Improved Ejection Fraction in Heart Failure Tied to Better Outcomes, But Clinical Risks Remain: Study Finds

USA: A substantial portion of patients diagnosed with heart failure with reduced ejection fraction (HFrEF) go on to experience meaningful improvement in cardiac function, but they remain at notable clinical risk—emphasizing the continued need for guideline-directed medical therapy (GDMT). The findings stem from a large, retrospective cohort study published in JACC by Dr. Kyung H. Min and colleagues from Kaiser Permanente San Francisco Medical Center.

Analyzing electronic health data from 28,292 patients with newly diagnosed HFrEF between 2013 and 2022, the study revealed the following:

  • Around 31% of patients experienced significant improvement in left ventricular ejection fraction (LVEF), meeting the criteria for heart failure with improved ejection fraction (HFimpEF).
  • This improvement was defined as an absolute increase in LVEF of more than 10%, reaching above 40% within one year of diagnosis.
  • Patients with HFimpEF had lower rates of worsening heart failure events (17.4 per 100 person-years) compared to those with persistent HFrEF (34.1 per 100 person-years).
  • All-cause mortality was also lower in the HFimpEF group, at 5.7 versus 11.0 per 100 person-years.
  • Despite clinical improvements, HFimpEF did not equate to complete recovery, and the risk of adverse events remained.
  • Reducing or discontinuing guideline-directed medical therapy (GDMT) after improvement was associated with increased clinical risk.
  • A slight decline in the use of evidence-based therapies such as beta-blockers, RAAS inhibitors, and MRAs was observed after patients transitioned to HFimpEF.
  • Researchers cautioned that this drop in therapy use could negatively affect long-term outcomes if not carefully managed.

Accompanying the study, an editorial by Drs. Andrew S. Perry and Lynne W. Stevenson from Vanderbilt University Medical Center emphasized the evolving landscape of heart failure treatment. They noted that while many patients benefit from GDMT, the heterogeneity of heart failure means that standard therapies may not be adequate for all. “The improvement journey will hopefully include new lanes as GDMT continues to evolve beyond traditional triple therapy,” they wrote.

Perry and Stevenson also highlighted the limitations of focusing solely on ejection fraction as a measure of heart failure progression. “The imminent era of broad population data will hopefully guide integration of primary and secondary causes, therapeutic responses, and multidimensional surveillance beyond EF, to personalize regimens and improve prognosis along all journeys with HF,” they suggested.

Ultimately, the study highlights both the encouraging potential for heart function recovery and the persistent vulnerability of patients even after improvement. Continued adherence to and optimization of GDMT remains crucial in managing HFimpEF, as personalized approaches based on emerging data may shape the future of care.

Reference:

Min KH, Go AS, Lee K, et al. Guideline-directed medical therapy and outcomes among patients with heart failure with improved ejection fraction. JACC. 2025;86:338-350.

Powered by WPeMatico

Surgical Serenity: How to Help Kids Cope with Anesthesia Anxiety?

Anxiety during anesthesia induction in children is a significant concern, associated with various adverse outcomes, including behavioral issues and prolonged induction times. Approximately 50-67% of pediatric patients experience this anxiety, highlighting the necessity for effective management strategies. Nonpharmacological interventions, such as parental presence, psychological therapy, and virtual reality, have been proposed as alternatives to pharmacological methods like midazolam, which can have undesirable effects. However, the specific impacts of various nonpharmacological interventions remain ambiguous due to a scarcity of direct comparative studies.

Recent systematic review analyzed 34 randomized controlled trials (RCTs) involving 3,040 participants to compare the efficacy of different nonpharmacological interventions. A Bayesian network meta-analysis approach facilitated both direct and indirect comparisons, crucial given the lack of head-to-head trials. The primary outcomes measured included anxiety levels during induction, assessed using standardized scales such as the modified Yale Preoperative Anxiety Scale (mYPAS).

Results of Nonpharmacological Interventions

Results indicated that interventions combining parental presence with interactive distraction techniques (PDI-PPIA and IDI-PPIA) showed the highest efficacy in reducing anxiety during anesthesia induction, achieving statistical significance with standardized mean differences (SMD) of -1.94 and -1.83, respectively. In contrast, traditional parental presence interventions alone (PPIA) and other passive or interactive distractions were less effective, with SMDs ranging from -0.91 to -1.18. Notably, no interventions demonstrated a significant reduction in parental anxiety levels.

Quality Assessment of Studies

The meticulous quality assessment revealed a predominantly low to moderate risk of bias across studies, although some concerns were raised regarding outcome measurement, primarily due to observer blinding issues. Sensitivity analyses confirmed the primary findings, reinforcing the conclusion that specific nonpharmacological strategies provide effective means to mitigate preoperative anxiety in children. The analysis underscores the pressing need for future head-to-head trials to further delineate the comparative effectiveness of these strategies, particularly in diverse populations and settings. Subgroup analyses were constrained by limited data on intravenous versus inhalation induction methods, suggesting a vital area for future exploration. The findings advocate for the integration of tailored, family-centered interventions into clinical practice to enhance the overall perioperative experience for pediatric patients.

Key Points

– Anxiety prevalence during anesthesia induction in pediatric patients is significant, with 50-67% experiencing anxiety, leading to behavioral issues and prolonged induction times, necessitating effective management strategies.

– A systematic review of 34 randomized controlled trials (RCTs) involving 3,040 participants was conducted to evaluate the efficacy of various nonpharmacological interventions compared to traditional pharmacological methods.

– Bayesian network meta-analysis was utilized to facilitate both direct and indirect comparisons of interventions, with the primary outcome being anxiety levels during induction measured by standardized scales like the modified Yale Preoperative Anxiety Scale (mYPAS).

– Interventions combining parental presence with interactive distraction techniques (PDI-PPIA and IDI-PPIA) demonstrated the highest efficacy in reducing anxiety with significant standardized mean differences (SMDs) of -1.94 and -1.83, whereas traditional parental presence alone (PPIA) and other distraction methods showed lower efficacy (SMDs range from -0.91 to -1.18).

– Quality assessment of the included studies revealed a low to moderate risk of bias, with concerns primarily related to outcome measurement and observer blinding, though sensitivity analyses confirmed the robustness of the primary findings.

– The findings emphasize the necessity for future head-to-head trials to better understand the comparative effectiveness of nonpharmacological interventions, particularly in diverse populations, while advocating for family-centered strategies to improve the perioperative experience for pediatric patients.

Reference –

Yuanyuan Li et al. (2025). Nonpharmacological Interventions For Decreasing Anxiety During Anesthesia Induction In Children: A Systematic Review And Bayesian Network Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03077-z.

Powered by WPeMatico

Even Mild CKD Elevates Infection Risk, Study Finds

Researchers have determined in a new study published in EClinicalMedicine that patients with chronic kidney disease (CKD), even at its earliest stages, have a substantially elevated risk of requiring hospitalization for serious infection. The results concluded that reduced kidney function and increased excretion of albumin in the urine are independently and stepwise related to increased risk of infection, even in individuals with only mildly decreased kidney function. The study was conducted by Junichi I. and colleagues.

In this large, meta-analysis, one of the Chronic Kidney Disease Prognosis Consortium (CKD-PC), data from 47 international cohorts with 1,246,912 participants were combined. The investigators compared estimated glomerular filtration rate using serum creatinine (eGFRcr) and urinary albumin-to-creatinine ratio (ACR) to determine the association of these biomarkers with infection-related hospitalization. Infections were infections of the respiratory, urinary, skin, gastrointestinal, genital, nervous, and cardiovascular tracts, and sepsis. Follow-up information was collected through December 31, 2019.

This analysis employed individual participant data from 1.2 million people in 47 cohorts worldwide, for which their eGFRcr and ACR were measured. Both the markers were analyzed as continuous and categorical markers. Acute infection hospitalization was monitored through discharge diagnostic codes, with follow-up censored in December 2019 or at cohort closure. Cox models of proportional hazards were employed to calculate the hazard ratios (HRs) for risk of infection associated with kidney function and with levels of albuminuria.

Key Findings

• Of more than 1.2 million participants, 170,864 persons (13.7%) were hospitalized for infections in follow-up.

• The overall rate of incidence (IR) was 22.0 per 1000 person-years (interquartile interval: 16.2–31.0).

• Relative to those with eGFRcr 90–104 ml/min/1.73 m² and ACR <10 mg/g:

• Patients with eGFRcr 60–89 had an HR of 1.09 (95% CI: 1.06–1.13)

• Individuals with eGFRcr 45–59 had an HR of 1.39 (95% CI: 1.34–1.45)

• ACR 10–29 mg/g was correlated with an HR of 1.40 (95% CI: 1.33–1.47)

• ACR 30–299 mg/g had an HR of 1.82 (95% CI: 1.72–1.92)

• Individuals with extremely high eGFRcr ≥105 ml/min/1.73 m² also had higher infection risk (HR: 1.22; 95% CI: 1.17–1.26)—a surprising result indicating non-linear relations at extreme levels.

• The highest risk was seen in those with both extremely low eGFRcr (<30 ml/min/1.73 m²) and elevated ACR (≥300 mg/g), with combined HR of 6.27 (95% CI: 5.70–6.90)—more than six times as high as the reference group.

• These trends were consistent regardless of the type of infection. For instance, HR of lower respiratory tract infections was 1.26 (95% CI: 1.22–1.30) per 15 ml/min/1.73 m² reduction in eGFRcr, and 1.48 (95% CI: 1.44–1.53) per 8-fold rise in ACR.

Risk of infection in CKD patients is significant, and this risk starts early in the progression of kidney impairment. The authors of the study concluded that both worsening kidney function and rising albuminuria are independent, additive predictors of hospitalization with infection. These results necessitate specific infection prevention measures not only in those with severe CKD but also in people in preceding stages of kidney disease.

Reference:

Ishigami, J., Surapaneni, A., Matsushita, K., Coresh, J., Grams, M. E., Ballew, S. H., Sang, Y., Stengel, B., Ärnlöv, J., Bell, S., Carrero, J.-J., Chang, A. R., Ciemins, E. L., Haynes, R., Ix, J., Kotsis, F., Lees, J. S., Pandit, K., Rao, P., … Surapaneni, A. (2025). Estimated glomerular filtration rate, albuminuria, and risk of infection: a collaborative meta-analysis of individual participant data. EClinicalMedicine, 86(103372), 103372.https://doi.org/10.1016/j.eclinm.2025.103372•

Powered by WPeMatico

Low FT4 Levels Linked to Higher Gestational Diabetes Risk: Study

Researchers have found in a global study of over 63,000 pregnant women that low free thyroxine (FT4) levels and isolated hypothyroxinaemia are linked to a higher risk of gestational diabetes. Contrary to prior assumptions, subclinical hypothyroidism showed no significant association, suggesting that universal screening and treatment for it may not reduce gestational diabetes risk.

Pregnancy is a state of increased metabolic demand that necessitates major changes in endocrine physiology. Gestational thyroid dysfunction and gestational diabetes are common endocrine conditions of pregnancy that frequently coincide. Although the effects of thyroid hormones on glucose metabolism are well documented, important knowledge gaps remain in terms of the extent and clinical relevance of these effects during pregnancy.

The aim of this meta-analysis is to assess the association of thyroid function test results with gestational diabetes and markers of glucose metabolism. In this systematic review and individual participant data meta-analysis, we searched Ovid MEDLINE, EMBASE, and Web of Science from database inception to Dec 12, 2024, for prospective population-based cohort studies with individual patient data on thyroid function, gestational diabetes, and measures of glucose homoeostasis during pregnancy. Furthermore, open invitations to join the Consortium on Thyroid and Pregnancy were issued to identify unpublished datasets. We excluded participants with multiple pregnancies; pre-existing thyroid disease or diabetes; current use of medications that could affect thyroid or glucose levels; or a history of infertility treatment, miscarriage, or stillbirth.

Exposures were maternal gestational concentrations of thyroid-stimulating hormone (TSH), free T4 (FT4), free T3 (FT3), and total T3; thyroperoxidase antibody positivity; thyroglobulin antibody positivity; and thyroid disease entities (ie, subclinical hypothyroidism, overt and subclinical hyperthyroidism, and isolated hypothyroxinaemia), which were defined according to current guidelines. The primary outcome was presence of gestational diabetes as defined in individual cohorts. Individual participant data were analysed using generalised linear mixed-effects regression models adjusting for maternal age, BMI, smoking status, parity, ethnicity, fetal sex, and gestational age at blood sampling.

They identified 638 published studies with our systematic search, of which 21 studies based on 17 cohorts met inclusion criteria; 11 of these prospective cohort studies provided individual participant data, and data from an additional 14 cohorts were added via personal contacts and open invitations, resulting in a study population of 63 548 participants from 25 cohorts after exclusions. Of the 52 632 participants in 17 cohorts with TPOAb measurements available to define thyroid disease entities, 1687 (3·2%) of these participants had subclinical hypothyroidism, 1153 (2·2%) had isolated hypothyroxinaemia, and 2958 (4·7%) had gestational diabetes. Compared with euthyroidism, isolated hypothyroxinaemia was associated with a higher risk of gestational diabetes (absolute risk 6·5% [72 of 1113] for isolated hypothyroxinaemia vs 3·5% [1555 of 44 787] for euthyroidism; adjusted odds ratio [aOR] 1·52 [95% CI 1·17–1·98], p=0·0017; 45 900 participants).

A lower FT4 concentration was associated with a higher risk of gestational diabetes (non-linear, p<0·0001). A higher risk of gestational diabetes was found both with a higher FT3 concentration (aOR 1·18 [95%CI 1·10−1·28], p<0·0001) and with a higher FT3-to-FT4 ratio (non-linear; p<0·0001). No evidence was found of associations of TSH, thyroid antibodies, or other thyroid function test abnormalities with gestational diabetes. I2 statistics for the primary analyses ranged from 0–43%, indicating low to moderate heterogeneity.

The funnel plot for overt hyperthyroidism indicated a possibility for publication bias (p=0·049), but funnel plots for all other variables did not. A lower FT4 concentration and isolated hypothyroxinaemia during pregnancy are associated with a higher risk of gestational diabetes. Our results challenge the long-standing notion that subclinical hypothyroidism or thyroid autoimmunity are risk factors for gestational diabetes and support both the risk profile for gestational thyroid dysfunction and ongoing efforts on optimisation of treatment targets for pregnant people taking levothyroxine. Follow-up studies are required to establish to what extent levothyroxine initiation or dose adjustments can affect insulin resistance and antihyperglycaemic therapies during pregnancy.

Reference:

Association of gestational thyroid function and thyroid autoimmunity with gestational diabetes: a systematic review and individual participant meta-analysis. Osinga, Joris A J et al. The Lancet Diabetes & Endocrinology, Volume 0, Issue 0

Powered by WPeMatico

Pemivibart Shows Promise as Preventive Treatment for COVID-19, suggests study

A new study published in Clinical Infectious Diseases highlights the potential of pemivibart, a long-acting monoclonal antibody, as a preventive therapy for COVID-19. Researchers evaluated the safety and efficacy of pemivibart in a phase 3 randomized controlled trial involving uninfected adults who were at increased risk of SARS-CoV-2 exposure.

The results showed that a single intramuscular dose of pemivibart significantly reduced the risk of symptomatic COVID-19 over a follow-up period of several months.

The antibody was well tolerated by participants, with adverse events comparable to those observed in the placebo group. Importantly, the study noted that the protective effects were maintained even as new variants of the virus circulated, underscoring the potential for pemivibart to serve as a robust option for pre-exposure prophylaxis-especially among immunocompromised individuals or those for whom vaccination offers limited protection.

Given the waning immunity from vaccines over time and ongoing concerns about breakthrough infections, especially in high-risk groups, long-acting antibodies like pemivibart may fill a critical gap in COVID-19 prevention strategies.

The authors of the study emphasize that further real-world effectiveness data and ongoing surveillance of viral mutations are needed to confirm its broad utility, but early results are encouraging. If approved for wider use, pemivibart could be integrated into preventive care protocols for vulnerable populations, including transplant recipients, cancer patients undergoing chemotherapy, and others with compromised immune systems.

The study adds to a growing body of evidence supporting antibody-based prophylaxis as a complement to vaccination efforts in controlling the COVID-19 pandemic.

Reference:
O’Brien, M. P., Forleo-Neto, E., Sarkar, N., et al. (2024). Efficacy and safety of pemivibart for prevention of symptomatic COVID-19: A phase 3 randomized trial. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaf265

Powered by WPeMatico

Alcohol withdrawal syndrome linked to worse surgical outcomes, higher costs, suggests study

Patients who develop alcohol withdrawal syndrome (AWS) after major surgery face significantly higher risks of complications, longer hospital stays, and increased health care costs, according to a study published in the Journal of the American College of Surgeons (JACS).

The findings underscore the need for screening before surgery and targeted interventions.

Using the National Inpatient Sample (2016–2019), researchers analyzed data from 3 million adults who underwent major operations, including colectomy, cardiac surgery, and liver resection. Among them, 16,504 (0.5%) were diagnosed with AWS, including 6,591 (0.2%) with life-threatening delirium tremens (DT). DT is a severe form of alcohol withdrawal that can include shaking, confusion, and hallucinations.

“AWS is a preventable complication, yet it’s often overlooked in surgical planning,” said lead author Timothy M. Pawlik, MD, PhD, MPH, FACS, surgeon-in-chief at the Ohio State University Wexner Medical Center. “Our study shows that proactive screening and multidisciplinary care — involving surgeons, social workers, and addiction specialists — can save lives and reduce costs.”

Key Findings

High-risk patients: AWS was more common in men (median age 61), Medicaid recipients, and those with substance use disorders.

Complications: AWS doubled the risk of respiratory failure and sepsis. DT increased mortality by 40%.

Economic impact: Adjusted hospitalization costs rose by $10,030 per patient with AWS; DT added another $5,300.

Interventions for the Future

The study highlights actionable strategies to improve outcomes:

Preoperative screening: Use validated tools (e.g., AUDIT-C) to identify high-risk patients.

Judgment-free care: “This is a disease, not a moral failing,” stressed Dr. Pawlik. “We need honest conversations to tailor treatment.”

Early intervention: For patients at risk, preventative medications (e.g., benzodiazepines) and ICU-level monitoring may prevent DT.

“A patient recovering from major surgery shouldn’t also battle withdrawal,” said Dr. Pawlik, recalling a case where AWS led to aspiration pneumonia post-surgery. “We can change this by addressing alcohol use before surgery and ensuring safer recovery environments.”

Limtations: The study relied on administrative data, potentially underestimating AWS incidence. Long-term outcomes and treatment specifics (e.g., benzodiazepine use) were not assessed.

Coauthors are Azza Sarfraz, MBBS; Areesh Mevawalla MD; Abdullah Altaf, MD; Mujtaba Khalil, MD; Zayed Rashid, MD; Shahzaib Zindani MD

The study is published as an article in press on the JACS website. 

Citation: Nationwide Trends and Perioperative Outcomes of Alcohol Withdrawal Syndrome After Major Operation. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001487

Powered by WPeMatico

Impact of kombucha, coffee, and turmeric beverages on the color stability of a single-shade versus a multi-shade resin-based composite: Study

A new study published in PeerJ has found that turmeric causes the most significant discoloration in dental resin-based composites (RBCs) compared to coffee and kombucha, with single-shade RBCs exhibiting poorer color stability than multi-shade composites. Researchers tested 60 composite specimens using two types of materials: a single-shade RBC with an advanced polymerization system (APS) (Vittra APS Unique, FGM Dental Group, Brazil) and a conventional multi-shade universal RBC (Tetric N-Ceram, Ivoclar Vivadent, Germany). Each group was subdivided and immersed in turmeric, coffee, or kombucha for 12 days, and color changes (ΔE*ab and ΔE00) were measured at baseline, day 6, and day 12. Results showed that turmeric caused the highest degree of discoloration (p < 0.001), followed by coffee and then kombucha. Additionally, the universal RBC demonstrated significantly better resistance to staining compared to the single-shade APS-based composite (p = 0.004). Researchers concluded that time, staining medium, and material type all significantly influenced color changes (p = 0.005 for three-way interaction). These findings highlight a potential esthetic limitation of single-shade composites, particularly when patients consume beverages or foods containing strong chromogens like turmeric. While turmeric’s staining potential was already well-documented on natural teeth, this study adds valuable evidence of its impact on modern composite resins, especially those marketed for universal shade-matching convenience. Clinicians may need to consider this when selecting materials for patients with high exposure to staining agents. The authors recommend further long-term studies to confirm these results and to evaluate whether surface finishing, polishing, and sealing techniques can mitigate discoloration over time. This study underscores the importance of patient education regarding dietary habits and the impact of staining beverages on restorative esthetics, especially for those seeking long-lasting cosmetic results.

Reference:
Yeslam, H. E., & Bakhsh, A. F. (2025). Impact of kombucha, coffee, and turmeric beverages on the color stability of a single-shade versus a multi-shade resin-based composite. PeerJ, 13, e19759. https://doi.org/10.7717/peerj.19759

Keywords: resin-based composites, color stability, turmeric staining, single-shade composites, universal RBC, PeerJ, Vittra APS Unique, Tetric N-Ceram, Yeslam & Bakhsh, dental esthetics

Powered by WPeMatico

Hypothyroidism May Lower Breast Cancer Risk, Especially After Menopause: Study

Researchers have found that women diagnosed with hypothyroidism may have a lower risk of developing breast cancer, especially after menopause. This conclusion was drawn from a large Danish cohort study that followed over 1 million women for nearly two decades. The study published in the International Journal of Cancer was conducted by Allan J. and colleagues.

The cohort consisted of 1,058,939 Danish-born women from January 1, 1960, to December 31, 1997. Information was gathered from a variety of Danish national registers, such as evidence of thyroid disease and breast cancer diagnoses, demographic characteristics, migration, and death. Median follow-up was 18.8 years, offering a strong longitudinal setting in which to compare long-term risk of cancer.

Among the entire population, 49,015 women were diagnosed with hypothyroidism and 26,950 with hyperthyroidism within the duration of the study. A total of 15,703 individuals were diagnosed with breast cancer. Cox proportional hazard regression models estimated the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for age, comorbidities, and menopausal status.

Key Findings

  • The main conclusion of the study was that hypothyroidism was linked to a statistically significant decrease in the risk of breast cancer.

  • That is, the hazard ratio for women with hypothyroidism was 0.85 (95% CI: 0.78–0.93), which means 15% lower risk compared to women without thyroid conditions.

  • For postmenopausal women, the protective effect looked even more pronounced, with a hazard ratio of 0.78 (95% CI: 0.68–0.90).

  • In contrast, no risk association was seen between hyperthyroidism and the risk of breast cancer.

  • The hazard ratio in this cohort was 1.00 (95% CI: 0.89–1.11), indicating no increase or decrease in risk.

  • These results were similar for different histological subtypes of breast cancer and were not importantly different by time since the first diagnosis of thyroid disease.

This large multicenter national study found that hypothyroidism is associated with a reduced risk of breast cancer, and the protective effect was most evident in postmenopausal women. Conversely, hyperthyroidism was not found to be associated with an altered risk of breast cancer. These results prompt further investigation into the biological rationale for this association and into whether thyroid function should be considered as an element of breast cancer prevention in the future.

Reference:

Jensen, A., Gottschau, M., Christensen, J., Lindquist, S., Aalborg, G. L., Rosthøj, S., Grand, M. K., Pedersen, J., Kjær, S. K., & Nøhr, B. (2025). Risk of breast cancer among women with hypo- and hyperthyroidism: Results from a large nationwide cohort study. International Journal of Cancer. Journal International Du Cancer. https://doi.org/10.1002/ijc.70007

Powered by WPeMatico

Age at woman’s first period can offer clues about long-term health risks: Study

The age at which a woman has her first period can offer valuable clues about her long-term risk for conditions like obesity, diabetes, heart disease and reproductive health issues, according to a study being presented Sunday at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, Calif.

The Brazilian study found that both early and late menarche-the age when women first get their period-are linked to different health risks. Women who had their first period before age 10 were more likely to develop obesity, high blood pressure, diabetes, heart problems and reproductive issues like pre-eclampsia later in life. Women who started their period after age 15 were less likely to be obese but had a higher risk of menstrual irregularities and certain heart conditions.

“We now have evidence from a large Brazilian population that confirms how both early and late puberty can have different long-term health impacts,” said study author Flávia Rezende Tinano of the University of Sao Paulo in Sao Paulo, Brazil. “While early menarche increases the risk for multiple metabolic and heart problems, late menarche may protect against obesity but increase certain heart and menstrual issues. Most women can remember when they had their first period, but they might not realize that it could signal future health risks. Understanding these links can help women and their doctors be more proactive about preventing conditions like diabetes, high blood pressure and heart disease.”

Tinano said the study is one of the largest of its kind in a developing country, providing valuable data on a topic that has mostly been studied in wealthier countries. “It highlights how early and late puberty can affect a woman’s long-term health, especially in underrepresented populations like those in Latin America,” she said.

The study was part of the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) and evaluated data from 7,623 women ages 35 to 74. The age of their first period was categorized as early (less than 10 years old), typical (ages 10 to 15) or late (older than 15). They assessed the women’s health through interviews, physical measurements, lab tests and ultrasound imaging.

“Our findings suggest that knowing a woman’s age at her first period can help doctors identify those at higher risk for certain diseases,” Tinano said. “This information could guide more personalized screening and prevention efforts. It also emphasizes the importance of early health education for young girls and women, especially in developing countries.”

Reference:

Age at woman’s first period can offer clues about long-term health risks, The Endocrine Society, Meeting: ENDO 2025.

Powered by WPeMatico

Probiotics Pretreatment Boosts H. pylori Eradication Rates and Cuts Side Effects, Meta-Analysis Finds

China: A systematic review and meta-analysis published in Annals of Medicine has found that administering probiotics before Helicobacter pylori (H. pylori) eradication therapy can significantly improve treatment success rates while minimizing adverse effects. The research, led by Shiyu Xiao and colleagues from the Department of Gastroenterology at Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, provides moderate to high-quality evidence supporting the use of probiotic pretreatment as an adjunct to standard H. pylori therapy.

H. pylori infection remains one of the most common chronic bacterial infections worldwide and is a major contributor to gastritis, peptic ulcer disease, and gastric cancer. While conventional eradication regimens are effective, treatment failure due to antibiotic resistance and gastrointestinal side effects remains a concern. Probiotics, known to inhibit H. pylori growth and modulate the gut microbiome, have been explored as a potential strategy to enhance eradication outcomes and reduce treatment-related discomfort.

The researchers performed a comprehensive analysis of 12 randomized controlled trials encompassing 2,144 participants to determine whether probiotics used before H. pylori eradication could improve clinical outcomes.

The following were the key findings:

  • The intention-to-treat analysis showed a higher eradication rate in the probiotics pretreatment group compared to controls (80.34% vs. 70.49%), with a relative risk (RR) of 1.14.
  • Per-protocol analysis also indicated better outcomes with probiotics (86.43% vs. 76.88%; RR = 1.12).
  • Patients who received probiotic pretreatment experienced fewer treatment-related side effects (16.0% vs. 28.3% in controls; RR = 0.59).
  • The findings suggest that probiotics can improve both treatment efficacy and tolerability, aiding better adherence to therapy.
  • The benefits of probiotics were consistent across different geographical regions, eradication regimens, and probiotic formulations.
  • Pretreatment durations of 14 days or longer showed the most significant improvement in eradication rates, indicating that sufficient exposure time may be key for probiotics to impact gut microbiome and H. pylori suppression.

The findings highlight the potential of integrating gut microbiome modulation into H. pylori management strategies. “Probiotic pretreatment offers a promising approach to enhance eradication efficacy and reduce side effects, especially in the face of growing antibiotic resistance,” the authors noted.

With H. pylori treatment failures posing a global challenge, this meta-analysis provides a compelling case for incorporating probiotics as part of a comprehensive eradication protocol. The authors recommend further large-scale, well-designed clinical trials to determine optimal probiotic strains, dosing regimens, and treatment durations to maximize therapeutic benefits.

“The research paves the way for a potential paradigm shift in H. pylori therapy, emphasizing the role of probiotics not just as a supportive measure but as a proactive component of eradication strategies aimed at improving patient outcomes and addressing the limitations of current treatment protocols,” the authors concluded.

Reference:

Zhang Y, Tu M, Long P, Zheng J, Du G, Xiao S, Gao C. Efficacy of probiotics pretreatment in Helicobacter pylori eradication therapy: a systematic review and meta-analysis of clinical outcomes. Ann Med. 2025 Dec;57(1):2533431. doi: 10.1080/07853890.2025.2533431. Epub 2025 Jul 23. PMID: 40697099; PMCID: PMC12288164.

Powered by WPeMatico