Study highlights Dental Safety Concerns: Anaphylaxis Linked to PEG-Infused Endodontic Materials in dental Patients

Norway: Recent case reports in the Journal of Endodontics have highlighted the rare but serious risk of anaphylaxis following treatment with endodontic materials containing polyethylene glycol (PEG). Two patients experienced severe allergic reactions after dental procedures involving these materials, raising important concerns within the dental community.

“While rare, clinicians should be aware that PEG in endodontic filling materials can trigger anaphylaxis. It is important to conduct a PEG allergy assessment when anaphylaxis is suspected,” the researchers wrote.

Anaphylaxis is a life-threatening allergic reaction that can occur rapidly, making early recognition and treatment critical. While anaphylactic reactions to PEG are uncommon, they are likely underreported and can lead to severe consequences for patients, especially those who remain undiagnosed. These cases emphasize the need for heightened awareness among dental professionals regarding the potential for PEG to trigger such reactions.

Marie Alnæs, Department of Clinical Medicine, University of Bergen, Bergen, Norway, and colleagues report two cases of anaphylaxis following the use of an endodontic temporary filling material that contains polyethylene glycol.

The first case involved a healthy man in his 30s who developed generalized itching, nausea, and cold sweats after undergoing endodontic treatment. He subsequently lost consciousness, with a blood pressure reading of 70/40 mm Hg when assessed in the ambulance. Fortunately, he recovered after receiving emergency medical care. The second case involved a patient around 50 years old, who also experienced skin itching following treatment. Tragically, this patient lost consciousness and suffered cardiac arrest upon arrival at the hospital, leading to his death.

The authors emphasize that these case reports highlight the need for increased awareness regarding the potential for endodontic materials containing polyethylene glycol (PEG) to cause anaphylaxis. They recommend that PEG allergy assessments be included in evaluations of patients experiencing anaphylaxis related to endodontic treatment. Confirmed PEG allergies can have significant implications for patients, particularly those who remain undiagnosed, as they face the risk of further anaphylactic reactions upon re-exposure.

Given the associated risks, the authors advise against using endodontic filling materials containing PEG, suggesting that alternative materials without PEG should be preferred. In cases where the benefits of using PEG-containing materials outweigh the risks, they recommend a 30-minute observation period post-treatment. Furthermore, they advocate for clear labeling in the instructions, explicitly stating that PEG in endodontic materials can trigger anaphylactic reactions.

“Thorough investigations were required to identify the source of the allergic reactions. Reports of allergies to polyethylene glycol are on the rise and can have serious consequences for patients,” the researchers concluded.

Reference:

Alnæs, M., Storaas, T., Vindenes, H. K., Guttormsen, A. B., Brudevoll, S., & Björkman, L. (2024). Anaphylaxis after treatment with an endodontic material containing polyethylene glycol. Journal of Endodontics. https://doi.org/10.1016/j.joen.2024.09.002

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Droxidopa Effective as Adjunct Therapy for Vasopressor Weaning in ICU Patients, finds study

USA: A recent multicenter, retrospective, single-arm observational study has unveiled promising results for the use of droxidopa in critically ill patients experiencing persistent hypotension.

The study, published in the Journal of Intensive Care Medicine, suggested that droxidopa may be a valuable adjunct therapy for facilitating vasopressor weaning, with comparable effects observed in patients receiving the medication through feeding tubes.

Persistent hypotension is a significant challenge in the management of critically ill patients, often leading to prolonged reliance on vasopressor agents. These medications can have adverse effects and complications, underscoring the need for alternative strategies to facilitate safe withdrawal.

According to the study authors, persistent reliance on vasopressors is a frequent factor contributing to delays in patient discharge from the intensive care unit (ICU). They note that adjunct oral agents can accelerate the timeline for discontinuing vasopressor treatment. Considering this, Andrew J Webb, Department of Pharmacy, Massachusetts General Hospital, Boston, USA, and colleagues sought to examine the application of droxidopa for facilitating vasopressor weaning in critically ill patients experiencing prolonged hypotension.

For this purpose, this retrospective, single-arm observational study focused on adult patients admitted to ICUs at two academic centers between June 2016 and July 2023 who received droxidopa for vasopressor weaning. Patients who had received droxidopa before admission or for other indications were excluded from the analysis.

The primary outcome measured was the time to vasopressor discontinuation, defined as the duration for which vasopressors were stopped and remained off for at least 24 hours. Secondary outcomes included the rates of tachycardia and hypotension following the initiation of droxidopa, norepinephrine equivalents before and after treatment, concomitant use of oral agents, and dosing details. Additionally, a subgroup analysis was performed on patients receiving droxidopa via feeding tubes.

The following were the key findings of the study:

  • A total of 30 patients met the inclusion criteria for the study. The median age was 62 years, with 12 patients being female, and 73% of participants were admitted to a cardiac or cardiac surgical ICU.
  • Before the initiation of droxidopa, patients had been on vasopressors for a median of 16 days.
  • The median time to vasopressor discontinuation was 70 hours, and norepinephrine equivalents showed a significant decrease immediately after droxidopa initiation (0.08 versus 0.02 mcg/kg/min).
  • Mean arterial pressure (MAP) increased following the start of droxidopa (68.8 versus 66.5 mm Hg), while heart rates remained stable (86 versus 84 BPM).
  • Patients who successfully weaned off vasopressors within 72 hours of initiating droxidopa had lower norepinephrine equivalents before treatment than those who took longer than 72 hours (0.05 versus 0.12 mcg/kg/min).
  • The method of administration via feeding tubes did not significantly affect the time to vasopressor discontinuation.

“The findings indicate that droxidopa could serve as an effective adjunct therapy for vasopressor weaning in critically ill patients. Further prospective studies are needed to assess this intervention comprehensively,” the researchers concluded.

Reference:

Webb, A. J., Casal, G. L., Newman, K. A., Culshaw, J. R., Northam, K. A., Solomon, E. J., Beargie, S. M., Johnson, R. B., Lopez, N. D., Hayes, B. D., & Roberts, R. J. (2024). Droxidopa for Vasopressor Weaning in Critically Ill Patients with Persistent Hypotension: A Multicenter, Retrospective, Single-Arm Observational Study. Journal of Intensive Care Medicine. https://doi.org/10.1177/08850666241270089

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Early postoperative exposure of skin to water safe, may not increase risk of infection or other complications: Study

Researchers in a study found that moisture on surgical wounds in the chosen 24-h postoperative period was not associated with an increase in the incidence of infection or other wound complications. It thereby rejects the conventional doctrine, which is the dry and undisturbed principle of the dressings in the time frame 24-72 hours post-surgery, unless there is a heightened possibility of moisture associated with most daily activities. Christen S. and colleagues reported it in the Journal of the American Academy of Dermatology.

Many standard patient instructions after surgical wound care include keeping the initial dressings clean and dry and free of contamination, and maintained for 24 to 72 hours to avoid the development of infection and to promote healing of the wound, which is in sharp contrast to the energetic levels required to meet daily activities like bathing, leisure, and optimum levels of functioning. The randomized controlled trial comparatively assessed standard keeping of wounds dry and covered for the period of 48 hours to early post-operative (6 hours) water exposure.

This was a randomized controlled, investigator-blinded, comparative study to assess infection rates and other outcomes. In total, 437 patients were randomized to early water exposure (6 hours post-operatively, n = 218) and standard care (48 hours post-operatively, n = 219). Primary outcome: Culture-proven infection. Other outcomes that were measured: bleeding rate, bruising rate, and scar assessment according to the Patient and Observer Scar Assessment Scale.

The key findings of the study were:

• The incidence of culture-proven infection was comparable between the early water exposure group, (1.8%), and the standard care group, (1.4%); this difference was not significant with (p > 0.99).

• There were no differences between groups in rates of bleeding or bruising.

• The scar results, recorded with the POSAS, did not reveal any significant differences between both groups, thus showing similar cosmetic results.

The study has revealed that allowing surgical wounds to get wet as early as six hours after surgery does not increase the rate of complications or infections. Hence, this increases flexibility in the post-operative care routine for patients, hence helping them to return back to normal activities earlier than thought.

This study was conducted in a single academic center. Generalizability of the results is therefore limited, and further studies are required in different clinical settings for the confirmation of these findings.

Surgical wounds can be safely exposed to water immediately after the operation without increasing the risk of infections or compromising the final cosmetic outcome. Evidence suggesting that post-operative care recommendations should be revised to allow greater patient convenience and comfort.

Reference:

Samaan, C., Kim, Y., Zhou, S., Kirby, J. S., & Cartee, T. V. (2024). Early post-operative water exposure does not increase complications in cutaneous surgeries: A randomized, investigator-blinded, controlled trial. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.05.098

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Study Links Hormone Dosage in Intrauterine Systems to Increased Depression Risk in First-Time Users

Denmark: A recent study has highlighted a concerning association between the dosage of hormones in levonorgestrel-releasing intrauterine systems (LNG-IUS) and the risk of developing depression among first-time users. The research, published in the American Journal of Psychiatry, reveals that the likelihood of experiencing depression increases with higher dosages of the hormone, suggesting a dose-dependent relationship.

The findings revealed that the first-time use of an LNG-IUS was associated with an increased risk of developing depression in a dose-dependent manner across low, medium, and high-dose options. 

“While the observational nature of the study does not allow for causal conclusions, the identified dose-response relationship adds to the growing body of evidence indicating a link between levonorgestrel exposure and depression risk,” the researchers wrote.

Levonorgestrel, a synthetic progestin commonly used in various contraceptive methods, has been the subject of scrutiny regarding its mental health implications. Søren Vinther Larsen, Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark, and colleagues compared the risk of developing incident depression among first-time users of low-, medium-, and high-dose levonorgestrel-releasing intrauterine systems.

The national cohort study utilized Danish register data on first-time users of LNG-IUSs aged 15 to 44 between 2000 and 2022. To calculate the 1-year average absolute risks, risk differences, and risk ratios for incident depression—defined as either starting an antidepressant or receiving a depression diagnosis—Cox regression and a G-formula estimator were employed.

The analysis was standardized for factors such as calendar year, age, education level, parental history of mental disorders, endometriosis, menorrhagia, polycystic ovary syndrome, dysmenorrhea, leiomyoma, and postpartum initiation.

The study led to the following findings:

  • A total of 149,200 women started using an LNG-IUS, among whom 22,029 started a low-dose one (mean age, 22.9 years), 47,712 a medium-dose one (mean age, 25.2 years), and 79,459 a high-dose one (mean age, 30.2 years).
  • The associated subsequent 1-year adjusted absolute risks of incident depression were 1.21%, 1.46%, and 1.84%, respectively.
  • For the users of high-dose LNG-IUSs, the risk ratios were 1.52 and 1.26 compared with users of the low- and medium-dose LNG-IUSs, respectively.
  • For users of medium-dose LNG-IUSs, the risk ratio was 1.21 compared with users of low-dose LNG-IUSs.

The researchers suggest that clinicians should advise patients that there is a modest yet elevated risk of depression linked to first-time LNG-IUS use. While this association is not causal, it can provide valuable information to help patients make informed choices regarding their contraceptive options.

“These findings should be considered within the context of the limitations inherent to an observational study design, including the potential for residual confounding. When offering personalized contraceptive counseling, it’s important to balance the observed risk differences against potential benefits and other side effects associated with LNG-IUS use,” the researchers concluded.

Reference:

Larsen SV, Mikkelsen AP, Ozenne B, Munk-Olsen T, Lidegaard Ø, Frokjaer VG. Association Between Intrauterine System Hormone Dosage and Depression Risk. Am J Psychiatry. 2024 Sep 1;181(9):834-841. doi: 10.1176/appi.ajp.20230909. Epub 2024 Jul 10. PMID: 38982827.

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Extended Lymphadenectomy fails to Improve Survival in Muscle-Invasive Bladder Cancer Patients: NEJM

A recent study published in the New England Journal of Medicine and found no significant survival benefit of extended lymphadenectomy over standard lymphadenectomy in patients with localized muscle-invasive bladder cancer undergoing radical cystectomy. The randomized trial enrolled a total of 658 patients to compare the outcomes of extended lymphadenectomy, involving the removal of additional lymph nodes with standard lymphadenectomy and to focus on survival and safety outcomes.

The trial included patients with clinical stage T2 to T4a bladder cancer (cancer confined to muscle or invading adjacent organs) and up to 2 positive lymph nodes. They were randomly assigned to either undergo standard lymph node dissection (involving pelvic nodes) or extended lymphadenectomy (removal of common iliac, presciatic, and presacral nodes). The primary focus was disease-free survival, with overall survival and safety being secondary outcomes.

The results of this study showed no significant improvement in disease-free or overall survival for patients who underwent extended lymphadenectomy at a median follow-up of 6.1 years. Also, recurrence or death occurred in 45% of patients in the extended group and 42% in the standard group. The estimated 5-year disease-free survival was 56% in the extended-lymphadenectomy group and 60% in the standard group, yielding a hazard ratio for recurrence or death of 1.10 (95% CI, 0.86–1.40; P=0.45). The overall survival at 5 years was 59% for the extended group and 63% for the standard group, with a hazard ratio for death of 1.13 (95% CI, 0.88–1.45).

In terms of safety, adverse events were more common in the extended-lymphadenectomy group, where 54% of patients experienced grade 3 to 5 complications when compared to 44% in the standard-lymphadenectomy group. Post-operative mortality within 90 days was also higher in the extended group where 7% of patients succumbed to complications than the 2% in the standard group.

The findings suggest that extended lymphadenectomy does not offer a significant survival advantage over the standard approach and comes with increased risks of perioperative complications. Further research may be needed to refine surgical guidelines and identify subgroups of patients who may benefit from extended procedures.

Reference:

Lerner, S. P., Tangen, C., Svatek, R. S., Daneshmand, S., Pohar, K. S., Skinner, E., Schuckman, A., Sagalowsky, A. I., Smith, N. D., Kamat, A. M., Kassouf, W., Plets, M., Bangs, R., Koppie, T. M., Alva, A., La Rosa, F. G., Pal, S. K., Kibel, A. S., Canter, D. J., & Thompson, I. M., Jr. (2024). Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer. In New England Journal of Medicine (Vol. 391, Issue 13, pp. 1206–1216). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2401497

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CHEST releases Guideline on handling endobronchial ultrasound transbronchial needle samples

The American College of Chest Physicians (CHEST) recently released a new clinical guideline on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen processing and handling. Published in the journal CHEST, the guideline contains nine evidence-based recommendations to identify best practices for collection, processing, and handling of EBUS-TBNA specimens.

“Endobronchial ultrasound-guided transbronchial needle aspiration has become the standard for initial lung cancer diagnosis and staging, but there is little guidance available on handling and processing specimens during and after acquisition to help optimize both diagnostic yield and specimen preservation for downstream ancillary testing,” says Christopher Gilbert, DO, MS, FCCP, lead author on the guideline. “In [the panel’s] experience, sample collection varies widely between institutions. This guideline seeks to leverage learned experiences of both pulmonologists and pathologists to standardize the process.”

Evidence of the handling and processing of EBUS-TBNA specimens varies in strength but is satisfactory in some areas to guide clinicians in certain aspects of specimen handling. The guideline authors conclude that additional research in many aspects of specimen handling and processing is needed to help improve the knowledge base.

The recommendations of the guideline include:

  • In patients with suspected malignant disease undergoing EBUS-TBNA, we recommend performing four or more needle passes over three or less needle passes. (Strong Recommendation)
  • In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest utilizing rapid on-site evaluation over usual care. (Conditional Recommendation)
  • In patients with suspected malignant disease undergoing EBUS-TBNA, we suggest using a smaller needle (21 gauge or 22 gauge) over a larger needle (19 gauge). (Conditional Recommendation)

The entire list of recommendations included in the new guideline can be accessed through the CHEST journal website.

Reference:

Gilbert, Christopher R. et al.,Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples – An American College of Chest Physicians Clinical Practice Guideline, CHEST Journal, DOI:10.1016/j.chest.2024.08.056.

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Faster Weight Loss on Anti-Obesity Medication Correlated With Lower Risk of Gout, finds research

Faster Weight Loss on Anti-Obesity Medication Correlated With Lower Risk of Gout suggests a new study published in the Arthritis Rheumatology.

Weight loss is conditionally recommended for gout management; however, its impact on incident gout and recurrent gout flares among overweight and obese individuals remains unknown. We aimed to investigate the relationship between weight loss rate following the initiation of anti-obesity medications and the risk of incident gout and recurrent gout flares among overweight/obese individuals. Using data from The Health Improvement Network, we selected individuals aged 18 and older who were overweight or obese and started anti-obesity medication. We emulated a target trial to examine the association of different weight loss rates, slow (2-5%), moderate (5-10%), or fast (≥10%), within the first year of treatment with incident gout and recurrent gout flares during a 5-year follow-up period. Results: Among 131,000 participants without gout starting orlistat, the 5-year risk of incident gout was 1.6% for those with weight gain/stable, compared with 1.5%, 1.3%, and 1.2% for those with slow, moderate, and fast weight loss, respectively. Compared with the weight gain/stable arm, the hazard ratios were 0.91 (95% confidence interval [CI]: 0.81 to 1.01), 0.82 (95%CI: 0.72 to 0.92), and 0.73 (95%CI: 0.62 to 0.86) for slow, moderate and fast rate of weight loss arms, respectively. Similar results were observed for the recurrent gout flares among 3,847 overweight or obese individuals with gout starting orlistat. A higher rate of weight loss after initiating orlistat within 1-year was associated with lower risks of incident gout and lower rates of recurrent gout flares among overweight or obese people.

Reference:

Wei J, Wang Y, Dalbeth N, et al. Weight loss after initiating anti-obesity medications and gout among overweight and obesity individuals: a population-based cohort study. Arthritis Rheumatol. Published online September 19, 2024. doi.org/10.1002/art.42996

Keywords:

Faster, Weight Loss, Anti-Obesity, Medication, Correlated, Lower Risk, Gout, Wei J, Wang Y, Dalbeth N

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Antibodies in breast milk provide protection against common GI virus, unravels research

A study led by researchers at the University of Rochester Medical Center found that breast milk provides protection against rotavirus, a common gastrointestinal disease that causes diarrhea, vomiting and fever in infants. Babies whose mothers had high levels of specific antibodies in their breast milk were able to fend off the infection for a longer period than infants whose mothers had lower levels. The findings are expected to drive future research to improve infant health through optimized breastfeeding practices.

Published in the Journal of Clinical Investigation and funded by the Bill and Melinda Gates Foundation, the study also found significant differences in antibody profiles in breast milk between mothers in high-income countries (HICs) and low- and middle-income countries (LMICs). Researchers analyzed human milk samples from 695 women in Finland, the U.S., Pakistan, Peru, and Bangladesh, and measured specific IgA and IgG antibodies, which are common antibodies produced in breast milk, against 1,607 proteins from 30 pathogens.

The research,led by Dr. Kirsi Jarvinen-Seppo, MD, PhD, professor in the Division of Allergy and Immunology at UR Medicine Golisano Children’s Hospital (GCH), tracked antibody levels and kinetics over time to analyze antibody responses to a wide range of respiratory, diarrheal and sepsis pathogens in human milk. The study’s primary aim was to understand the protective properties of these antibodies and how they vary across different geographic and economic regions.

“We would expect to find differences in antibody levels in different countries, due to different diseases circulating among areas of the world, but this is one of the first times that there’s been a head-to-head comparison for dozens of pathogens across several continents,” said Jarvinen-Seppo. “It was encouraging to see such a clear link between higher antibody levels and a delay to rotavirus infection, and this was consistently observed among an independent validation cohort.”

Other notable findings from the study:

  • Milk from women in LMICs had higher levels of IgA and IgG antibodies against various intestinal and respiratory pathogens compared to milk from HICs. This difference was particularly notable for pathogens such as Shigella and pneumococcus, which are major contributors to morbidity and mortality in young children.
  • Higher body mass index (BMI) was associated with lower antibody levels, which went against expectations.

“The variation in antibody profiles between regions highlights the impact of economic and environmental factors on maternal immunity,” said Jarvinen-Seppo.

In addition to Rotavirus findings, the discovery that a higher BMI was associated with lower antibody counts in breast milk was also unexpected.

“We had anticipated that underweight mothers might have lower antibody levels due to poorer nutritional status,” said Jarvinen-Seppo. “Due to rising obesity rates worldwide, this could be a significant finding, but this is preliminary and additional research is needed since this is the first time this has been measured.”

“While the data on rotavirus protection is compelling, the geographical and BMI-related variations highlight areas where further research is essential. The study sets the stage for additional investigations that could lead to better understanding and interventions for improving infant health globally,” said Jarvinen-Seppo.

Reference:

Dr. Kirsi Jarvinen-Seppo, Human milk antibodies to global pathogens reveal geographic and interindividual variations in IgA and IgG, Journal of Clinical Investigation, https://doi.org/10.1172/JCI168789.

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Stroke rates increasing in individuals living with SCD despite treatment guidelines, reveals study

The incidence of stroke continues to increase for adults and children living with sickle cell disease (SCD) despite the Stroke Prevention Trial in Sickle Cell Anemia (STOP) establishing standards of care like transfusions and tests to measure blood flow in the brain for those deemed high-risk, according to a study published today in Blood.

Individuals living with SCD, the most common inherited red blood cell disorder in the United States, are especially susceptible to cerebrovascular events (CVEs). This includes ischemic or hemorrhagic strokes, when a blood vessel leading to the brain is either blocked by a blood clot or bursts, and transient ischemic attacks (TIAs), when a blood clot temporarily blocks a blood vessel leading to the brain but does not cause long-term damage.

STOP, a landmark clinical trial published in 1998, demonstrated that chronic red blood cell transfusions effectively decreased the incidence of cerebrovascular events (CVEs) – such as strokes – in high-risk children with SCD identified by abnormal blood flow as measured by a Transcranial Doppler (TCD) testing, a type of brain ultrasound.

In a real-world, population-based study, Dr. Wun and his team found that the risk of stroke increased with age, doubling for every 20 years of age.

“As hematologists, our training emphasizes that the risk of stroke is highest in young children, but I think that has resulted in far less attention being paid to adult patients,” said Ted Wun, MD, associate dean for clinical and translational research at the University of California Davis School of Medicine and study senior author. “There’s very little data on [stroke in adults living with SCD], so we just extrapolate what happens in children to adults, but we don’t know if that’s appropriate or not – if the TCD value cutoffs in children can apply to adults, if TCD works in adult patients and we just don’t do it.”

The researchers used data from California’s Emergency Department Utilization (2005 – 2019) and Patient Discharge Data hospitalization (1991 – 2019) databases to identify 7,636 patients with a diagnosis of SCD. Of these patients, 733 (9.6%) had experienced at least one CVE, defined as an ischemic stroke, hemorrhagic stroke, or TIA, with prevalences of 451 (5.9%), 227 (3%), and 205 (2.7%), respectively. CVEs were more common in women and patients hospitalized three or more times per year.

The cumulative incidence of hemorrhagic stroke increased 13-fold from age 20 to age 60. Additionally, despite a two-year decline in CVEs following the publication of the STOP study, the highest rates of all CVEs occurred across all age groups in the most recent decade, 2010 – 2019.

“Even in children, who probably get the best care for patients with SCD in this country, these trends are opposite what we would hope,” said Dr. Wun. “Based on these results, it appears that STOP guidelines haven’t been effectively implemented.”

Dr. Wun and his team hypothesized that the increase in strokes post-STOP could be due to decreasing adherence to the TCD screening guidelines, improved technology to diagnose ischemic strokes, low rates of blood transfusion therapy, or low usage of hydroxyurea, a drug commonly used to decrease the likelihood of blood cells developing a sickle shape. The researchers also looked at modifiable risk factors for stroke and found that factors increasing risk of ischemic stroke included frequent hospitalization, high blood pressure, high cholesterol, and a prior TIA. However, patients exhibiting risk factors such as acute chest syndrome, liver failure, and prior ischemic stroke were more likely to suffer a hemorrhagic stroke.

These updated data on modifiable risk factors of stroke “emphasize the need to pay attention to screenings for high cholesterol, high blood pressure, and other risk factors in adults,” said Olubusola Oluwole, MD, assistant professor at the University of Pittsburgh and study first author.

“The preventive steps that we know help prevent stroke in the general population are just as important for people living with SCD,” added Dr. Wun, especially as people with SCD live longer and their risk of stroke increases.

The study had several limitations, including a lack of reliable data on tobacco use, which increases the risk of stroke, and SCD genotype. Additionally, the authors did not have access to imaging reports and could not radiographically confirm a stroke diagnosis. Furthermore, the rate of CVEs in patients in California may be underestimated if patients had a stroke outside of the state, died of stroke prior to hospitalization, or if TIA symptoms were managed at home.

The researchers hope this study will stimulate more interventional and prospective studies on stroke and SCD in adults.

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Study compares Pregnancy outcomes of fresh with cryopreserved-thawed embryo transfer

The use of cryopreserved donor oocytes in the United States
has been steadily increasing. One question that remains unanswered about
cryopreserved donor oocytes is whether there is a difference in pregnancy
outcomes among patients who use a fresh embryo transfer (ET) compared with
patients who cryopreserve the resulting embryo, followed later by a frozen ET.
Given the widespread use of frozen donor oocytes, determining whether an
association exists between either fresh or cryopreserved-thawed ET and the
resulting pregnancy outcome is imperative. Therefore, this study by Lauren
Barrison et al evaluated pregnancy outcomes among frozen donor oocyte cycles,
comparing fresh ET with cryopreserved-thawed ET.

This retrospective cohort study examined donor oocyte thaw
cycles using cryopreserved oocytes from Donor Egg Bank USA between 2016 and
2021. The study received institutional review board approval. Donor Egg Bank’s
standardized protocols were followed for donor screening, donor stimulation,
oocyte retrieval, oocyte vitrification, and oocyte shipping. Authors included
donor cycles with oocyte lots that were received by 2 different recipients,
with one undergoing fresh blastocyst transfer and one undergoing
cryopreservedthawed blastocyst transfer. The primary outcome was an ongoing
pregnancy, defined as a viable intrauterine pregnancy at the time of referral
to an obstetrician at approximately 8 weeks of gestation. Secondary outcomes
included additional pregnancy and embryonic development outcomes

A total of 1,210 recipient cycles of cryopreserved donor
oocytes were included (605 underwent fresh ET, 605 underwent
cryopreserved-thawed ET). The distribution for the year of oocyte thawing
between the fresh and frozen ET groups was distributed similarly for both
groups. The 2 groups were identical in regard to donor characteristics given
the sibling oocyte study design (mean age 25.5 years, mean body mass index 23.0
kg/m2 , mean antimullerian hormone level 5.9 ng/mL, mean antral follicle count
28.3). The recipients in the 2 groups were similar in age (mean age: 42.2 vs.
42.0 years). Surgically retrieved sperm was used by 2.8% of the fresh ET group
and 1.3% of the cryopreserved-thawed ET group.

There was no statistically significant difference in the
ongoing pregnancy rate between the fresh vs. cryopreserved-thawed ET groups
(51.2% vs. 49.6%; relative risk 0.97 [95% confidence interval, 0.83–1.14]).
Secondary pregnancy outcomes were also similar between the 2 groups.

Prior studies with mixed findings focused on comparing the
use of fresh vs. cryopreserved donor oocytes in fresh ET cycles or comparing
fresh vs. cryopreserved-thawed ET using fresh donor oocytes. Many patients use
cryopreserved donor oocytes because of their greater availability and access,
shorter time to treatment, and greater ease of cycle synchronization.

This study specifically addressed cryopreserved donor
oocytes and the potential impact of a second ‘‘freeze-thaw’’ on these gametes.

The retrospective study design restricts analysis to data
previously collected; the Donor Egg Bank’s data set did not include additional
recipient demographic information or transfer cycle characteristics, which
limits the ability to account for these potential confounders and the
generalizability of the findings. In conclusion, among patients using frozen
donor oocytes, pregnancy outcomes per donor oocyte thaw cycle were comparable
between recipients undergoing fresh ET compared with recipients using sibling
oocytes undergoing cryopreserved-thawed ET. On the basis of these findings,
patients using cryopreserved donor oocytes should not be deterred from subsequent
embryo cryopreservation.

Source: Lauren Barrison, M.D.a Melissa Stratton, B.A.b Wayne
Caswell, M.S; VOL. 122 NO. 3 /FertilitySterilty

https://doi.org/10.1016/j.fertnstert.2024.04.027

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