In ischaemic stroke, Tenecteplase tied to better recovery and reduced disability than alteplase: Study

For people with ischemic stroke, treatment with the clot-busting drug tenecteplase is associated with a slightly higher likelihood of an excellent recovery and reduced disability three months later than the drug alteplase, according to a meta-analysis published in the October 16, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers found that the likelihood of good recovery was similar between the two treatments.

Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

Alteplase is the only drug approved by the U.S. Food and Drug Administration (FDA) for ischemic stroke. Tenecteplase, a newer clot-busting drug, is approved for treatment of ischemic stroke in Europe but not in the U.S. It is approved in the U.S. for treating clots blocking coronary arteries and is used off-label for ischemic stroke at some stroke centers.

“When a person has an ischemic stroke, they may be treated with either tenecteplase or alteplase,” said study author Georgios Tsivgoulis MD, PhD, MSc, of the National and Kapodistrian University of Athens in Greece and a Fellow of the American Academy of Neurology. “While treatment with either drug increases the chances of a good recovery after stroke, we found people who were given tenecteplase were more likely to have an excellent recovery.”

For the meta-analysis, researchers reviewed 11 studies that compared the safety and efficacy of treatment with tenecteplase or alteplase within four-and-a-half hours after having a stroke. In those studies, 3,788 people were treated with tenecteplase and 3,757 people were treated with alteplase.

Researchers examined participants’ recovery after three months. They used a scale with a score of zero to six where zero represents no symptoms and six represents death. An excellent recovery was defined as a score of zero to one where one represents no significant disability despite some symptoms. A good recovery was defined as a score of zero to two where two represents slight disability when someone is unable to do all previous tasks but can take care of themselves without help. Reduced disability was defined as a drop of one point or more on the scale at three months.

Researchers found people who were given tenecteplase had a 5% higher likelihood of excellent recovery than people who were given alteplase, as well as a 10% higher likelihood of reduced disability three months after stroke. The chances of a good recovery were similar for both groups.

“Our meta-analysis shows that while both drugs have similar safety and increase the chances of good recovery after stroke, tenecteplase is superior to alteplase with a greater chance of excellent recovery and reduced disability,” said Tsivgoulis. “Our findings support using tenecteplase over alteplase when treating people for ischemic stroke.”

A limitation of the meta-analysis was that while it looked at all available randomized-controlled clinical trials on tenecteplase and alteplase, three of the 11 studies were presented at scientific conferences but not yet published in a scientific journal.

Reference:

Lina Palaiodimou,  Aristeidis H. Katsanos, Guillaume Turc, Alexandros-Georgios Asimakopoulos, and Georgios Tsivgoulis,Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours A Systematic Review and Meta-Analysis of Randomized Trials, Neurology, https://doi.org/10.1212/WNL.0000000000209903.

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Age-related hearing loss linked to cognitive decline associated with Alzheimer’s disease, suggests study

A new study published in the journal of Audiology Research found the intricate connections between hearing loss, central auditory processing disorders, and cognitive decline, specially in the context of Alzheimer’s disease. The World Health Organization defines hearing loss as the incapacity to perceive noises louder than 25 decibels. The stria vascularis, the auditory nerve, and the mechano-transducing cochlear inner and outer hair cells are among the auditory components that degenerate in age-related hearing loss (ARHL).

An increasing amount of evidence points to a connection between ARHL and structural alterations in the brain, particularly reduced volumes in areas linked to auditory processing. As a compensating mechanism, ARHL also causes nonauditory brain areas to become more active and people may be more susceptible to dementia as a result of these alterations. Determining the causal direction of this connection is the primary goal of hearing-dementia research. 

To investigate the prevalence of dementia risk factors (RF) and self-reported cognitive complaints (SCC) in a group of audiology patients, Dominique Poelarends and colleagues carried out this comprehensive study.

The International Classification of Functioning Disability and Health was the basis for an online intake form given to 1100 patients (51 percent female, average age 61 years) who were visiting audiology clinics. Memory and concentration (SCC), loneliness, sleep, depression, and vision (dementia RF), and self-reported hearing issues (SHP) were among the domains that were retrieved for analysis. This study looked at prevalence rates and their relationships to SHP and demographic factors.

More over half of the patients with SCC reported having memory or attention issues which indicated how common the condition was. More over 50% of respondents with dementia RF reported feeling upset, anxious, or depressed, and 68% reported having trouble sleeping. The self-reported loneliness, eyesight issues, and memory issues all showed a strong correlation with SHP.

Overall, the significant incidence of SCC and some dementia RF in this descriptive cohort analysis points to a greater risk of cognitive problems in the audiology clinic group. These results of this study highlight the significance of using a comprehensive patient-centered strategy and taking into account the tighter collaboration within treatment pathways such as audiology and neurology.

Reference:

Nagaraj, N. K. (2024). Hearing Loss and Cognitive Decline in the Aging Population: Emerging Perspectives in Audiology. In Audiology Research (Vol. 14, Issue 3, pp. 479–492). MDPI AG. https://doi.org/10.3390/audiolres14030040

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Smoking associated with early dental implant failure, reports research

Smoking is associated with early dental implant failure particularly at the maxillary location, at both implant and individual level suggests a study published in the Journal of Dentistry.

There is uncertainty about the extent to which smoking influences early dental implant failure.

A study was done to assess the association between smoking and early dental implant failure by conducting a systematic review and meta-analysis of observational studies. Thirty-two observational clinical studies published between 1994 and 2024 were included, with a total of 59,246 implants at implant level and 14,115 patients at individual level. At implant level, a meta-analysis of 21 included cohort studies showed that smoking was associated with increased risk of early dental implant failure compared with non-smoking (odds ratio [OR], 2.59; 95% confidence interval [CI], 2.08–3.23). Three included studies reported that smoking was associated with higher maxillary early dental implant failure risk (OR, 5.90; 95%CI, 2.38–14.66) than that of mandible (OR, 3.76; 95%CI, 1.19–11.87). At individual level, meta-analysis of thirty cohort studies indicated that risk of early implant failure in smokers was 100% higher than in non-smokers (OR, 2.00; 95%CI, 1.43–2.80). Three case-control studies found that risk of early implant failure of smokers was 59% higher than that of non-smokers (OR, 1.59; 95%CI, 1.28–1.97). Smoking was significantly associated with early dental implant failure, particularly at the maxillary location, at both implant and individual level. These findings suggest smoking cessation is a crucial factor in reducing risk of early dental implant failure. There is uncertainty about the extent to which smoking influences early dental implant failure, our meta-analysis of findings emphasize smoking was significantly associated with early dental implant failure, particularly at the maxillary location.

Reference:

Ying-Ying Fan, Shu Li, Ye-Jun Cai, Tai Wei, Peng Ye. Smoking in relation to early dental implant failure: A systematic review and meta-analysis, Journal of Dentistry, 2024,

105396,ISSN 0300-5712. https://doi.org/10.1016/j.jdent.2024.105396

(https://www.sciencedirect.com/science/article/pii/S0300571224005669)

Keywords:

Smoking, relation, early, dental, implant, failure, Journal of Dentistry, Ying-Ying Fan, Shu Li, Ye-Jun Cai, Tai Wei, Peng Ye

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Nanoparticle therapy offers new hope for prostate cancer patients, suggests research

Prostate cancer is the second leading cause of cancer death among American men.

A ground-breaking study, conducted by researchers from the University of Virginia, Mount Sinai, the University of Michigan, the University of Texas and others, has demonstrated the clinical success of a new nanoparticle-based, laser-guided therapy for prostate cancer treatment.

The study, which involved 44 men with localized prostate cancer, used gold nanoshellss in combination with magnetic resonance imaging (MRI) and ultrasound fusion-an advanced technique that enhances MRI data-to precisely target and eliminate cancerous prostate tissue.

Gold nanoshells are tiny particles, thousands of times smaller than a human hair, that can be engineered to strongly absorb specific wavelengths of light and generate heat. In this case, gold nanoshells were designed to accumulate in the tumors, allowing for highly targeted near-infrared laser treatment that heats and destroys the cancerous tissue while sparing surrounding healthy cells.

This innovative method, called nanoparticle-directed focal photothermal ablation, successfully eliminated cancerous cells in 73% of patients after 12 months, as confirmed by negative biopsies in the treated areas. Importantly, the treatment was able to achieve these results while preserving key functions, including urinary and sexual health, and without observed side effects, marking a significant improvement in the quality of life for patients.

“Our findings represent a major step forward in prostate cancer treatment. This therapy not only effectively eliminates cancerous cells but also preserves key quality-of-life factors, which is a huge win for patients,” said Jennifer L. West, Ph.D., Dean of the School of Engineering and Applied Science at the University of Virginia, an author on this paper and inventor of this technology.

“This study showcases the strength of interdisciplinary collaboration,” West continued. “Together, we’re pushing the boundaries of what’s possible in cancer treatment, and it’s exciting to be at the forefront of this innovation.”

Reference:

Canfield SE, George AK, Jue JS, Lewis SC, Davenport MS, Tammisetti VS, et al. A Multi-Institutional Study of Magnetic Resonance/Ultrasound Fusion–Guided Nanoparticle-Directed Focal Therapy for Prostate Ablation. Journal of Urology [Internet]. [cited 2024 Oct 16];0(0). Available from: https://doi.org/10.1097/JU.0000000000004222

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What are Key Risk Factors for Postop Infections in Negative Pressure Retrograde Intrarenal Surgery for Kidney Stones?

China: A recent study has delved into the postoperative infection factors associated with retrograde intrarenal surgery (RIRS) combined with negative pressure equipment for treating renal stones.

The findings, published in Scientific Reports, indicated that three variables consistently served as independent risk factors for postoperative infection complications. Notably, the infection rate following a combination of negative pressure equipment and RIRS (NP-RIRS) was lower than TRIRS for kidney stones.

“The length of the stones, the duration of the surgery, and the CT value of the stones were identified as independent risk factors for infections in patients treated with NPRIRS. However, the small sample size limits the credibility and generalizability of these conclusions,” the researchers wrote.

Guoqiang Chen, Department of Urology, The Second Hospital of Longyan, Longyan, Fujian, China, and colleagues aimed to retrospectively analyze patients who received treatment for renal stones using a combination of negative pressure equipment and retrograde intrarenal surgery, identifying new high-risk factors associated with infection.

For this purpose, the researchers examined 456 patients with renal stones measuring 3 cm or less who underwent NP-RIRS in their department between January 2022 and October 2023. The patients were categorized into two groups: the non-infection group (NIRIRS) and the infection group (IRIRS), based on the occurrence of infection complications during the perioperative period.

They established a receiver operating characteristic (ROC) curve using variables that showed statistical differences and employed the Youden index to determine the optimal cutoff value. The data were then classified into two categories based on this cutoff, and binary logistic regression analysis was conducted on the classified data.

The study led to the following findings:

  • In the IRIRS group, there were ten instances of fever and 2 cases of sepsis, with no occurrences of septic shock or fatalities.
  • The length of the stones and their CT values were significantly different, measuring 16 mm versus 22 mm and 764 HU versus 1372 HU, respectively.
  • The surgical times differed significantly between the NIRIRS group and the IRIRS group, recorded at 57 minutes versus 75 minutes.
  • The stone-free rate (SFR) three months post-surgery was 97.60% for NIRIRS compared to 91.70% for IRIRS, indicating no significant difference.
  • The length of stones, surgical duration, and CT values were further analyzed using ROC curves, resulting in areas of 0.791, 0.791, and 0.816, respectively.
  • Based on the Youden index, the optimal cutoff values identified were 17.5 mm for stone size, 64.5 minutes for surgical time, and 732.5 HU for stone CT value. These three continuous variables were then converted into binary data using the best cutoff criteria, and the classified results underwent binary logistic regression analysis.

The authors concluded that infection incidence following NPRIRS was lower than that observed with TRIRS for kidney stones. They identified the length of the stones, surgical time, and CT value of the stones as independent risk factors for postoperative infection in NPRIRS treatment. However, they also noted that the small sample size limited the credibility and generalizability of these findings.

Reference:

Cui, D., Ma, Q., Zhang, Q., Zhang, L., & Chen, G. (2024). Analysis of postoperative infection factors of retrograde intrarenal surgery combined with negative pressure equipment for renal stones. Scientific Reports, 14(1), 1-8. https://doi.org/10.1038/s41598-024-75073-1

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Lonely people more susceptible to dementia and compromised cognition: Study

A recent study published in the journal of Nature Mental Health found that dementia from all causes was more likely to occur in people who are alone. One important risk factor for cognitive health is loneliness. Being lonely is not the same as being alone or isolated. Loneliness can occur when a person is socially connected and engages in social activities. It also possible to be socially isolated and genuinely love it. The Lancet Commission’s assessment of modifiable dementia risk factors includes both loneliness and isolation. Thus, to examine the relationship between loneliness and demetia, Martina Luchetti and colleagues integrated data from ongoing ageing research and the published literature in this study.

This meta-analysis evaluated the associations between loneliness and dementia of all causes in 608,561 participants aggregated over 21 samples, which comprised current aging cohort studies and published literature. 3 publications evaluated the risk for vascular dementia (489,467 people), while 5 articles evaluated the risk for Alzheimer’s disease (492,967 people). To examine cognitive impairment that was not dementia, this study examined 16 samples, comprising both published papers and ongoing investigations. 

The findings of this study found a 31% increased risk of dementia overall was associated with loneliness. According to Luchetti and colleagues, loneliness was linked to vascular dementia and Alzheimer’s disease. It was also associated with non-dementia-related cognitive impairment. Even after adjusting for social isolation, depression, and/or other modifiable dementia risk factors, the relationships remained.

Overall, in the models that took into consideration depression, social isolation, or other modifiable risk factors, the meta-analytic effects for dementia and cognitive impairment were less but still substantial. Specifically, sadness and social isolation show up as potential mediating factors behind the relationships. Depressive symptomatology and loneliness are tightly linked, and this raises the risk of cognitive deterioration. 

This study indicates that, even after accounting for depressive symptoms, loneliness has a relationship of its own with dementia. The outcome of this study observed that while treatments aimed at reducing depressive symptoms and social isolation may lessen loneliness and promote cognitive health, there may be additional processes at play. Other modifiable risk variables for dementia, such as hearing function and air pollution, were not included in the current analysis because they were not accessible in all trials.

Source:

Luchetti, M., Aschwanden, D., Sesker, A. A., Zhu, X., O’Súilleabháin, P. S., Stephan, Y., Terracciano, A., & Sutin, A. R. (2024). A meta-analysis of loneliness and risk of dementia using longitudinal data from >600,000 individuals. In Nature Mental Health. Springer Science and Business Media LLC. https://doi.org/10.1038/s44220-024-00328-9

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A potential non-invasive stool test and novel therapy for endometriosis

Promising findings by researchers at Baylor College of Medicine and collaborating institutions could lead to the development of a non-invasive stool test and a new therapy for endometriosis, a painful condition that affects nearly 200 million women worldwide. The study appeared in the journal Med.

“Endometriosis develops when lining inside the womb grows outside its normal location, for instance attached to surrounding intestine or the membrane lining the abdominal cavity. This typically causes bleeding, pain, inflammation and infertility,” said corresponding author Dr. Rama Kommagani, associate professor in the Department of Pathology and Immunology at Baylor. “Generally, it takes approximately seven years to detect endometriosis and is often diagnosed incorrectly as a bowel condition. Thus, delayed diagnosis, together with the current use of invasive diagnostic procedures and ineffective treatments underscore the need for improvements in the management of endometriosis.”

“Our previous studies in mice have shown that the microbiome, the communities of bacteria living in the body, or their metabolites, the products they produce, can contribute to endometriosis progression,” Kommagani said. “In the current study, we took a closer look at the role of the microbiome in endometriosis by comparing the bacteria and metabolites present in stools of women with the condition with those of healthy women. We discovered significant differences between them.”

The findings suggested that stool metabolites found in women with endometriosis could be the basis for a non-invasive diagnostic test as well as a potential strategy to reduce disease progression.

The researchers discovered a combination of bacterial metabolites that is unique to endometriosis. Among them is the metabolite called 4-hydroxyindole. “This compound is produced by ‘good bacteria,’ but there is less of it in women with endometriosis than in women without the condition,” said first author Dr. Chandni Talwar, postdoctoral associate in Kommagani’s lab.

“These findings are very exciting,” Talwar said. “There are studies in animal models of the disease that have shown specific bacterial metabolite signatures associated with endometriosis. Our study is the first to discover a unique metabolite profile linked to human endometriosis, which brings us closer to better understanding the human condition and potentially identifying better ways to manage it.”

Furthermore, extensive studies also showed that administering 4-hydroxyindole to animal models of the disease prevented the initiation and progression of endometriosis-associated inflammation and pain.

“Interestingly, our findings also may have implications for another condition. The metabolite profile we identified in endometriosis is similar to that observed in inflammatory bowel disease (IBD), revealing intriguing connections between these two conditions,” Kommagani said. “Our findings support a role for the microbiome in endometriosis and IBD.”

The researchers are continuing their work toward the development of a non-invasive stool test for endometriosis. They are also conducting the necessary studies to evaluate the safety and efficacy of 4-hydroxyindole as a potential treatment for this condition.

Reference:

Talwar, Chandni et al., Identification of distinct stool metabolites in women with endometriosis for non-invasive diagnosis and potential for microbiota-based therapies, Med, DOI:10.1016/j.medj.2024.09.006

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Women with ankylosing spondylitis more prone to Increased risk of obstetric complications, reports study

A new study published in the journal of BMC Pregnancy and Childbirth showed that women with ankylosing spondylitis (AS) are more likely to experience obstetric difficulties such as caesarean delivery (CD), small-for-gestational-age (SGA) and intrauterine fetal death (IUFD).

The sacroiliac joints and spine are the main organs affected by the inflammatory, chronic, systemic illness known as ankylosing spondylitis. It is among the most prevalent seronegative spondyloarthropathies, with a significant hereditary component. Many autoimmune illnesses exhibit a modification of their disease activity during pregnancy. Contrary to rheumatoid arthritis, the majority of AS patients are in an active state of illness when they get pregnant, and pregnancy has no discernible positive impact on the disease activity of AS. Also, most AS patients experience a postpartum exacerbation of disease activity between six weeks and six months following birth.

Limited research with small sample numbers has examined how AS affects fetal and neonatal outcomes. Despite this condition being not rare among women of reproductive age, research on pregnancy outcomes has yielded mixed results. Thereby, Uri Amikam and his team conducted this study to assess pregnancy and perinatal outcomes in women with and without AS.

This retrospective cohort research utilized the Nationwide Inpatient Sample (HCUP-NIS) of the Healthcare Cost and Utilisation Project. All expectant mothers who gave birth or had a maternal death in the United States between 2004 and 2014 were included in the study. Before or during pregnancy, women having an ICD-9 diagnosis of AS were compared to the individuals who did not. Using multivariate logistic regression models that controlled for relevant confounders, delivery, pregnancy, and neonatal results were compared between the two groups.

A total of 9,096,788 women in all were included in the analysis. Of these, 383 women (3.8/100,000) were diagnosed with AS, while the remaining women served as controls. The women with AS were more likely to be older, Caucasian, originate from higher income quartiles, have thyroid issues, and become pregnant more than once when compared to women without AS.

When compared to the women without AS, the patients in the AS group showed greater rates of placenta previa, gestational diabetes, and caesarean delivery (CD) after controlling for variables. In terms of newborn outcomes, there was a greater incidence of small-for-gestational-age neonates and intrauterine fetal death in individuals with AS as opposed to those without. Overall, in addition to a higher risk of SGA and IUFD, women with AS are more likely to experience obstetric problems, such as CD.

Source:

Amikam, U., Badeghiesh, A., Baghlaf, H., Brown, R., & Dahan, M. H. (2024). Obstetric and neonatal outcomes in women with Ankylosing spondylitis – an evaluation of a population database. In BMC Pregnancy and Childbirth (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12884-024-06833-0

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Breakdancers may risk ‘headspin hole’ caused by repetitive headspins, doctors warn

Breakdancers may be at risk of developing a condition caused by repeatedly doing a cardinal move of their practice and performance-the headspin-warn doctors in the journal BMJ Case Reports.

Dubbed the ‘headspin hole,’ or ‘breakdance bulge,’ the condition is unique to breakdancers, and appears as a protruding lump on the scalp, often accompanied by hair loss and tenderness.

Breakdancers are particularly prone to injuries because of the complexities and physical demands of the moves, note the authors. Sprains, strains, and tendinitis are particularly common. Head and brain injuries, including subdural haematomas (pooling of blood between the skull and the brain), have also been reported.

Prolonged breakdancing often leads to ‘breakdancer overuse syndrome’ which includes various conditions, such as carpal tunnel syndrome and swollen and inflamed tendons (tenosynovitis) as well as hair loss and scalp irritation, add the authors.

They treated a man in his early 30s with a growth on his scalp. The man said that he had performed various types of headspin manoeuvres for more than19 years.

He practised his moves 5 times a week for around 1.5 hours a time. During these sessions direct pressure was applied to the top of his head for between 2 and 7 minutes.

Despite hair loss and a burgeoning lump on his head, he continued to practise headspins, but was prompted to act when the lump started to grow a lot larger and his scalp began to feel tender.

A head scan revealed thickening of the skin, tissue, and skull around the lump, but no obvious signs of cancer, which was confirmed on biopsy.

The lump was removed, but the surrounding skin tissue remained thickened. Nevertheless, the man was happy with the result and felt able to go out in public once again without having to wear a cap.

This report represents just one case, and details of only one other have been published to date, so the findings should be interpreted in this context.

But the authors conclude: “This case underscores the importance of recognising chronic scalp conditions in breakdancers and suggests that surgical intervention can be an effective treatment.” 

Reference:

https://casereports.bmj.com/lookup/doi/10.1136/bcr-2024-261854

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Dexmedetomidine as adjunct may help manage One-Lung Ventilation in high-risk pediatric thoracic surgery, finds study

Recent paper investigates the effects of dexmedetomidine on oxygenation and pulmonary shunt fraction in high-risk pediatric patients undergoing one-lung ventilation (OLV) for thoracic surgery. The study highlights the unique considerations of pediatric thoracic surgery due to the immaturity of the respiratory system and the common technique of OLV. The randomized controlled trial involved 63 children undergoing thoracic surgery with OLV, divided into two groups – one receiving dexmedetomidine and the other receiving a placebo. The study measured parameters such as partial pressure of arterial oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean arterial pressure (MAP), heart rate (HR), and peak inspiratory pressure (PIP) at various time points during the surgery.

Main Findings

The findings indicate that dexmedetomidine significantly improved PaO2 and decreased Qs/Qt compared to the placebo group during OLV. Additionally, dexmedetomidine was shown to decrease PIP during OLV and maintain hemodynamic stability, including MAP and HR. The study demonstrated that dexmedetomidine infusion during OLV in high-risk pediatric thoracic surgery reduces shunt and pulmonary shunt fraction Qs/Qt, improves PaO 2 and body oxygenation, reduces PIP, and maintains hemodynamic stability. These findings reinforce the potential of dexmedetomidine as a beneficial adjunct in managing OLV in pediatric thoracic surgery.

Study Methodology

The paper provides detailed insights into the unique anatomical and physiological characteristics of the pediatric cardiovascular and respiratory systems, as well as the challenges associated with OLV in pediatric patients. The study discusses the methodology, including the rigorous design of a double-blind, randomized controlled trial with a parallel-group design, as well as the inclusion and exclusion criteria, and the administration protocol for the intervention group.

Conclusion and Limitations

The conclusion emphasizes the potential value of dexmedetomidine as an adjunct for managing OLV in high-risk pediatric thoracic surgery, particularly in improving oxygenation and reducing pulmonary shunt fraction. The paper also acknowledges the limitations of the study, such as the relatively small sample size and the need for further research into alternative dosing regimens and larger patient populations to validate the findings. Overall, the paper provides comprehensive and detailed insights into the effects of dexmedetomidine in pediatric thoracic surgery, highlighting its potential benefits in improving patient outcomes during OLV.

Key Points

– The study investigated the effects of dexmedetomidine on oxygenation and pulmonary shunt fraction in high-risk pediatric patients undergoing one-lung ventilation (OLV) for thoracic surgery, considering the unique considerations of pediatric thoracic surgery due to the immaturity of the respiratory system and the common technique of OLV.

– The randomized controlled trial involved 63 children undergoing thoracic surgery with OLV, divided into two groups – one receiving dexmedetomidine and the other receiving a placebo. Parameters such as partial pressure of arterial oxygen (PaO2), pulmonary shunt fraction (Qs/Qt), mean arterial pressure (MAP), heart rate (HR), and peak inspiratory pressure (PIP) were measured at various time points during the surgery.

– The findings indicated that dexmedetomidine significantly improved PaO2 and decreased Qs/Qt compared to the placebo group during OLV. Additionally, dexmedetomidine was shown to decrease PIP during OLV and maintain hemodynamic stability, including MAP and HR. – The study demonstrated that dexmedetomidine infusion during OLV in high-risk pediatric thoracic surgery reduces shunt and pulmonary shunt fraction Qs/Qt, improves PaO2 and body oxygenation, reduces PIP, and maintains hemodynamic stability.

– The paper provided detailed insights into the unique anatomical and physiological characteristics of the pediatric cardiovascular and respiratory systems, as well as the challenges associated with OLV in pediatric patients. The methodology involved a double-blind, randomized controlled trial with a parallel-group design, as well as the inclusion and exclusion criteria and the intervention group’s administration protocol.

– The conclusion highlighted the potential value of dexmedetomidine as an adjunct for managing OLV in high-risk pediatric thoracic surgery, particularly in improving oxygenation and reducing pulmonary shunt fraction, while acknowledging the study’s limitations, such as the relatively small sample size and the need for further research into alternative dosing regimens and larger patient populations to validate the findings.

Reference –

Khddam A, Rostom F, Hajeer M (September 18, 2024) Effects of Dexmedetomidine in Improving Oxygenation and Reducing Pulmonary Shunt in High-Risk Pediatric Patients Undergoing One-Lung Ventilation for Thoracic Surgery: A Double-Blind Randomized Controlled Trial. Cureus 16(9):e69659. DOI 10.7759/cureus.69659

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