Gestational Exposure to NSAIDs Tied to Childhood Chronic Kidney Disease
Gestational exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk for childhood chronic kidney disease (CHD), although the association is not seen in sibling comparisons, according to a study published online Dec. 23 in JAMA Pediatrics.
You-Lin Tain, M.D., Ph.D., from Kaohsiung Chang Gung Memorial Hospital and the Chang Gung University College of Medicine in Taiwan, and colleagues examined the association between gestational exposure to NSAIDs and the risk for CKD in childhood in a cohort study involving 1,025,255 children born alive in Taiwan from Jan. 1, 2007, to Dec. 31, 2017, with follow-up until Dec. 31, 2021.
The study included 163,516 singleton-born children whose mothers used at least one dispensing of an NSAID during pregnancy. The researchers observed a significant association between gestational NSAID exposure and a higher risk for childhood CKD (weighted hazard ratio [wHR], 1.10). In sibling comparisons, there was no association seen between NSAID use and fetal nephrotoxicity. In singleton-born children, increased risks were seen for exposure during the second and third trimesters (wHRs, 1.19 and 1.12, respectively). Specific NSAID exposures associated with elevated CKD risk included indomethacin and ketorolac in the first trimester (wHRs, 1.69 and 1.28, respectively); diclofenac and mefenamic acid in the second trimester (wHRs, 1.27 and 1.29, respectively); and ibuprofen in the third trimester (wHR, 1.34).
"Future research should investigate the specific roles of genetic and environmental factors in kidney development across different stages of pregnancy," the authors write.
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Bleeding Risk Increased With NSAID Use for VTE Patients Receiving Anticoagulants
Patients with venous thromboembolism (VTE) initiating oral anticoagulants have an increased risk for bleeding when using nonsteroidal anti-inflammatory drugs (NSAIDs), according to a study published online Nov. 17 in the European Heart Journal.
Søren Riis Petersen, from Aarhus University Hospital in Denmark, and colleagues conducted a nationwide cohort study of 51,794 VTE patients initiating oral anticoagulants between Jan. 1, 2012, and Dec. 31, 2022. Adjusted hazard ratios between NSAID use and hospital-diagnosed bleeding episodes were computed.
The researchers found that the event rates for any bleeding per 100 person-years were 3.5 and 6.3 during periods without and with NSAID use, respectively (number needed to harm, 36 patients treated for one year). The adjusted hazard ratios for any bleeding associated with NSAID use versus nonuse were 2.09, 1.79, 3.30, and 4.10 overall, for ibuprofen, for diclofenac, and for naproxen, respectively. The adjusted hazard ratios associated with NSAID use versus nonuse were 2.24, 3.22, 1.36, 1.57, and 2.99 for gastrointestinal bleeding, intracranial bleeding, thoracic and respiratory tract bleeding, urinary tract bleeding, and anemia caused by bleeding, respectively. For anticoagulant and VTE subtypes, the results were consistent.
"The common use of NSAIDs in patients with cardiovascular disease emphasizes the importance of being aware of the bleeding risks associated with their use," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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American Society of Anesthesiologists, Oct. 18 to 22
The annual meeting of the American Society of Anesthesiologists was held from Oct. 18 to 22 in Philadelphia, attracting approximately 5,000 participants from around the world, including anesthesiologists and other health care professionals. The conference featured presentations focusing on the latest advances in the relief of pain and total care of surgical patients prior to, during, and after surgery.
In one study, Ivie Izekor, of the Texas A&M College of Medicine in Bryan, and colleagues found a strong association between the number of surgeries a patient undergoes and their risk for malnutrition.
A total of 28,475,485 patients who underwent orthopedic surgery of any kind were identified through the National Inpatient Sample database between 2016 and 2019, including 1,853,360 (6.5 percent) who were diagnosed with malnutrition after admission. The researchers found that patients with more frequent surgeries were significantly more likely to be malnourished, which led to longer hospital stays, higher health care costs, and increased in-hospital mortality. For instance, patients with six to 10 surgeries had a 1.6 times greater risk for malnutrition, and those with 21 to 25 surgeries had more than a five times greater risk.
"The risk of malnutrition increases significantly with the number of surgeries," Izekor said. "Mathematically, based on our study's population, malnutrition-related mortality is higher than aspiration-related mortality."
In another study, Elizabeth Pealy, M.D., of the University of Chicago Medicine, and colleagues aimed to determine the feasibility of administering the recently developed, pediatric-specific, computerized adaptive mental health assessment tool (KCAT) on pediatric surgical patients in the preoperative area. The authors also examined the prevalence of anxiety and depression in this population.
The researchers found that all 65 patients who were enrolled in the study and were scheduled for elective surgery were able to complete KCAT in an average of two minutes and 13 seconds. There were no major issues noted with performing this assessment in the preoperative area. The prevalence of preoperative anxiety was more than 50 percent, and preoperative depression was observed in about one-third of the patients who were screened.
"Using this tool to identify preoperative anxiety and/or depression will allow the patient's care team to individualize management of these mental health issues preoperatively, intraoperatively, and postoperatively and focus resources on patients who could have the most benefit," Pealy said.
Ryan C. Nicholson, M.P.H., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues found that simple interventions such as treating a patient with a nonsteroidal anti-inflammatory drug (NSAID) around the time of surgery may reduce the incidence of postoperative delirium.
The medical records from a large database were assessed to identify patients who had surgery with anesthesia between 2014 and 2023. The researchers found that NSAIDs like ibuprofen reduced the incidence of postoperative delirium more than Tylenol when given before, during, or immediately after surgery. Furthermore, nonsalicylates were superior compared with salicylates in reducing the incidence of delirium. The reduction in delirium was most significant in patients older than 65 years, who have a higher risk for delirium due to comorbidities and age.
"We have been increasingly incorporating NSAIDs into our surgical recovery protocols. We routinely use medications like the nonsalicylate NSAID celecoxib for this purpose," Nicholson said. "Additional research needs to be completed to identify NSAIDs that are most effective, the patient population we should target most, and exact timing of the intervention (pre-, intra-, or postoperative)."
ASA: Risk for Postoperative Delirium Increased With Poor and Worsening Sleep
FRIDAY, Oct. 25, 2024 (HealthDay News) -- Inadequate sleep and worsening sleep trajectory are associated with postoperative delirium among adults undergoing noncardiac surgery under general anesthesia, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
ASA: Fibrinogen-to-Albumin Ratio Is Risk Factor for Preeclampsia
THURSDAY, Oct. 24, 2024 (HealthDay News) -- The fibrinogen-to-albumin ratio is an independent risk factor for development of any preeclampsia and preeclampsia with severe features, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
ASA: Repeated Fasting Increases Malnutrition Risk in Patients Undergoing Multiple Surgeries
THURSDAY, Oct. 24, 2024 (HealthDay News) -- Malnutrition is more likely among patients undergoing multiple orthopedic surgeries, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from Oct. 18 to 22 in Philadelphia.
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Dengue Cases Mount in Los Angeles
The Los Angeles area is seeing a troubling increase in local dengue fever cases, health officials warned Wednesday.
In a public notice posted on its website, the Los Angeles County Public Health Department said at least three people have fallen ill with dengue fever this month after being bitten by mosquitoes in the Baldwin Park neighborhood east of downtown Los Angeles.
"The Los Angeles County Department of Public Health has confirmed 3 cases of locally acquired dengue. These residents had no history of travel to places where dengue is common prior to their symptoms," health officials said in the notice. "Cases of locally acquired dengue are very rare in LA County. Last fall, two cases of locally acquired dengue were identified in Long Beach and Pasadena. Almost all reported dengue cases in LA County have involved travel to a country where dengue is commonly spread."
So far this year, 82 cases have been reported in LA County by people returning from traveling abroad, health officials said.
But the three locally-acquired cases are particularly concerning, they added.
"These additional cases of local virus transmission are a stark reminder for all Los Angeles County residents that simple steps to prevent mosquito breeding and mosquito bites can lower the risk of mosquito-borne diseases and prevent more sustained transmission in the future," health officials stressed in the notice.
What can residents do to protect themselves?
“Reducing exposure to mosquitoes and the risk for mosquito bites are crucial to preventing transmission of mosquito-borne disease, including dengue fever,” Los Angeles County Health Officer Dr. Muntu Davis said in the notice. “This can be as simple as using insect repellent to prevent mosquito bites, eliminating any standing water around your home where mosquitoes can breed, and keeping your home mosquito-free by using or fixing screens on your doors and windows. These straightforward measures can significantly reduce the risk of mosquito-borne disease for both you and your neighbors."
Los Angeles is not alone is seeing more local cases of dengue fever emerge this year: Illnesses have been reported in Florida, the U.S. Virgin Islands and Puerto Rico, where officials have declared a dengue epidemic. There have been 3,277 locally-acquired cases in the United States this year, of which 96% were in Puerto Rico, according to the U.S. Centers for Disease Control and Prevention.
Cases of dengue have been surging globally as climate change brings warmer weather that allows mosquitoes to breed and spread further.
Dengue fever is commonly spread through the bite of infected Aedes mosquitoes in tropical areas. While Aedes mosquitoes are common in Los Angeles County, local infections weren’t confirmed until last year, health officials noted.
Dengue can cause high fevers, rashes, headaches, nausea, vomiting, muscle pain, and bone and joint pain. About 1 in 4 patients will develop symptoms, which usually appear within five to seven days of a bite from a dengue-carrying mosquito, according to the CDC. One in 20 people with symptoms will develop severe dengue, which can lead to severe bleeding and can be life-threatening.
There are no antiviral medications to treat dengue. Instead, treatment involves ibuprofen, acetaminophen and other nonsteroidal anti-inflammatory drugs (NSAIDs).
Luckily, there are two vaccines that can tackle dengue: One is Dengvaxia, developed by Sanofi, while the other is Dengue Tetravalent Vaccine, developed by Takeda Pharmaceuticals.
More information
The CDC has more on dengue fever.
SOURCE: Los Angeles County Department of Public Health, health notice, Sept. 18, 2024
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Myorelaxants, NSAIDs, NSAID-Acetaminophen Combo Ease Lower Back Pain
FRIDAY, March 3, 2023 (HealthDay News) -- For adults with acute lower back pain (LBP), myorelaxants, nonsteroidal anti-inflammatory drugs (NSAIDS), and NSAIDs combined with acetaminophen can reduce pain and disability, according to a review published online Feb. 22 in the Journal of Orthopaedic Research.
Alice Baroncini, M.D., Ph.D., from RWTH University Hospital in Aachen, Germany, and colleagues conducted a systematic review to examine whether pharmacological management of acute LBP can effectively reduce pain and disability and which drugs have the highest efficacy. All randomized controlled trials examining the efficacy of myorelaxants, NSAIDs, and acetaminophen for acute (less than 12 weeks) LBP of the lumbar spine in adults were included; studies assessing opioid use in acute LBP were not included. Data were obtained from 18 trials with 3,478 patients.
The researchers found that at approximately one week, myorelaxants and NSAIDs were effective for reducing pain and disability in acute LBP. Greater improvement was seen with the combination of NSAIDs and acetaminophen than with NSAIDs alone, while no significant improvement was seen with acetaminophen alone. Placebo was not effective for pain reduction.
"This is a first step towards the optimization of the management of acute low back pain. However, specific patient characteristics such as having allergies and comorbidities must always be taken into consideration," Baroncini said in a statement. "Further research will need to focus on the identification of the type of drugs that not only offer the best and quickest pain relief, but also show the lowest rate of symptom recurrence."
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