing the effectiveness of TEVAR and BMT in treating Type B aortic dissection. Researchers searched multiple electronic databases to gather relevant studies for comparison. In total, 32 cohort studies involving 150,836 patients were included in the final analysis.

Findings:

  • The results revealed that TEVAR was associated with a significantly lower 30-day mortality rate compared to BMT.
  • The relative risk (RR) of 30-day mortality for patients undergoing TEVAR was 0.79, with a confidence interval (CI) of 0.63 to 0.99 and a P-value of 0.04. This reduction in mortality was particularly notable in patients aged 65 and older, where the relative risk was 0.78 (CI: 0.64–0.95, P = 0.01).
  • However, patients who underwent TEVAR had significantly longer hospital stays compared to those who received BMT. The mean difference (MD) in hospital stay was 3.42 days (CI: 1.69–5.13, P = 0.0001), and the mean ICU stay was 3.18 days longer (CI: 1.48–4.89, P = 0.0003).
  • On the other hand, BMT was associated with an increased risk of stroke, with an RR of 1.52 (CI: 1.29–1.79, P < 0.00001).
  • In terms of long-term outcomes, no significant differences were found between TEVAR and BMT groups for late mortality rates at 1, 3, and 5 years.
  • Similarly, there were no significant differences in the incidence of major complications such as acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, or sepsis between the two groups.
Also Read: IVC:Ao index sensitive indicator for predicting Post-spinal Hypotension-Study

Thus, the meta-analysis demonstrated that TEVAR is associated with a significantly lower mortality rate for patients with Type B aortic dissections compared to BMT, particularly in older patients aged 65 and above. Although TEVAR patients experience longer hospital and ICU stays, the procedure’s benefits in reducing early mortality make it a viable alternative to medical therapy alone. Despite these promising findings, further randomized controlled trials are necessary to confirm the advantages of TEVAR over BMT and to explore potential long-term benefits or risks.

Further reading: Motawea, K.R., Rouzan, S.S., Elhalag, R.H. et al. Efficacy of thoracic endovascular aortic repair versus medical therapy for treatment of type B aortic dissection. BMC Surg 24, 259 (2024). https://doi.org/10.1186/s12893-024-02555-4

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Peribulbar corticosteroid administration clinically useful treatment for ocular myasthenia gravis: Study

Researchers find that long-acting agents, such as triamcinolone, are effective for treating ocular myasthenia gravis (OMG). Oral myasthenia gravis is a condition characterized by weakness in the muscles controlling eye movements and eyelids. The use of peribulbar injections with dexamethasone and triamcinolone, according to a new study, constitutes a safer and better localized alternative, suggesting their efficacy in maintaining permanent resolution of symptoms. The study was published in the Journal of Neuro-Ophthalmology by Lasry R. and colleagues.

OMG weakens the extraocular muscles around the eyes, which often leads to paralysis of eye movements and ptosis or drooping eyelids. Oral treatments with corticosteroids are well established but carry the risk of side effects to so many other body tissues that localized treatments are highly desirable. This article reports on the use of peribulbar corticosteroid injections in OMG patients, thereby providing a more localized form of treatment.

A retrospective chart review was performed in order to determine the effectiveness of peribulbar corticosteroid injections in a small group of patients who had ocular myasthenia gravis. Five patients who received that treatment could be identified for the case-analysis. The study focused on the effects of peribulbar dexamethasone or triamcinolone (40-mg Triesence), which is a longer-acting corticosteroid, which targets the area behind the eye rather than injecting the affected extraocular muscles itself. The results of resolution of symptoms, time to treatment, and recurrence of symptoms after injection were monitored by the review.

Of the total five patients inducted:

  • Four patients had isolated ophthalmoparesis, that manifested as paralysis of eye muscles

  • One patient had isolated ptosis.

  • Four of the five patients had combinations of ptosis and ophthalmoparesis.

  • Cases of ptosis and ophthalmoparesis are documented in three out of four cases, where symptoms subsided completely within a few weeks after one single injection in the peribulbar region.

  • Symptoms remained improved for 5 to 6 months, and patients responded well to repeated injections in cases of symptom relapse.

In summary, peribulbar corticosteroids, mainly triamcinolone, hold considerable promise as a treatment for ocular myasthenia gravis with a possibility of holding relief for many months after less injection. This treatment carries minimal systemic adverse effects and, hence, is a more friendly option to the patient. As such, the healthcare providers should henceforth consider the peribulbar triamcinolone approach as an effective alternative for the management of OMG, especially in patients who experience frequent relapse of symptoms.

Reference:

Lasry, R., Gotkine, M., & Kruger, J. M. (2024). Peribulbar corticosteroids for ocular myasthenia gravis. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 44(3), 419–422. https://doi.org/10.1097/wno.0000000000002148

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Vitamin D Levels Linked to Periodontitis and Tooth Loss in Older Irish Adults, Study Reveals

Ireland: Recent research published in the British Journal of Nutrition has highlighted a significant connection between vitamin D levels, periodontitis, and tooth loss among older adults in Ireland.

A cross-sectional study involving a diverse group of older men and women revealed that concentrations of 25-hydroxyvitamin D (25(OH)D) were associated with both periodontal disease and the likelihood of tooth loss, independent of other risk factors.

Periodontitis, a serious gum infection that damages soft tissue and can destroy the bone that supports teeth, is common among older adults. It is often exacerbated by a variety of factors, including poor oral hygiene, smoking, and systemic health issues. However, the study sheds light on the role of vitamin D, a nutrient crucial for bone health and immune function.

In the study, Lewis Winning, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Republic of Ireland, and colleagues aimed to examine the relationship between 25(OH)D levels and periodontitis and tooth loss in older adults.

For this purpose, 2,346 adults participated in a comprehensive dental examination as part of the health assessment for The Irish Longitudinal Study of Ageing. Analysis of 25-hydroxyvitamin D (25(OH)D) levels was conducted on frozen, non-fasting total plasma samples using liquid chromatography-mass spectrometry (LC-MS). The study employed multiple logistic and multinomial logistic regression to explore the relationships between 25(OH)D concentrations, periodontitis, and tooth loss while adjusting for various potential confounding factors.

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

  • The mean age of participants was 65·3 years, and 55·3 % of the group were female.
  • Based on the quintile of 25(OH)D concentration, participants in the lowest versus highest quintile had an OR of 1·57 of having periodontitis in the fully adjusted model.
  • For tooth loss, participants in the lowest v. highest quintile of 25(OH)D had a RRR of 1·55 to have 1–19 teeth and a RRR of 1·96 to be edentulous, relative to those with ≥ 20 teeth in the fully adjusted models.

The cross-sectional study of older men and women in Ireland found an association between 25-hydroxyvitamin D levels and periodontitis and tooth loss.

“These results are particularly significant, considering the high rates of vitamin D deficiency among older adults in the country. Future longitudinal studies should focus on exploring the potential causality and mechanisms involved,” the researchers wrote.

“Furthermore, since vitamin D supplementation generally provides health benefits with a low risk of toxicity or side effects, clinical trials are needed to determine whether vitamin D supplementation can effectively prevent periodontitis and tooth loss in the elderly population in Ireland,” they concluded.

Reference:

Winning L, Scarlett S, Crowe M, O’Sullivan M, Kenny RA, O’Connell B. Vitamin D, periodontitis and tooth loss in older Irish adults. British Journal of Nutrition. Published online 2024:1-9. doi:10.1017/S000711452400148X

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PG Medical Admissions 2024 in Karnataka: KEA to close application window tomorrow, register now

Karnataka- Karnataka Examinations Authority (KEA) is going to close the application window for PG medical degree, DNB, and diploma courses. Candidates who have qualified the National Eligibility and Entrance Test-Postgraduate (NEET PG) 2024 and meet the eligibility criteria for PG medical courses can apply for the programme. The last date to apply for admission is tomorrow i.e. October 5, at 5:30 pm.

Candidates will be allotted seats in government medical colleges, government quota seats in private and minority medical colleges, and private seats in private and minority medical colleges such as KPCF, KRLMPCA, AMPCK, and private universities of Karnataka.

Also Read: KEA Extends NEET 2024 Round 2 Counselling dates, check details

Candidates who have secured a minimum percentile or above in NEET PG 2024 are eligible to register for admission to postgraduate medical courses. However, candidates from outside Karnataka will have no seat reservation quota applicable to their applications.

The general category candidates who have obtained the minimum percentile in NEET-PG 2024 i.e. 50th percentile are eligible to apply and register for KEA admissions. Moreover, the SC, ST, and OBC eligibility criteria will be only applicable to SC, ST, and OBC candidates of Karnataka.

Meanwhile, the details regarding the registration fee, document verification schedule, and original documents to be submitted for document verification will soon be published on the KEA official website.

However, KEA does not entitle candidates to admission if they are unable to fulfil the eligibility criteria or fail to produce the prescribed certificates for document verification. Candidates who register and complete the document verification process will be eligible for admission to PG medical and dental courses in government and private colleges in Karnataka.

Karnataka Examinations Authority is governed by the Governing Council headed by the Honourable Minister of Higher Education. The Government of Karnataka established Common Entrance Test Cell in the year 1994 for conducting of entrance test and determining the eligibility/merit, for admission to the first year or first semester of full-time professional courses for Government share of seats in Medical, Dental, Indian systems of medicine and Homeopathy, B-Pharma, Pharma-D Courses, etc.

Also Read: KEA Releases NEET 2024 2nd Round counselling Schedule, Instructions For Candidates

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Liver X receptor beta: A new frontier in treating depression and anxiety

In a Bench to Bedside review published in the journal Brain Medicine, researchers Dr. Xiaoyu Song and Professor Jan-Åke Gustafsson from the University of Houston and Karolinska Institutet (Sweden) shed light on the therapeutic potential of liver X receptor beta (LXRβ) in treating depression and anxiety. This comprehensive analysis marks a significant step forward in understanding the molecular underpinnings of mental health disorders and potentially revolutionizing their treatment.

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Kids missed out on learning to swim during pandemic, widening racial and ethnic disparities

Nearly three out of four kids in Chicago had no swimming lessons in the summer of 2022, with significant racial and ethnic differences, according to a parent survey from Ann & Robert H. Lurie Children’s Hospital of Chicago published in Pediatrics. Black and Hispanic/Latine kids were disproportionately affected (85% and 82%, respectively), compared to white kids (64%).

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Study finds toddlers get nearly half their calories from ultra-processed foods

Toddlers in the UK obtain nearly half (47%) of their calories from ultra-processed foods (UPFs), and this rises to 59% by the age of seven, according to a new study led by UCL researchers.

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Water fluoridation found to be less effective now than in past

The dental health benefits of adding fluoride to drinking water may be smaller now than before fluoride toothpaste was widely available, an updated Cochrane review has found.

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Study demonstrates that mpox vaccine antibody responses wane within a year

A study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) has demonstrated that mpox antibody levels declined rapidly and nearly returned to baseline six to 12 months after patients received the mpox vaccination. The findings, published in JAMA, suggest that protective immunity may have waned in previously vaccinated individuals and that boosting may be required to maintain robust protection.

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RG Kar PG Medico Rape-Murder Case: Junior doctors hold mega protest march, unveil victim’s statue

Kolkata: Thousands of junior doctors, joined by supporters from various walks of life, marched in protest on Wednesday, demanding justice for a postgraduate medico who was raped and murdered at R G Kar Medical College and Hospital in August.

The demonstration, organized by the Bengal Junior Doctors’ Front, commenced at College Street and concluded at Esplanade, escalating the ongoing agitation for improved safety measures for healthcare workers.

According to the PTI report, “We are not in a ‘Puja’ or ‘Utsav’ mood, and we will continue protesting on the streets till our sister gets justice. We have chosen this day of Mahalaya to send out this message,” said one of the protesters, identifying herself as a colleague of the deceased. 

Also Read:RG Kar Case: ‘Why Progress on safety measures so tardy?’ SC pulls up WB Govt, seeks National Task Force’s Report

Mahalaya marks the beginning of Devi Paksha in the Hindu calendar, heralding the start of Durga Puja celebrations, when devotees invoke Goddess Durga to descend to Earth.

Carrying placards, and national flags, the protesters raised slogans, asserting they would not rest until justice was served. 

The march comes amid doctors’ ‘cease-work’ stir in hospitals in protest against the rape and murder of their colleague.

As the rally concluded at Esplanade, leaders of the Bengal Junior Doctors’ Front vowed to continue their agitation until the government took definitive action.

“We will not give up. This is about our safety, our dignity, and justice for Abhaya. The government cannot expect us to remain silent while they do nothing,” said an agitating junior doctor, while addressing the crowd, news agency PTI reported.

The rally, one of the largest demonstrations in recent weeks, attracted a diverse mix of participants, including doctors, nurses, medical students, and concerned citizens.

The protesters later gathered on the banks of Ganga, lighting 1,000 diyas as a symbolic act in their fight for justice.

Despite the festive air in the city as people prepared for the upcoming Durga Puja, protesters maintained that the movement for justice overshadowed celebrations.

“Today is the 52nd day of our protest, and we are still facing attacks. There is no positive response from the state government toward meeting our safety and security demands,” said Aniket Mahato, one of the agitating junior doctors, addressing the crowd at Esplanade.

The protesters, mostly junior doctors, have been on a ‘cease work’ since Tuesday, accusing the West Bengal government of failing to fulfil promises made in mid-September.

Although the doctors had partially resumed services after 42 days of the strike, they went back to ‘cease-work’ on Tuesday, alleging that key demands such as enhanced safety measures for medical staff were not implemented.

Among the key demands raised by the Bengal Junior Doctors’ Front are the installation of CCTV cameras on hospital premises, round-the-clock security for healthcare workers, and stricter protocols to prevent similar incidents of violence against medical professionals.

The culture of fear and intimidation within state-run hospitals has also been a focal point of the protests, with the doctors alleging that the administration has failed to provide a safe working environment.

“We joined our profession to serve the people, but how can we do so when we constantly live in fear? We don’t feel safe in the very places where we are supposed to save lives,” said another junior doctor.

While the West Bengal government had initially promised to address many of the doctors’ concerns following the first phase of protests, the agitating doctors claimed there has been little follow-up action.

“The promises made were hollow. We are being asked to return to work without any concrete measures being put in place to ensure our safety,” Mahato said.

Attempts by the government to broker peace with the doctors have so far failed, with state officials urging the medics to return to work and suggesting that police investigations into the alleged murder of the junior doctor are ongoing.

The junior doctors’ protest has garnered widespread support from Kolkata’s general public, with many residents expressing solidarity with the movement.

“This is not just about doctors. This is about justice, about safety in our institutions, and about holding those in power accountable,” said Swati Mukherjee, a homemaker who joined the rally along with her family.

With no clear resolution in sight, and tensions between the junior doctors and the state government intensifying, the protest movement looks set to continue in the coming weeks, even as Kolkata prepares for its biggest festival of the year.

Meanwhile, a statue christened ‘Abhaya’ was unveiled on RG Kar Hospital premises, which the agitating doctors claimed is a symbol of the ghastly act that occurred on August 9 and also of the ongoing protests demanding justice, adds PTI.

“This statue is not of the victim, but a symbol of pain, torture she went through and the ongoing protests,” a junior doctor of the hospital told reporters.

Also Read:Kolkata Doctor Death Case: Bengal Doctors hold torch rally ahead of SC hearing

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