Tag: 25/11/22

Categories : Metabolic DisordersTags :

Metabolic Syndrome Increases Gout Risk Nearly Four-fold

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In a population-based study published in Arthritis & Rheumatology, researchers found that men with metabolic syndrome (MetS) and those who developed MetS – especially those with the MetS components of elevated triglycerides and abdominal obesity – were at higher risk of developing gout.

Gout is one of the most common causes of chronic inflammatory arthritis, characterised by monosodium urate (MSU) monohydrate crystals deposition in the tissues. 

Dietary sources that can contribute to hyperuricemia and gout include the consumption of animal food such as seafood (eg, shrimp, lobster), organs (eg, liver and kidney), and red meat (pork, beef). Some drinks like alcohol and sweetened drinks may also contribute to this disease. Epidemiological studies reported an increased disease burden of gout, which is largely explained by lifestyle changes like increased protein consumption and a sedentary lifestyle. 

The study included nearly 1.3 million men aged 20–39 years who participated in three serial health check-ups at two-year intervals. Among these participants, 18 473 developed gout, and those with MetS at all checkups had a nearly four-fold higher risk than participants who were MetS-free. Development of MetS more than doubled the risk of incident gout. Conversely, recovery from MetS reduced incident gout risk by nearly half.

Among MetS components, changes in elevated triglycerides and abdominal obesity displayed the greatest association with altered risk of incident gout. Age was also a factor: associations among MetS changes and incident gout were more pronounced in subjects in their 20s than subjects in their 30s and in subjects who were under- or normal weight.

“This is the first large-scale study to explore the association between dynamic changes in MetS and risk of gout,” said co–corresponding author Jaejoon Lee, MD, PhD of the Sungkyunkwan University School of Medicine, in South Korea. “Prevention and recovery from MetS can significantly lower the risk of gout in young adults.”

Source: Wiley

Categories : Metabolic DisordersTags :

Surprising Reasons for Hospitalisation among Type 2 Diabetes Patients

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Findings from a new study published in Diabetes Research and Clinical Practice reveal that some unexpected conditions such as iron deficiency anaemia are leading to more hospitalisations in people living with type 2 diabetes compared to the general population.

The emergence of iron deficiency anaemia, mental health disorders and gastrointestinal disorders as leading reasons for excess hospitalisation  among those with type 2 diabetes compared to the general population came as a surprise.

The study from Baker Heart and Diabetes Institute found that people with type 2 diabetes are far more likely to be hospitalised with iron deficiency anaemia than those without diabetes.

“We’ve never seen this result described before,” said lead researcher, Professor Dianna Magliano. “The burden of anaemia in those with type 2 diabetes was one of the most surprising observations. While it’s known that diabetes can contribute to anaemia through reduced iron absorption, gastrointestinal bleeding and through complications that cause anaemia, it was unexpected to see the association between diabetes and iron deficiency anaemia feature so significantly as a complication.”

The study used data from 456 265 people with type 2 diabetes registered in the National Diabetes Services Scheme between 2010–2017. Previous studies have assessed hospitalisations by disease group but this study is the first of its kind to delve into the specifics of hospitalisations for people living with type 2 diabetes.

“Because we now have better diabetes management, the proportion of those presenting to hospital with cardiovascular disease and kidney disease is reducing,” Prof Magliano said. “But we are now seeing a diversification of diabetes complications.

“This is an important clinical finding as it means we may have to reassess diabetes management to include treatment and prevention of these other rising conditions.”

Prof Magliano’s team will conduct further studies using other datasets to validate the recent findings and explore the mechanisms underpinning these findings.

“Our findings suggest the possibility of a biological link between type 2 diabetes and iron deficiency anaemia, but further research is required to confirm this,” she said.

Iron deficiency anaemia can cause fatigue, dizziness, a rapid or irregular heartbeat, and can put extra stress on the heart. It is usually easily treatable.

“Recognising that this is an issue, and working out what is causing the problem, will help us to identify and treat iron deficiency before it gets to a stage of needing a hospital admission,” said co-author Professor Jonathan Shaw.

The leading cause of excess hospitalisations for men living with type 2 diabetes was cellulitis, a well-known complication of diabetes. Other well-known complications that were responsible for large numbers of excess hospitalisations included heart failure, heart attack and angina.

However, mental health disorders, including stress disorders, depression, and schizophrenia, had levels of hospitalisations that in some cases exceeded the top-ranked traditional diabetes complications. 

“In men, stress disorders accounted for the highest number of excess admissions of all diagnoses, with the exception of cellulitis,” Prof Magliano said. “This reinforces the evidence that mental health disorders are also an emerging complication of diabetes.”

Asthma was also associated with a high number of hospitalisations in women. While this is a novel finding, there is evidence suggesting a link between obesity, diabetes, and asthma, which is thought to be related to high cholesterol, high insulin levels and physical inactivity.

“What our study has shown is that people with type 2 diabetes are at greater risk of hospitalisation for most medical conditions compared to the general population, including conditions not commonly associated with diabetes,” Prof Magliano said. “These are important findings that demonstrate the need to revise diabetes management to account for the changing spread of complications.”

Source: Baker Heart and Diabetes Institute

Categories : CancerTags :

Adverse Effects of Antibody Drug Conjugates for Cancer Treatment

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Over the past two decades, numerous complex cancer therapies called antibody drug conjugates (ADCs) have been tested in clinical trials and approved for use in patients. An analysis of multiple scientific databases has found that some ADCs have higher rates of adverse effects. The findings were reported in the journal CANCER.

An ADC has a complex structure comprised of a monoclonal antibody (MoAb) that targets a protein expressed on cancer cells, a toxic compound to kill the targeted cells (also called a payload or warhead), and a linker to join the two. The clinical efficacy and toxicity of ADCs are affected by each component. Data have established that ADCs as anticancer therapeutics have a unique mechanism of action, which includes the targeted delivery and release of its payload at the tumours site through MoAb antibody components, thus exerting simultaneous roles as both targeted therapy and chemotherapy

In 2000, gemtuzumab ozogamicin was the first ADC approved by the US Food and Drug Administration, and more than a dozen ADCs have been approved worldwide to date. To investigate the side effects associated with different ADCs, a team led by Prof Hong Zhu of Xiangya Hospital, Central South University, in China, conducted a systematic review and meta-analysis of published clinical trials of ADCs that reported treatment-related toxicities.

The researchers found 2511 records of 169 relevant trials involving 22 492 patients. The incidence of treatment-related adverse events was 91.2% for all events and 46.1% for serious adverse events (grade 3 or higher). The most common adverse events overall were lymphopenia, nausea, neutropenia, vision blurriness, and peripheral neuropathy. The most common serious adverse events were neutropenia, hypaesthesia, thrombocytopenia, neutropenia with fever, and lymphopenia. Certain ADCs were linked with higher average incidences of adverse events.

“Different ADCs appear to vary in their treatment-related adverse events. Our results provide an important reference for clinicians and patients on how to address ADCs’ toxicity in clinical practice,” said Prof Zhu.

Source: Wiley

Categories : DentistryTags :

Vaping Device Use Tied to Increased Risk of Developing Cavities

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Research published in The Journal of the American Dental Association found patients who said they used vaping devices were more likely to have a higher risk of developing cavities. The findings of this study on the association between vaping and risk of caries serve as an alert that this once seemingly harmless habit may be very detrimental, says Karina Irusa, assistant professor of comprehensive care at Tuftst University and lead author on the paper.

Over the last few years, public awareness has increased about the dangers of vaping to systemic health, particularly after the use of vaping devices was tied to lung disease. Some dental research has shown ties between e-cigarette use and increased markers for gum disease, and, separately, damage to the tooth’s enamel, its outer shell. But relatively little emphasis has been placed on the intersection between e-cigarette use and oral health, even by dentists, says Irusa.

Irusa says that the finding may be just a hint of the damage vaping causes to the mouth. “The extent of the effects on dental health, specifically on dental decay, are still relatively unknown,” she says. “At this point, I’m just trying to raise awareness,” among both dentists and patients.

This study, Irusa says, is the first known specifically to investigate the association of vaping and e-cigarettes with the increased risk for getting cavities. She and her colleagues analysed data from more than 13 000 patients older than 16 who were treated at Tufts dental clinics from 2019–2022.

Irusa found a significant difference in dental caries risk levels between the e-cigarette/vaping group and the control group. Some 79% of the vaping patients were categorised as having high-caries risk, compared to just about 60% of the control group. The vaping patients were not asked whether they used devices that contained nicotine or THC, although nicotine is more common.

“It’s important to understand this is preliminary data,” Irusa says. “This is not 100% conclusive, but people do need to be aware of what we’re seeing.” Further studies need to be done, and Irusa wants to take a closer look at how vaping affects the microbiology of saliva.

One reason why e-cigarette use could contribute to a high risk of cavities is the sugary content and viscosity of vaping liquid, which, when aerosolised and then inhaled through the mouth, sticks to the teeth. (A 2018 study published in the journal PLOS One likened the properties of sweet-flavoured e-cigarettes to gummy candies and acidic drinks.) Vaping aerosols have been shown to change the oral microbiome making it more hospitable to decay-causing bacteria. It’s also been observed that vaping seems to encourage decay in areas where it usually doesn’t occur – such as the bottom edges of front teeth. “It takes an aesthetic toll,” Irusa says.

The Tufts researchers recommend that dentists should routinely ask about e-cigarette use as part of a patient’s medical history, including paediatric dentists who see adolescents. According to the FDA/CDC, 7.6% of middle- and high-school students said they used e-cigarettes in 2021.

The researchers also suggest patients who use e-cigarettes should be considered for a “more rigorous caries management protocol,” which could include prescription-strength fluoride toothpaste and fluoride rinse, in-office fluoride applications, and checkups more often than twice a year.

“It takes a lot of investment of time and money to manage dental caries, depending on how bad it gets,” Irusa says. “Once you’ve started the habit, even if you get fillings, as long as you continue, you’re still at risk of secondary caries. It’s a vicious cycle that will not stop.”

Source: Tufts University

Categories : CancerTags :

Irradiating only Select Lymph Nodes Reduces Cancer Recurrences

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A new study published in Nature Communications suggests that the recurrence of certain cancers can be significantly decreased by only irradiating a select set of lymph nodes near a tumour instead of all of them. By doing so, some immune cells that can recognise the cancer are able to survive.

“Doctors have traditionally irradiated all the lymph nodes surrounding a tumour in a process called ‘elective nodal irradiation,'” said senior author Sana Karam, MD, PhD, associate professor of radiation oncology at the University of Colorado School of Medicine. “But the problem with this scorched-earth approach in the era of immunotherapy is that doing so also eliminates the source of immune cells for the immunotherapy to work on. Lymph nodes are the hub for priming and expanding the major immune cells that can go and fight the cancer.”

Karam and her team learned that irradiating all of the lymph nodes around a tumour significantly decreased immune memory and antigen spread, creating a much greater risk of metastasis. “That was an unexpected finding,” says Karam.

The team tested this theory pre-clinically on several different tumour models of head and neck, along with a breast cancer and melanoma model. The results remained the same: when radiation killed immune cells that recognised the cancer, the patient’s immune system lost the ability to fight the cancer systemically.

On the other hand, the researchers found that irradiating certain lymph nodes known as sentinel lymph nodes was absolutely critical. Failure to irradiate those resulted in recurrence nearby.

“This study confirms why elective nodal irradiation has long been the clinical standard of care, as it does decrease regional recurrence,” said Laurel B. Darragh, the paper’s first author and an MD/PhD student in Dr. Karam’s lab. “But it also shows that to combine radiation with immunotherapy effectively, we need to re-evaluate our strategies and restrict nodal irradiation to the sentinel lymph nodes. This eliminates regional neck recurrence, and far away spread, while preserving long-term, systemic immune response.”

The findings were corroborated by data from a recent human patient clinical trial where pre-surgical radiation was limited to the gross tumour and the sentinel lymph nodes while avoiding all other lymph nodes so as to sustain immune memory. Researchers found that the immune system in these patients was highly activated, which has been shown to correlate with a better prognosis.

“We’re hopeful that this data will set the stage for future clinical trial design, not only reducing patients’ side effects but also improving long-term outcomes,” said Karam.

Source: University of Colorado Anschutz Medical Campus