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No adverse CV outcomes and excess risks of death from Febuxostat

Cr. Halacious

Source from MIMS.com

According to the results of a meta-analysis, the use of febuxostat does not appear to come with an increased hazard of mortality or adverse cardiovascular (CV) outcomes, for the treatment of patients with gout and hyperuricemia.

Data from 15 randomized controlled trials were collected by researchers and contributed to a total of 16,070 participants. The proportion of patients with hypertension varied between 27.7 percent and 100.0 percent, while those with diabetes ranged from 6.9 percent to 100.0 percent.

A median follow-up of 6.4 months were used across the trials, and the use of febuxostat vs control (allopurinol or placebo) did not result in a significant increase in the risk of CV mortality and all-cause mortality.

The same was true for adverse CV outcomes, as follows: major adverse CV events (risk difference [RD] 1.40 percent), myocardial infarction (RD, -0.06 percent), stroke (RD, 0.10 percent), or new-onset hypertension (RD, 1.58 percent).

Among patients with existing CV disease, the findings were consistent and the test (Egger’s regression test) did not detect significant publication bias.

The evidence were limited by the presence of low to moderate certainty, the researchers said. Recommendations of evaluating CV events and mortality as an outcome were stated by the researchers, as well as defining major adverse CV events, and comparing the outcomes among different doses of febuxostat over a longer follow-up duration in future trials.

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Women with recurrent pregnancy loss could reduce their stress with emotion-focused strategies

Cr. Matteo Di iorio

Source from MIMS.com

According to the data presented at ESHRE 2020, perceived stress in women who had recurrent pregnancy loss (RPL) could be reduced by meditation and mindfulness interventions.

Karen Kirchheiner from Hdidovre Hospital in Denmark, stated that studies have shown perceived stress and moderate-to-severe depression are more prevalent in women with RPL than other women trying to conceive.

“A 7-week meditation and mindfulness programme significantly reduced perceived stress [vs] a standard supportive care programme for women with RPL,” she said.

The researchers in the study randomized 76 women, 1:1 to receive supportive care alone or with a 7-week meditation and mindfulness programme facilitated by an authorized instructor. Daily guided audio of meditation for 10-20 minutes were also instructed for the women in the intervention arm while women in the control arm were instructed against meditation; 63 women completed the study.

Mean perceived stress significantly dropped from baseline in both the intervention and the control arms at 7 weeks with intervention outweighed the control protocol in terms of perceived stress reduction for between-group comparison.

The between-group difference was not significant as the perceived stress levels remained low in both intervention and control arms at 12 months vs baseline.

Women in the intervention arm had a significant reduction in personal stress from baseline, which were based on COMPI-FPSS scores at week 7. No significant differences were seen in the other two domains despite the reduced scores.

Consistent numerical reductions were seen across all COMPI-FPSS domains with the intervention protocol at 12 months, 9.2 to 8.7 points, and 7.9 to 7.6 points with only the social domain score reduction was statistically significant.

At week 7, depression was reported at baseline, dropping to none for two women in the intervention and at 12 months, only one had depression. However, these reductions did not equate to statistical significance.

Kirchheiner stated that there are no any significant decrease in depression in all three timelines and underlined that the study was not powered to detect differences in Major Depression Index (MDI).

“[Nevertheless, our studies suggest that] guided self-administered meditations could be a useful tool in the care for women experiencing RPL …. We now have a documented tool to reduce perceived stress. The question now is how to implement this in our clinical practice,” she concluded.

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Early ageing of ovary: A future health problem?

Cr. Andre Piacquadio

Source from MIMS.com

A large cohort study that was presented at the 2020 ESHRE Meeting suggested that early ovarian ageing may be predictive of later health problems.

Few oocytes in Assisted Reproductive Technology (Art) were harvested from young women with premature ovarian ageing and were discovered to have a much higher risk of age-related diseases such as cardiovascular diseases (CVD) and osteoporosis compared to those with undergoing normal ovarian ageing and happens to be in line with what was known so far regarding early menopause.

Mette Wulf Christensen from Aarhus University in Denmark suggested that a few oocytes that were repeatedly harvested in well stimulated ART cycles is a likely predictor of advanced menopausal age when seen in young women and may thus serve as an early marker of accelerated general ageing. There is also an association shown between early menopause with a greater risk of CVD, osteoporosis, and death. She also said that identifying women at risk of early menopause may thus allow early preventive health initiatives in terms of  a healthy lifestyle.

The national cohort study that was based in Danish included >19,000 young women (≤37 years) who were undergoing their first ART treatment in a fertility clinic between the period of 1995-2014 with the number of oocytes harvested in the first and following cycles serves as a marker.

In a follow-up of 6 years span, women with early ovarian ageing for overall-disease risk has a higher risk than those with a normal oocyte field and they consisted of Alzheimer’s or Parkinson’s disease, all-cause death, cancer, cataract, Charlson Comorbidity index, CVD, early retirement benefit, osteoporosis and type 2 diabetes.

To be specific, the early ovarian ageing group was significantly more likely to develop osteoporosis, CVD, comorbidity, and have early retirement benefit than women with normal ovarian ageing.

Christhensen concluded that it is important to have a counselling towards the women who are affected with a much earlier menopause, with the introduction of a new lifestyle habit or  applying the use of hormone replacement therapy (HRT) to reduce the adverse health risks.

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