Among Older ACS Patients early invasive therapy fails to reduce mortality vs conservative treatment: JAMA

A new meta-analysis published in the Journal of American Medical Association found an early invasive strategy did not reduce all-cause mortality compared to conservative treatment in acute coronary syndrome (ACS). However, it did lower the risk of recurrent myocardial infarction (MI) and need for repeated coronary revascularization, though it also increased the risk of major bleeding. These competing outcomes highlight the need for shared decision-making when choosing treatment strategies in older ACS patients.

This systematic review drew from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through October 2024. It included only randomized controlled trials comparing early invasive versus conservative strategies in patients aged 70 or older presenting with ACS. The trials involved both ST-elevation and non-ST-elevation ACS were considered. The mean age of participants was 82.6 years, and nearly half were women.

The analysis revealed no statistically significant difference in all-cause mortality between the two approaches (relative risk [RR], 1.05; 95% CI, 0.98–1.11), a finding consistent across various subgroups and with zero heterogeneity across studies (I² = 0%). This suggests that an invasive strategy does not improve survival in elderly patients with ACS.

The patients receiving early invasive treatment had a 22% lower risk of experiencing another myocardial infarction (RR, 0.78; 95% CI, 0.67–0.91). Also, the risk of needing repeated coronary revascularization was cut by more than half (RR, 0.43; 95% CI, 0.30–0.60). These results suggest that invasive strategies can provide meaningful reductions in recurrent cardiac events.

This invasive strategy was associated with a 60% increased risk of major bleeding (RR, 1.60; 95% CI, 1.01–2.53). Though bleeding events varied by trial, this finding reinforces concerns about the vulnerability of older patients to procedure-related complications. Other secondary endpoints, including stroke, cardiovascular death, heart failure hospitalization, and major adverse cardiovascular or cerebrovascular events, showed no significant differences between the two strategies.

The outcomes in patients with non–ST-elevation ACS mirrored the overall results, which suggested the findings are broadly applicable across ACS subtypes in the elderly. While early invasive therapy for older ACS patients can reduce heart attacks and the need for repeat procedures, these advantages must be carefully weighed against a significantly higher bleeding risk and no apparent survival benefit. Overall, the findings highlight the importance of individualized, shared decision-making between clinicians and elderly patients, factoring in comorbidities, frailty, and patient preferences.

Reference:

Reddy, R. K., Koeckerling, D., Eichhorn, C., Jamil, Y., Ardissino, M., Braun, V., Abu Sharar, H., Frey, N., Howard, J. P., & Ahmad, Y. (2025). Early invasive or conservative strategies for older patients with acute coronary syndromes: A meta-analysis. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.2058

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FDA Approves At-Home Belimumab Injection for Children with Lupus Nephritis

The FDA has approved a 200 mg/mL autoinjector of belimumab (Benlysta) for at-home subcutaneous use in children aged 5 years and older with active lupus nephritis receiving standard therapy-marking the first treatment of its kind for pediatric patients.

Lupus nephritis is one of the most serious complications of lupus and occurs when the immune system mistakenly attacks the kidneys, leading to inflammation and possibly to organ damage. About 30-50% of children with lupus develop LN, typically within one to two years after their initial lupus diagnosis.1,2

Louise Vetter, President and Chief Executive Officer, Lupus Foundation of America said: “In children, lupus tends to be more aggressive and severe than it is in adults. The symptoms can be more intense, and the disease can have long-term effects on a child’s growth and quality of life.1,2 Having the Benlysta autoinjector provides a much-needed option that can help reduce the burden of frequent clinic visits for treatment and add greater flexibility for children and their families when considering continuity of care and routines of daily life.”

Court Horncastle, Senior Vice President, and Head of US Specialty, GSK said: “For children and parents of children with lupus nephritis, this approval represents a choice in their care. Providing this at-home treatment option with the efficacy and safety of Benlysta is a testament to our ongoing commitment to the lupus community. GSK is driven by the belief that our therapeutic solutions should always prioritize improving patients’ well-being and easing their treatment journey, including for younger patients.”

Caregivers of children who are currently using intravenous infusions of belimumab to manage their LN can work with their child’s healthcare provider to decide if at-home administration via autoinjector is appropriate. If so, the healthcare provider will administer treatment or the healthcare provider will provide instructions to the patients’ caregiver that will allow them to administer the medicine at home via an autoinjector. The 200 mg/mL autoinjector of belimumab will be available for pediatric patients and their caregivers immediately.

About systemic lupus erythematosus (SLE) and lupus nephritis (LN)

Systemic lupus erythematosus (SLE), the most common form of lupus, is a chronic, incurable, autoimmune disease associated with a range of symptoms that can fluctuate over time including painful or swollen joints, extreme fatigue, unexplained fever, skin rashes and organ damage. LN is a complication of SLE and occurs when the immune system mistakenly attacks the kidneys and leads to inflammation and potential organ damage. This inflammation can harm the kidney’s ability to remove waste from the blood.1

LN can lead to end-stage kidney disease, which requires kidney dialysis or a transplant. Despite improvements in both diagnosis and treatment over the last few decades, LN remains an indicator of poor prognosis for people living with lupus.3,4 Manifestations of LN include proteinuria, elevations in serum creatinine and the presence of red and white blood cells in the urine.

About Benlysta

Benlysta (belimumab) is a B-lymphocyte stimulator (BLyS) specific inhibitor that binds to soluble BLyS. By binding BLyS, Benlysta inhibits the survival of B cells, including autoreactive B cells, and reduces the differentiation of B cells into immunoglobulin-producing plasma cells. Benlysta does not bind B cells directly. The US FDA first approved Benlysta for the treatment of active SLE; it is the first and only approved biologic for both SLE and LN in more than 50 years, including for the pediatric population.

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New Ultrasound-Driven Model Boosts Accuracy in Diagnosing Endometrial Malignancy: Study Shows

China: A new study published on April 21 in the Journal of Radiation Research and Applied Sciences has shown that combining clinical parameters with ultrasound imaging significantly improves the detection of endometrial malignancy in postmenopausal women.

The research, led by Dr. Xiu Yun Dong and her team at the Jinan Maternal and Child Health Hospital Affiliated with Shandong First Medical University, emphasizes a more personalized approach to evaluating endometrial thickening. The study aims to evaluate the diagnostic effectiveness of transvaginal ultrasound (TVUS) and to develop a multivariable risk stratification model for identifying endometrial malignancy and precursor lesions in postmenopausal women presenting with asymptomatic endometrial thickening.

For this purpose, the researchers analyzed retrospective data from 587 postmenopausal women who had asymptomatic endometrial thickening detected during routine transvaginal ultrasound examinations. Participants were categorized based on histopathological results—221 women were found to have malignant or precursor lesions, while 366 had benign outcomes.

By developing a multivariable risk stratification model, the researchers aimed to better distinguish which women were more likely to have underlying malignancies. The model incorporated ultrasound findings—such as endometrial thickness, border irregularities, and heterogeneous texture—alongside clinical data like age, BMI, and diabetes status.

The key findings of the study were as follows:

  • Women with malignant or pre-malignant findings had a significantly thicker endometrium (average 14.2 mm) than those with benign lesions (10.1 mm).
  • Ultrasound abnormalities were more commonly observed among women in the positive group.
  • Independent predictors of malignancy included increased endometrial thickness (OR 2.94), abnormal ultrasound features (OR 4.12), presence of diabetes (OR 1.98), and obesity with a BMI ≥ 30 kg/m² (OR 1.82).
  • The predictive model showed strong diagnostic performance, achieving an area under the curve (AUC) of 0.81, reflecting good accuracy in identifying high-risk cases.

According to the researchers, incorporating clinical and imaging data enables a more holistic understanding of a patient’s risk profile. “This model provides a practical method for identifying high-risk postmenopausal women,” the authors noted, highlighting the potential to reduce unnecessary invasive tests while ensuring timely intervention for those who need it.

They also stressed the importance of future research to validate this model across broader populations and explore new imaging techniques that may further refine diagnostic capabilities.

By aligning with personalized medicine principles, the study marks a step forward in enhancing care pathways for postmenopausal women with endometrial abnormalities.

Reference:

Qiu, S., Wu, S., Song, Y., Wang, B., & Dong, X. Y. (2025). Endometrial thickness and its diagnostic utility in postmenopausal women: A retrospective analysis of ultrasound and histopathological findings. Journal of Radiation Research and Applied Sciences, 18(2), 101509. https://doi.org/10.1016/j.jrras.2025.101509

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Iron Deficiency Linked to Altered Brain Development in Adolescents, Even in Anemia Absence: JAMA

USA: Researchers have found in a new study that even in the absence of anemia, iron deficiency (ID) during adolescence is associated with changes in brain development. Early screening for ID in at-risk adolescents may help improve neuropsychiatric outcomes.

The study, conducted by Dr. Dimitri Fiani and colleagues from Baylor College of Medicine in Houston, Texas, and published in JAMA Network Open, explored how iron deficiency (ID) without anemia affects brain iron levels and related cognitive and psychiatric outcomes in adolescents.

Although iron is crucial for processes such as neurogenesis, myelination, and neurotransmitter production, ID is typically diagnosed using blood-based measures of anemia. This research focused instead on how ID—without the presence of anemia—might influence brain iron content, particularly in the basal ganglia, a region critical to motor control and cognitive function.

In this cross-sectional analysis, 209 otherwise healthy, unmedicated adolescents aged 10 to 17 years were enrolled between December 2020 and April 2024 through a network of pediatric clinics. The group included both adolescents with depressive or anxiety disorders and those without psychopathology. Participants with anemia or acute inflammation were excluded, and ID without anemia was defined by serum ferritin levels below 15 ng/mL, in line with WHO guidelines.

Participants underwent brain MRI scans to measure basal ganglia susceptibility—a marker of iron content—as well as clinical assessments of psychiatric symptoms and neuropsychological performance.

The study revealed the following findings:

  • 30% of the adolescent participants had iron deficiency (ID) without anemia.
  • These adolescents showed significantly lower iron content in the caudate and putamen regions of the brain.
  • The reduction in brain iron content was more pronounced in females.
  • The differences in brain iron levels appeared to increase with age, indicating a possible dose-dependent effect.
  • In females, the interaction between age and ID status led to progressively larger differences in brain iron content over time.
  • Lower basal ganglia iron content was associated with structural brain changes.
  • Reduced iron levels were also linked to more severe psychiatric symptoms.
  • Poorer cognitive performance was observed in adolescents with lower brain iron content, with stronger associations in females.

The authors note that this is one of the first studies to demonstrate that iron deficiency, even in the absence of anemia, can influence brain development during adolescence, a critical period for neurodevelopment.

However, the study’s cross-sectional design means the researchers could not determine when ID without anemia first developed in these individuals. They also call for future longitudinal studies to clarify how early-life ID might have lasting effects, to include more male participants, and to explore additional biomarkers beyond ferritin for better detection.

Given that certain racial and ethnic groups are more prone to ID, these findings highlight an urgent need to update clinical screening guidelines and proactively identify adolescents at risk, potentially preventing long-term neuropsychiatric consequences.

Reference:

Fiani D, Kim J, Hu M, et al. Iron Deficiency Without Anemia and Reduced Basal Ganglia Iron Content in Youths. JAMA Netw Open. 2025;8(6):e2516687. doi:10.1001/jamanetworkopen.2025.16687

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Maternal Smoking during pregnancy and Secondhand Smoke Exposure tied to Increased Stroke Risk: Study

Researchers have discovered in a new study that both maternal smoking and secondhand smoke (SHS) exposure were independently and jointly associated with a higher risk of stroke. Therefore there was an urgent need for stronger tobacco control policies to reduce these harmful exposures and their public health consequences.

A study was done to evaluate the independent and combined associations of secondhand smoke (SHS) exposure and maternal smoking during pregnancy with the risk of total stroke and its subtypes, including ischemic and hemorrhagic stroke, among nonsmokers. A study was done to investigate the independent and combined associations of SHS exposure and maternal smoking during pregnancy with stroke risk in nonsmokers. A prospective analysis was conducted using 336,640 nonsmoking participants from a nationwide cohort, free from pre-existing cardiovascular disease. SHS exposure was categorized based on hours per week (0, >0–4, >4), and maternal smoking was assessed via participant recall. Outcomes included total stroke, ischemic stroke, and hemorrhagic stroke, identified through hospital records. Cox regression models adjusted for demographic, behavioral, and clinical covariates were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Results: Over a median follow-up of 11.8 years, 5,051 participants experienced strokes. SHS exposure >4 hours/week was associated with increased incident stroke risk (HR 1.34, 95 % CI 1.18–1.52) compared to no exposure. Maternal smoking was associated with a 7 % increase in total stroke risk (HR 1.07, 95 % CI 1.02–1.14). Combined exposure to SHS >4 hours/week and maternal smoking conferred the highest stroke risk (HR 1.57, 95 % CI 1.29–1.90). Subgroup and sensitivity analyses confirmed these findings. SHS exposure and maternal smoking was independently and jointly associated with higher stroke risk, underscoring the need for robust tobacco control policies to mitigate these exposures and their public health impact.

Reference:

Association between secondhand smoke exposure, maternal smoking during pregnancy, and stroke incidence in nonsmokers. Huang, Yi-Ping et al. Journal of Stroke and Cerebrovascular Diseases, Volume 34, Issue 8, 108379

Keywords:

Maternal, Smoking, during, pregnancy, Secondhand, Smoke, Exposure, tied, Increased Stroke Risk, Study , Secondhand smoke, Maternal smoking, Stroke, Ischemic stroke, Hemorrhagic stroke, Uk Biobank, ournal of Stroke and Cerebrovascular Diseases

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New clinical practice guideline for surgical management of chronic rhinosinusitis in adults

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published the new Clinical Practice Guideline (CPG): Surgical Management of Chronic Rhinosinusitis today in Otolaryngology-Head and Neck Surgery.

Chronic rhinosinusitis (CRS) affects 11.6% of adults and prompts 4.1 million annual ambulatory visits.

“Chronic rhinosinusitis doesn’t just affect the nose—it can influence a person’s general life. Patients can struggle with poor sleep, brain fog, depression, anxiety, and reduced productivity that ripples through their relationships and work or school performance,” said Jennifer J. Shin, MD, SM, Chair of the CPG Guideline Development Group.

“Many people don’t realize that chronic rhinosinusitis can affect patients as much as diseases that have traditionally been viewed as life-threatening or more serious. Patients with CRS face daily challenges that deserve our full attention and comprehensive care. This CPG provides the guidance for developing the needed care pathways for patients who may undergo surgery for CRS, based on current best evidence, such as systematic reviews, meta-analyses, and randomized control trials, as well as observational studies when these were more apt for specific clinical research questions.”

CRS is diagnosed when a patient has two or more symptoms or signs of CRS for 12 weeks or longer, and inflammation is documented by one or more findings. The symptoms and signs include:

Thick and/or discolored drainage (from the front of the nose, down the back of the nose, or both),

Nasal obstruction (congestion),

Facial pain, pressure, and fullness, or

Decreased sense of smell

Some people with chronic sinus problems need surgery when medications alone don’t provide enough relief. For certain types of sinus disease, having surgery sooner can help prevent worsening symptoms and reduce pain. Surgery works especially well for people who have fungal infections or nasal polyps (small growths), since these conditions often don’t respond well to medication alone. Surgery may also help people whose sinus problems cause frequent infections, ongoing symptoms, or make other conditions like asthma worse.

This CPG provides proven, research-based recommendations for the best ways to treat chronic sinus problems. Specifically, through 11 evidence-based key action statements, it covers the main surgery and additional treatments that might be needed, as well as follow-up procedures when necessary. The goal is to ensure patients receive excellent care before, during, and after their sinus surgery, while making sure doctors clearly explain treatment options and involve patients in making informed decisions about their care.

The guideline development group consisted of 18 panel members representing experts in specialties/subspecialities encompassing rhinology, comprehensive otolaryngology, otolaryngic allergy, otorhinolaryngological advanced practice provision, as well as a consumer representative.

Members of the media who wish to request an interview or obtain a copy of the guideline should contact newsroom@entnet.org.

References: Betty S. Tsai Do MD, Matthew L. Bush MD, PhD, MBA, Heather M. Weinreich MD, MPH, Seth R. Schwartz MD, MPH, Samantha Anne MD, MS, Oliver F. Adunka MD, MBA, Kaye Bender PhD, RN, Kristen M. Bold MPAS, PA-C, Michael J. Brenner MD, Ardeshir Z. Hashmi MD, Teresa A. Keenan PhD, Ana H. Kim MD, Denée J. Moore MD, Carrie L. Nieman MD, MPH, Catherine V. Palmer PhD, Erin J. Ross DNP, APRN, Kristen K. Steenerson MD, Kevin Y. Zhan MD, Joe Reyes MS, Nui Dhepyasuwan MEd First published: 30 April 2024 https://doi.org/10.1002/ohn.750

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Weekly Oral Risperidone Found Effective and Safe for Schizophrenia in Phase III Trial

Researchers have found in a Phase III Trial that patients with schizophrenia who were treated with the investigational long-acting oral weekly risperidone formulation (LYN 005) remained clinically stable without any unexpected safety issues. The findings of the trial have been published in Lancet Psychiatry. The new drug formulation may assist in solving one of schizophrenia treatment’s greatest challenges: adherence to medication. This phase 3 trial reinforced that once-weekly LYN-005 offers extended drug release and achieves pre-specified pharmacokinetic equivalence requirements, with potential as a long-acting oral drug for those with difficulty maintaining daily dosing regimens. The study was conducted by Citrome and colleagues.

Schizophrenia medication non-adherence is an epidemic problem that results in a common relapse, hospitalization, and deterioration of disease course. While long-acting injectable antipsychotics have improved adherence in some patients, a non-invasive, oral, long-acting formulation might prove more acceptable and feasible. LYN-005, a long-acting oral formulation of risperidone for weekly dosing, was developed to fill this gap. The purpose of this study was to determine if LYN-005 was able to produce stable therapeutic levels equivalent to once-daily risperidone without raising new safety issues.

This non-randomized, open-label, phase 3 trial recruited 83 clinically stable subjects with schizophrenia or schizoaffective disorder at five inpatient sites in the USA between April 13 and December 1, 2023. Participants (mean age: 49.3 years, SD 11.5) were 75% male (n=62) and 81% Black or African American (n=67). After 7 days of run-in with daily immediate-release risperidone (2 mg or 6 mg), the participants were administered five weekly doses of LYN-005 (15 mg or 45 mg, respectively) and a half-dose supplement of daily risperidone for the first week in order to taper off the transition.

The trial assessed principal pharmacokinetic parameters—minimum concentration (Cmin), peak concentration (Cmax), and mean concentration (Cavg)—at weeks 1 and 5. Predefined acceptance criteria were on geometric mean ratios of LYN-005 versus immediate-release risperidone.

Findings

  • 47 subjects completed the study, and 44 subjects were included in the analysis for pharmacokinetics.

  • At week 1, Cmin for LYN-005 was 1.02 (90% CI: 0.93–1.12) versus immediate-release risperidone.

At week 5, the ratios were:

  • Cmin: 1.04 (90% CI: 0.87–1.23)

  • Cmax: 0.84 (90% CI: 0.77–0.92)

  • Cavg: 1.03 (90% CI: 0.93–1.13)

All results were within or near the pre-established ranges of acceptance, confirming pharmacokinetic equivalence.

  • Gastrointestinal treatment-emergent adverse events occurred in 66% (n=44) of 67 patients treated with LYN-005, and these were predominantly mild.

  • A single serious adverse event was reported, with no safety signals outside expectations.

  • Patients were clinically stable during the study, reaffirming the efficacy of the formulation.

This phase 3 trial concludes that oral LYN-005 weekly administers steady therapeutic risperidone levels with equal bioavailability compared to daily risperidone. The preparation was tolerable, with no emerging safety issues, and achieved clinical stability among subjects. These findings attest to the promise of LYN-005 as an alternative long-acting oral agent for schizophrenia and schizoaffective disorder management, with the potential to enhance adherence and long-term outcomes.

Reference:

Citrome, L., Nagaraj, N., Traverso, G., Dumas, T., & Scranton, R. (2025). Long-acting oral weekly risperidone (LYN-005) for schizophrenia in the USA (STARLYNG-1): a multicentre, open-label, non-randomised phase 3 trial. The Lancet. Psychiatry, 12(7), 504–512. https://doi.org/10.1016/s2215-0366(25)00135-x

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Most Indirect Pulp Capping Materials Safe for Deep Cavities Without Compromising Dentin Seal: Study

Most indirect pulp capping Materials, except for Kerr Life, do not compromise the peripheral seal to dentin in very deep cavity areas. Further, hydraulic cements can be used without negatively affecting the dentin seal.

The aim of this in-vitro study was to evaluate the effect of different indirect pulp capping (IPC) materials on bond strength to surrounding dentin. Fifty-six human third molars were used in this study. Occlusal dentin of 42 teeth was exposed. Dentin surfaces (n = 6) were left uncovered (control) or received a 1 × 1 mm central IPC (KL: Kerr life, DY: Dycal, TC: Theracal LC, CL: Calcimol LC, BD: Biodentine, and PR: ProRoot MTA) and were then bonded with Scotchbond Universal adhesive and restored with a composite resin build-up (Filtek™ Z250). After 24 h of water storage, the specimens were cut into sticks, which were marked red (1 mm distance from IPC spot), green (2 mm distance), and blue (3 mm distance). Consequently, µ-TBS tests were performed and analyzed using one-way ANOVA (P 0.05) for normal distributions and Mann–Whitney U-test (P 0.05) for non-normal distributions. Pretesting failures were recorded as 0 MPa. Fracture modes were analyzed under a fluorescence microscope, and interfaces and surfaces of 14 additional specimens were visualized under a scanning electron microscope (SEM). Results: A significant reduction in peripheral seal was only observed for KL (Mann–Whitney U-test, P 0.05). All groups showed increasing bond strengths from the IPC area to the periphery, indicating a certain contamination potential of IPC materials. IPC materials being applied in very deep cavity areas except Kerr Life do not harm peripheral seal to dentin. Especially, hydraulic cements can be used without a negative effect on the peripheral dentin seal.

Reference:

Frankenberger, R.; Koch, A.; Plohmann, L.; Beck-Broichsitter, B.; Becker, S. The Outcome of Old-School Indirect Pulp Capping over 40 Years: A Practice-Based Retrospective Evaluation. Dent. J. 2025, 13, 182. https://doi.org/10.3390/dj13050182

Keywords:

Frankenberger, R.; Koch, A.; Plohmann, L.; Beck-Broichsitter, B.; Becker, S, Outcome, Old-School, Indirect, Pulp Capping, over, 40 Years, dentistry journal

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Urgent Laparoscopic Cholecystectomy feasible among Older Adults with acute cholecystitis: Study

Researchers have found in a new study that urgent laparoscopic cholecystectomy (LC) with proper perioperative care is a viable treatment option for acute cholecystitis in older adults. While advanced age is linked to longer hospital stays and increased treatment costs, it does not correlate with a rise in short-term postoperative complications.

This study aimed to compare the clinical outcomes and hospital costs between younger and older adult with acute cholecystitis patients who received urgent laparoscopic cholecystectomy. A 3-year retrospective study was conducted. Patients admitted to surgical units for urgent laparoscopic cholecystectomy at Chi-Mei Hospital from January 1, 2019, to December 31, 2021, were included. Patients’ baseline data were collected from medical records review. Postoperative complications are defined by the Clavien-Dindo classification as being greater than grade I. Total costs during admission were also collected based on disease-related groups (DRG system). Results: Among 300 patients selected, 68.3% (n = 205) were aged < 60 years, 19.3% (n = 58) were aged between 60 and 69 years, and 12.3% (n = 37) were aged ≥ 70 years. Patients aged ≥ 70 years had higher rates of comorbidities, higher ASA levels, and lower platelet counts than those in patients aged < 60 years. After adjusting for possible confounders in the multivariable models, older age was significantly associated with longer hospital stays (length of stay, or LOS) (β = 0.56 for patients aged 60–69 years and 1.30 for those aged ≥ 70 years) and correspondingly higher hospital costs (β = 219.69 for patients aged 60–69 years and 302.48 for ≥ 70 years) compared to those for patients aged < 60 years. No significant associations were found between older age and the occurrence of postoperative complications. Urgent LC with adequate perioperative care is feasible for treating acute cholecystitis in older adult patients. Older age is independently associated with longer LOS and higher costs but not with short-term postoperative complications.

Reference:

Kao, YM., Lu, CY. Impact of age on outcomes and hospital costs of urgent laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study. BMC Surg 25, 228 (2025). https://doi.org/10.1186/s12893-025-02963-0

Keywords:

Urgent, Laparoscopic, Cholecystectomy, feasible, among, Older, Adults, acute cholecystitis, Study, Kao, YM., Lu, CY, Urgent laparoscopic cholecystectomy, Medical costs, Prognosis, Older adults

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Aging Women with PANDO Face Higher Risk of Acute Dacryocystitis, suggests study

Researchers have discovered that age, especially in older women with primary acquired nasolacrimal duct obstruction (PANDO), strongly predicts the development of acute dacryocystitis (AD), an inflammatory and potentially serious infection of the lacrimal sac. A recent study was conducted by Amber D. published in the British Journal of Ophthalmology. The research also reveals that weather-related factors like temperature and humidity are not significantly correlated with the prevalence of AD.

This single-center, retrospective observational study examined data on all clinically diagnosed adult patients with acute dacryocystitis between January 2000 and February 2020. Patient data were compared to environmental data collected from the Royal Meteorological Institute of Belgium in order to determine if weather conditions may have influenced AD occurrence. Patients were divided into three groups according to the condition of their nasolacrimal ducts: PANDO, non-PANDO, or unclassified, as a function of whether lacrimal syringing information was present. Principal patient variables were age and sex, and the investigators used multivariate regression analysis to analyze risk factors.

Results

  • 106 first-onset AD patients were included in the analysis. Of these, 86 (81%) were women and 20 (19%) were men, with an average age of 64.9 years.

  • PANDO was diagnosed in 50% of the cases, and 20% had non-PANDO forms, and the other 30% could not be classified clearly.

  • Risk for AD increased significantly with age.

  • For each 5-year increase in age, the total incidence of AD increased by 14.5% (p=0.012, Exp(B)=1.145).

  • This risk with age was particularly notable in the PANDO group, where the incidence increased by 22.1% for each 5-year increase in age (p<0.002, Exp(B)=1.221).

  • This age-dependent increase was not noted in PANDO-negative patients.

  • The examination did not identify any statistically significant relationships between AD incidence and weather factors such as temperature, humidity, atmospheric pressure, or rainfall.

Acute dacryocystitis occurs much more frequently in older women, especially those with primary acquired nasolacrimal duct obstruction. A high-risk predictor was identified as age, particularly in the PANDO subgroup, while meteorological factors had no significant correlation. These results justify proactive counseling and preventive surgical procedures such as dacryocystorhinostomy for elderly female patients with symptomatic PANDO in an effort to limit the burden of AD.

Reference:

Demeuleneere A, Kusmierczyk J, Mombaerts I. Risk factors for the development of acute dacryocystitis in adults. Br J Ophthalmol. 2025 Jun 18:bjo-2024-326753. doi: 10.1136/bjo-2024-326753. Epub ahead of print. PMID: 40533106.

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