AIIMS Releases Examination Fee and Admit Card Schedule for MBBS Supplementary Professional Exams Oct-Nov 2024

New Delhi  : All India Institute of Medical Sciences (AIIMS) has released the schedule for payment of examination fees and release of admit cards for undergraduate  professional examinations.

As per the notice, the online registration for submission of the examination fee is now open from 14.10.2024 and the registration for Undergraduate Professional Examinations is going to close on 21.10.2024.

To fill out the examination form and pay the examination fee, undergraduate students who are likely to appear for the undergraduate professional examination are advised to visit the official website of AIIMS, under student TAB , go to desired course, Click on Professional Exams Registration link, fill the Examination Form and make payment.

It is to be noted that, the payment of the examination fee for the undergraduate professional examinations should only be done through Debit/Credit Card/Net Banking. However, the fees to be paid will be populated automatically depending upon the course.

Also, only those eligible candidates who have paid their examination fees as per the mentioned schedule will be able to download their admit card from 14th October 2024 onwards by visiting the official website of AIIMS under the Student tab for the desired course.

STEPS TO DOWNLOAD THE ADMIT CARD

1 Click on the Admit Card link.

2 Enter the Enrolment Number.

3 Enter the date of Birth.

To view the official Notice, Click here :  https://medicaldialogues.in/pdf_upload/notice-fee-admit-card-second-mbbs-supple-oct-nov-2024-website-256485.pdf

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Novel procedure ReCET combined with semaglutide eliminates insulin dependence in type 2 diabetes: Study

Groundbreaking research presented today at UEG Week 2024 reveals a promising new treatment strategy for type 2 diabetes (T2D) that could significantly reduce or even eliminate the need for insulin therapy.

This innovative approach, which combines a novel procedure known as ReCET (Re-Cellularization via Electroporation Therapy) with semaglutide, resulted in the elimination of insulin therapy for 86% of patients.

Globally, T2D affects 422 million people, with obesity recognised as a significant risk factor. While insulin therapy is commonly used to manage blood sugar levels in T2D patients, it can result in side effects such as weight gain and further complicate diabetes management. A need therefore exists for alternative treatment strategies.

The first-in-human study included 14 participants aged 28 to 75 years, with body mass indices ranging from 24 to 40 kg/m². Each participant underwent the ReCET procedure under deep sedation, a treatment intended to improve the body’s sensitivity to its own insulin. Following the procedure, participants adhered to a two-week isocaloric liquid diet, after which semaglutide was gradually titrated up to 1mg/week.

Remarkably, at the 6- and 12-month follow-up, 86% of participants (12 out of 14) no longer required insulin therapy, and this success continued through the 24-month follow-up. In these cases, all patients maintained glycaemic control, with HbA1c levels remaining below 7.5%.

The maximum dose of semaglutide was well-tolerated by 93% of participants, one individual could not increase to the maximum dose due to nausea. All patients successfully completed the ReCET procedure, and no serious adverse effects were reported.

Dr Celine Busch, lead author of the study, commented, “These findings are very encouraging, suggesting that ReCET is a safe and feasible procedure that, when combined with semaglutide, can effectively eliminate the need for insulin therapy.”

“Unlike drug therapy, which requires daily medication adherence, ReCET is compliance-free, addressing the critical issue of ongoing patient adherence in the management of T2D. In addition, the treatment is disease-modifying: it improves the patient’s sensitivity to their own (endogenous) insulin, tackling the root cause of the disease, as opposed to currently available drug therapies, that are at best disease-controlling.”

Looking ahead, the researchers plan to conduct larger randomised controlled trials to further validate these findings. Dr Busch added, “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”

Reference:

Novel procedure combined with semaglutide may eliminate insulin dependency in type 2 diabetes, Beyond, Meeting: UEG Week 2024.

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Bidirectional Associations Between Chronic Diabetes Complications and Mental Health Disorders, revealed in new Study

A groundbreaking study revealed that there is a stable, constant, and bidirectional relationship between chronic diabetic complications (CDCs) and mental health disorders (MHDs) in an individual. The study highlighted the importance of their relationship and the importance of preventing comorbidity to reduce the disease risk. The study results were published in the journal Diabetes Care. 

Diabetes is a global pandemic and individuals with type 1 or type 2 diabetes are at an increased risk of developing chronic diabetic complications and mental health disorders. Diabetic individuals can develop multiple complications. The development of complications can affect the mental health of the individuals. Hence, researchers from Michigan State University conducted a study to understand the bidirectional associations between the timing of chronic diabetes complications (CDCs) and mental health disorders (MHDs) in individuals with type 1 or type 2 diabetes. 

Also Read: Voice pitch may be of use for non-invasive glucose monitoring for people living with Type 2 diabetes: Study

Researchers used the nationally representative health care claims database to identify individuals with type 1 or type 2 diabetes and a matched cohort without diabetes. Propensity score matching was employed to quasi-randomize the cohorts and stratify the individuals by age groups like 0–19, 20–39, 40–59, and ≥60 years. ICD-9/10 codes were used to diagnose CDCs and MHDs to capture both diabetes-related complications and mental health conditions. Cox proportional hazards models were used to explore the relationship between CDCs and MHDs. The influence of one condition leading to the development of the other were determined by incorporating time-varying diagnoses of CDCs and MHDs. 

Findings:

  • The study analyzed data from 553,552 individuals spanning from 2001 to 2018.
  • This included 44,735 individuals with type 1 diabetes, 152,187 individuals with type 2 diabetes, and 356,630 individuals without diabetes.
  • A significant bidirectional association was found between CDCs and MHDs.
  • Specifically, individuals who developed a CDC were at a higher risk of subsequently developing an MHD, with hazard ratios (HRs) ranging from 1.9 to 2.9 (P < 0.05).
  • Old age grouped individuals had higher risk than others.
  • Similarly, individuals with a pre-existing MHD had an elevated risk of developing a CDC, with HRs between 1.4 and 2.5 (P < 0.05), with the highest risk observed in the 0–19 years age group.
  • Further analysis revealed differences in the likelihood of developing CDCs and MHDs between individuals with type 1 and type 2 diabetes.
  • Among those under the age of 60 the study found that individuals with type 1 diabetes were more prone to developing CDCs, while individuals with type 2 diabetes had a higher likelihood of developing MHDs.
  • However, the overall relationship between CDCs and MHDs did not differ by diabetes type.
  • Interaction effects between CDCs and MHDs across different types of diabetes were not significant (P > 0.05). 
Also Read: Healthy lifestyle may counteract diabetes-associated brain ageing, reveals study

Thus, the study determined an immense bidirectional relationship between chronic diabetes complications and mental health disorders across all age groups. Individuals who develop CDCs are at a greater risk of developing MHDs, and vice versa and hence it is important to recognize and address the interplay between physical and mental health in diabetes care and address both physical and mental health outcomes across the lifespan. 

TAKE-HOME MESSAGE

  • This study examined the bidirectional associations between mental health disorders and chronic diabetes complications in individuals with type 1 or type 2 diabetes by analyzing data from a nationally representative healthcare claims database.
  • Using the data the authors analyzed 44,735 individuals with type 1 diabetes and 152,187 individuals with type 2 diabetes.
  • Having a chronic diabetes complication increased the risk of developing a mental health disorder (HR, 1.9–2.9) and having a mental health disorder increased the risk of developing a chronic diabetes complication (HR, 1.4–2.5).
  • There is a bidirectional association between mental health disorders and chronic diabetes complications in individuals with type 1 and type 2 diabetes.

Further reading: Watanabe M, Reynolds EL, Banerjee M, et al. Bidirectional Associations Between Mental Health Disorders and Chronic Diabetic Complications in Individuals With Type 1 or Type 2 Diabetes. Diabetes Care. 2024;47(9):1638-1646. doi:10.2337/dc24-0818

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Low-Dose Colchicine Effective for Preventing Ischaemic Stroke and Atherosclerotic Events, Meta-Analysis Reveals

Netherlands: A recent meta-analysis published in eClinicalMedicine has revealed promising findings regarding the use of colchicine for secondary prevention in patients with a history of ischaemic stroke and atherosclerotic events.

This analysis suggests that in patients with a history of stroke or coronary artery disease, colchicine lowered the incidence of ischaemic strokes and major adverse cardiovascular events (MACE). The treatment demonstrated a consistent effect across important subgroups and did not increase serious safety issues or mortality.

Colchicine, traditionally used to treat gout and familial Mediterranean fever, has garnered attention for its anti-inflammatory properties. Guidelines suggest the use of low-dose colchicine for secondary prevention in cardiovascular disease; however, uncertainties persist regarding its effectiveness for stroke, its efficacy in specific subgroups, and the potential for uncommon yet serious safety outcomes.

Against the above background, Aernoud T.L. Fiolet, Department of Cardiology at University Medical Center Utrecht, the Netherlands, and colleagues conducted a collaborative meta-analysis. Their primary objective was to assess the effectiveness of colchicine in preventing ischaemic strokes and MACE. Additionally, they aimed to provide detailed safety data and examine the efficacy of colchicine in key clinical subgroups.

In the trial-level meta-analysis, the researchers comprehensively searched bibliographic databases and trial registries from inception till May 16, 2024. We included randomized trials assessing the use of colchicine for the secondary prevention of ischaemic stroke and MACE, which encompasses ischaemic stroke, myocardial infarction, coronary revascularization, and cardiovascular death. Secondary outcomes included serious safety events and mortality. A fixed-effect inverse-variance model was employed to calculate a pooled estimate of relative risk (RR).

The following were the key findings of the study:

  • The analysis included six trials with a total of 14,934 patients who had a history of stroke or coronary disease.
  • Compared to placebo or no colchicine, the use of colchicine led to a 27% reduction in the risk of ischaemic stroke (132 events in the colchicine group versus 186 events in the control group, RR 0.73) and a 27% reduction in MACE (505 events versus 693 events, RR 0.73).
  • The effectiveness of colchicine was consistent across key subgroups, including gender, age (below versus above 70), presence of diabetes, and statin use.
  • Colchicine was not linked to an increased risk of serious safety outcomes. Hospitalization for pneumonia occurred in 1.5% of patients in the colchicine group compared to 1.5% in the control group (RR 0.99).
  • Cancer diagnoses were reported in 3.5% of patients on colchicine versus 3.6% on placebo (RR 0.97).
  • Gastrointestinal events were similar, with 2.1% in the colchicine group compared to 1.9% in the control group (RR 1.15).

To conclude, the authors found that in patients with a history of stroke or coronary disease, low-dose colchicine effectively reduced the risk of ischaemic stroke and MACE. These benefits were consistent across key clinical subgroups, and there were no significant increases in other serious safety events or all-cause mortality.

“Our study supports the incorporation of low-dose colchicine into clinical practice for the secondary prevention of stroke and coronary events,” they wrote.

Reference:

Fiolet, A. T., Poorthuis, M. H., Opstal, T. S., Amarenco, P., Boczar, K. E., Buysschaert, I., Budgeon, C., Chan, N. C., Cornel, J. H., Jolly, S. S., Layland, J., Lemmens, R., Mewton, N., Nidorf, S. M., Pascual-Figal, D. A., Price, C., Shah, B., Tardif, J., Thompson, P. L., . . . Kelly, P. J. (2024). Colchicine for secondary prevention of ischaemic stroke and atherosclerotic events: A meta-analysis of randomised trials. EClinicalMedicine, 76, 102835. https://doi.org/10.1016/j.eclinm.2024.102835

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Study Links New-Onset Atrial Fibrillation After Coronary Surgery to Increased Stroke Risk

Sweden: A recent nationwide cohort study has shed light on the relationship between new-onset atrial fibrillation (AF) following coronary artery bypass grafting (CABG) and the subsequent risk of ischemic stroke. The findings were published online in the BMJ Journal Heart.

The researchers revealed that in individuals with postoperative AF following CABG, factors such as a history of ischemic stroke, older age, heart failure, and previous myocardial infarction were linked to an increased risk of ischemic stroke within one year. The findings suggest that clinicians should closely monitor these high-risk groups following surgery.

New-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting raises the risk of ischemic stroke, but the factors influencing this risk remain poorly understood. To fill this knowledge gap, Amar Taha, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden, and colleagues aimed to identify the main factors associated with one-year ischemic stroke risk, compare the predictive capabilities of the CHA2DS2-VASc and ATRIA scores for ischemic stroke, and evaluate the dispensing of oral anticoagulation (OAC) at discharge.

For this purpose, the researchers conducted a nationwide cohort study utilizing prospectively collected data from four mandatory Swedish national registries. They included all first-time isolated CABG patients who developed POAF between 2007 and 2020. Multivariable logistic models were employed to identify predictors of ischemic stroke, while C-statistics assessed the predictive abilities of the CHA2DS2-VASc and ATRIA scores in patients not receiving OAC. Additionally, the study described OAC dispensing patterns concerning stroke-associated factors.

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

  • A total of 10,435 patients with postoperative atrial fibrillation were identified. Among those not receiving oral anticoagulation (OAC) (n=6,903), 3.1% experienced an ischemic stroke within one year.
  • Key independent predictors of ischemic stroke included advancing age (adjusted odds ratio (aOR) 1.86 per 10-year increase), prior ischemic stroke (aOR 18.56 at 60 years, aOR 5.95 at 80 years), myocardial infarction (aOR 1.55), and heart failure (aOR 1.53).
  • The area under the receiver-operating characteristic curve was 0.72 for the CHA2DS2-VASc score and 0.74 for the ATRIA score.
  • 71.0% of patients with a stroke risk greater than 2% per year, as indicated by the CHA2DS2-VASc score, were not discharged on OAC.

This large study of patients with postoperative atrial fibrillation after CABG found that having a previous ischemic stroke, being older, having a heart attack, and having heart failure were significant risk factors for ischemic stroke in the first year after surgery. The CHA2DS2-VASc and ATRIA scoring systems were moderately effective at predicting stroke risk within a year for these patients, similar to those with atrial fibrillation who hadn’t had surgery.

The researchers note that while one-third of patients with POAF were discharged on oral anticoagulation, the factors linked to higher stroke risk did not strongly influence the decision to prescribe OAC for these patients.

Reference:

Taha A, Martinsson A, Nielsen SJ, et al. New-onset atrial fibrillation after coronary surgery and stroke risk: a nationwide cohort studyHeart Published Online First: 04 October 2024. doi: 10.1136/heartjnl-2024-324573

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Pomalidomide Significantly Reduces Epistaxis Severity in HHT Patients, Study Finds

Researchers have found that the severity of epistaxis significantly diminishes in affected patients with hereditary hemorrhagic telangiectasia (HHT) with pomalidomide treatment. HHT is a genetic disorder characterized by the growth of widespread telangiectasias and arteriovenous malformations which causes recurrent nosebleeds or epistaxis, iron-deficiency anemia, and diminished quality of life. Epistaxis can be severe and debilitating, highly affecting patients’ daily activities and overall well-being. A recent study was conducted by Al-Samkari and colleagues and was published in The New England Journal of Medicine.

The primary objective of this study was to investigate whether pomalidomide lessens the severity of epistaxis in HHT patients, as defined by the Epistaxis Severity Score. An important secondary outcome was how pomalidomide impacts patient quality of life: to be measured with a specific HHT quality-of-life score.

144 Patients were randomized to receive either pomalidomide (4 mg daily) or placebo for 24 weeks in a 2:1 ratio. The first objective was the change from baseline to week 24 in the Epistaxis Severity Score. This score is standardized from 0 to 10, with higher values indicating a more significant bleeding, and any decrease with a value of at least 0.71 points is considered clinically relevant. The secondary endpoint was the HHT-specific quality-of-life score, ranging from 0 to 16, with higher values meaning more restrictions.

Results

• At baseline for all patients the mean Epistaxis Severity Score was 5.0 ± 1.5, denoting moderate to severe nosebleeds.

• At week 24, the mean change in Epistaxis Severity Score was -0.94 points for the pomalidomide group compared with the placebo group (95% CI, −1.57 to −0.31; P=0.004), crossing the clinically significant threshold of 0.71 points.

• Compared with the placebo group, the mean difference in HHT-specific quality of life between baseline and end was −1.4 points (95% CI, −2.6 to −0.3), suggesting improvement in daily functioning and reduction of disease-related limitations.

• Neutropenia, constipation, and rash were more common in the pomalidomide group, but no new safety signals emerged.

Pomalidomide markedly decreased the severity of epistaxis, a HHT, on the criterion of clinical significance for more than half of those affected. The treatment also seemed to improve quality of life, and safety. Therefore, pomalidomide could be a promising therapeutic intervention in HHT, but more studies are needed to adequately describe its long-term benefits and safety across the larger populations of affected individuals.

Reference:

Al-Samkari, H., Kasthuri, R. S., Iyer, V. N., Pishko, A. M., Decker, J. E., Weiss, C. R., Whitehead, K. J., Conrad, M. B., Zumberg, M. S., Zhou, J. Y., Parambil, J., Marsh, D., Clancy, M., Bradley, L., Wisniewski, L., Carper, B. A., Thomas, S. M., & McCrae, K. R. (2024). Pomalidomide for epistaxis in hereditary hemorrhagic telangiectasia. The New England Journal of Medicine, 391(11), 1015–1027. https://doi.org/10.1056/nejmoa2312749

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Study Identifies Signs Tied to More Severe Cases of RSV

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in young children due to respiratory complications such as bronchiolitis and pneumonia. Yet little is understood about why some children develop only mild symptoms while others develop severe disease. To better understand what happens in these cases, clinician-scientists from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, and Boston Children’s Hospital analyzed samples from patients’ airways and blood, finding distinct changes in children with severe cases of Respiratory syncytial virus, including an increase in the number of natural killer (NK) cells in their airways.
The descriptive study, which focuses on understanding the underpinnings of severe disease, may help to lay groundwork for identifying new targets for future treatments. Results are published in Science Translational Medicine.
“As a physician, I help to care for children who have the most severe symptoms, and as a researcher, I’m driven to understand why they become so sick,” said corresponding author Melody G. Duvall, MD, PhD, of the Division of Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital (BWH) and the Division of Critical Care Medicine at Boston Children’s Hospital. “NK cells are important first responders during viral infection – but they can also contribute to lung inflammation. Interestingly, our findings fit with data from some studies in COVID-19, which reported that patients with the most severe symptoms also had increased NK cells in their airways. Together with previous studies, our data link NK cells with serious viral illness, suggesting that these cellular pathways merit additional investigation.”
Duvall and colleagues, including lead author Roisin B. Reilly of the Division of Pulmonary and Critical Care Medicine at BWH, looked at samples from 47 children critically ill with Respiratory syncytial virus, analyzing immune cells found in their airways and peripheral blood. Compared to uninfected children, those with severe illness had elevated levels of NK cells in their airways and decreased NK cells in their blood. In addition, they found that the cells themselves were altered, both in appearance and in their ability to perform their immunological function of killing diseased cells.
Reference: Roisin B. Reilly et al.’An altered natural killer cell immunophenotype characterizes clinically severe pediatric RSV infection.Sci. Transl. Med.16,eado6606(2024).DOI:10.1126/scitranslmed.ado6606

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Deprescribing Antihypertensives May Preserve Cognitive Function in Nursing Home Residents: JAMA

USA: Deprescribing antihypertensive medications may benefit elderly individuals in long-term care facilities by reducing the risk of cognitive decline, new data from the Veterans Health Administration has shown.

The study, published in JAMA Internal Medicine, revealed that elderly patients who had their blood pressure (BP) medications reduced—either by decreasing the overall number of drugs or adjusting dosages—experienced a slower rate of cognitive decline compared to those who continued their usual medication regimen. This effect was especially notable among patients with dementia.

Deprescribing antihypertensive medications is common among nursing home residents, but the relationship between this practice and cognitive decline remains unclear. To fill this knowledge gap, Bocheng Jing, Division of Geriatrics, Department of Medicine, University of California, San Francisco, and colleagues aimed to examine the relationship between deprescribing antihypertensive medications and changes in cognitive function among nursing home residents.

For this purpose, the researchers conducted a cohort study using a target trial emulation approach, including VA long-term care residents aged 65 and older who had been in residence for at least 12 weeks between 2006 and 2019. Residents not prescribed antihypertensive medications, those with blood pressure above 160/90 mm Hg, or those with heart failure were excluded. Eligible residents with stable medication use for four weeks were divided into deprescribing or stable user groups and followed for two years or until death or discharge, for intention-to-treat (ITT) analysis. Participants who switched treatment groups were censored in the per-protocol analysis.

Deprescribing was defined as a reduction in the total number of antihypertensive medications or a dosage decrease of 30% sustained for at least two weeks. Cognitive function was evaluated using the Cognitive Function Scale (CFS), categorized as cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4).

Follow-up data were analyzed using an ordinal generalized linear mixed model, adjusting for confounders with inverse probability of treatment weighting, and per-protocol analysis included the inverse probability of censoring weighting.

The following were the key findings of the study:

  • Of 45,183 long-term care residents, 12,644 (mean age 77.7 years; 2.6% female, 97.4% male) qualified for intention-to-treat (ITT) analysis, while 12,053 (mean age 77.7 years; 2.6% female, 97.4% male) met the criteria for per-protocol analysis.
  • At the end of the follow-up, 12.0% of residents showed a worsened Cognitive Function Scale (CFS) score, while 7.7% demonstrated improvement.
  • Among the deprescribing group, 10.8% experienced a worsening CFS score compared to 12.1% in the stable user group.
  • In the per-protocol analysis, the deprescribing group had a 12% lower likelihood of progressing to a worse CFS category every 12 weeks (odds ratio, 0.88) than the stable users.
  • Among residents with dementia, deprescribing was linked to a 16% reduction in the odds of cognitive decline (odds ratio, 0.84). These trends were consistent in the ITT analysis.

This cohort study suggests that deprescribing is linked to reduced cognitive decline in nursing home residents, especially among those with dementia. The researchers suggest that additional data are necessary to fully understand the benefits and risks of antihypertensive deprescribing, which will help guide patient-centered medication management in nursing homes.

“These findings highlight the importance of patient-centered strategies for deprescribing antihypertensive medications, ensuring that treatment regimens for older adults are optimized to maintain cognitive function while minimizing potential harm,” the researchers concluded.

Reference:

Jing B, Liu X, Graham LA, et al. Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents. JAMA Intern Med. Published online September 23, 2024. doi:10.1001/jamainternmed.2024.4851

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1 in 4 Adults Suspect They Have Undiagnosed ADHD: Survey

A new national survey of 1,000 American adults commissioned by The Ohio State University Wexner Medical Center and College of Medicine finds that 25% of adults now suspect they may have undiagnosed ADHD. But what worries mental health experts is that only 13% of survey respondents have shared their suspicions with their doctor.
That’s raising concerns about the consequences of self-diagnosis leading to incorrect treatment.
“Anxiety, depression and ADHD – all these things can look a lot alike, but the wrong treatment can make things worse instead of helping that person feel better and improving their functioning,” said psychologist Justin Barterian, PhD, clinical assistant professor in Ohio State’s Department of Psychiatry and Behavioral Health.
An estimated 4.4% of people ages 18 to 44 have ADHD, and some people aren’t diagnosed until they’re older, Barterian said.
“There’s definitely more awareness of how it can continue to affect folks into adulthood and a lot of people who are realizing, once their kids have been diagnosed, that they fit these symptoms as well, given that it’s a genetic disorder,” Barterian said.
The survey found that younger adults are more likely to believe they have undiagnosed ADHD than older generations, and they’re also more likely to do something about it.
Barterian said that should include seeing a medical professional, usually their primary care provider, to receive a referral to a mental health expert to be thoroughly evaluated, accurately diagnosed, and effectively treated.
“If you’re watching videos on social media and it makes you think that you may meet criteria for the disorder, I would encourage you to seek an evaluation from a psychologist or a psychiatrist or a physician to get it checked out,” Barterian said.
This study was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from August 16 – August 18, 2024, among a sample of 1,006 respondents. The survey was conducted via web (n=975) and telephone (n=31) and administered in English. The margin of error for total respondents is +/-3.8% points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.

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Bacteria involved in gum disease linked to increased risk of head and neck cancer: JAMA

More than a dozen bacterial species among the hundreds that live in people’s mouths have been linked to a collective 50% increased chance of developing head and neck squamous cell carcinoma (HNSCC), a new study shows. Some of these microbes had previously been shown to contribute to periodontal disease, serious gum infections that can eat away at the jawbone and the soft tissues that surround teeth.

Experts have long observed that those with poor oral health are statistically more vulnerable than those with healthier mouths to HNSCC, a group that includes the most common cancers of the mouth and throat. While small studies have tied some bacteria in these regions (the oral microbiome) to the cancers, the exact bacterial types most involved had until now remained unclear.

Led by researchers at NYU Langone Health and its Perlmutter Cancer Center, the new analyses looked at the genetic makeup of oral microbes collected from healthy men and women. Of the hundreds of different bacteria that are routinely found in the mouth, 13 species were shown to either raise or lower risk of HNSCC. Overall, this group was linked to a 30% greater likelihood of developing the cancers. In combination with five other species that are often seen in gum disease, the overall risk was increased by 50%.

“Our findings offer new insight into the relationship between the oral microbiome and head and neck cancers,” said study lead author Soyoung Kwak, PhD. “These bacteria may serve as biomarkers for experts to flag those at high risk,” added Kwak, a postdoctoral fellow in the Department of Population Health at NYU Grossman School of Medicine.

Previous investigations had uncovered certain bacteria in tumor samples of people already diagnosed with these cancers, says Kwak. Then, in a small 2018 assessment, the current research team explored how microbes in healthy participants may over time contribute to future risk of HNSCC.

Their latest report, publishing online Sept. 26 in the journal JAMA Oncology, is the largest and most detailed analysis of its kind to date, says Kwak. It is also among the first to examine whether common fungi, organisms like yeast and mold that, along with bacteria, make up the oral microbiome, might play a role in HNSCC. The new experiments found no such role for fungal organisms.

For the research, the team analyzed data from three ongoing investigations tracking 159,840 Americans from across the country to better understand how diet, lifestyle, medical history, and many other factors are involved in cancer. The data were gathered for the American Cancer Society Cancer Prevention Study II; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; and the Southern Community Cohort Study.

Shortly after enrolling, participants rinsed with mouthwash, providing saliva samples that preserved the numbers and species of microbes for testing. Researchers then followed up for roughly 10 to 15 years to record any presence of tumors.

In the current study, the investigators analyzed bacterial and fungal DNA from the spit samples. Then, they identified 236 patients who were diagnosed with HNSCC and compared the DNA of their oral microbes with that of 458 randomly selected study subjects who had remained cancer-free. In their research, the team accounted for factors known to play a role, such as age, race, and how often they smoked cigarettes or drank alcohol.

“Our results offer yet another reason to keep up good oral-hygiene habits,” said study co-senior author Richard Hayes, DDS, MPH, PhD. “Brushing your teeth and flossing may not only help prevent periodontal disease, but also may protect against head and neck cancer,” added Hayes, a professor in the Department of Population Health at NYU Grossman School of Medicine and a member of its Perlmutter Cancer Center.

The researchers emphasized that their study was designed to identify correlations between risk of cancer and certain bacteria in the mouth, but not to establish a direct cause-and-effect link. That will require further research.

“Now that we have identified key bacteria that may contribute to this disease, we next plan to explore the mechanisms that allow them to do so and in what ways we can best intervene,” said study co-senior author Jiyoung Ahn, PhD. Ahn is a professor in the Departments of Population Health and Medicine at NYU Grossman School of Medicine and is the associate director for population research at its Perlmutter Cancer Center.

Ahn cautions that while the added risks from bacteria are concerning, overall cases of head and neck cancer remain fairly uncommon.

Reference:

Kwak S, Wang C, Usyk M, et al. Oral Microbiome and Subsequent Risk of Head and Neck Squamous Cell Cancer. JAMA Oncol. Published online September 26, 2024. doi:10.1001/jamaoncol.2024.4006.

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