Medical Bulletin 05/ August/ 2024
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Here are the top medical news for the day:
Early Pregnancy Subclinical Hypothyroidism Linked to Quadrupled Risk of Postpartum Thyroid Dysfunction
A new study has shown that subclinical hypothyroidism diagnosed before 21 weeks of pregnancy is associated with more than fourfold higher rates of overt hypothyroidism or thyroid replacement therapy within 5 years of delivery. The study is published in the peer-reviewed journal Thyroid®, the official journal of the American Thyroid Association.
Subclinical hypothyroidism, or a change in the levels of thyroid-stimulating hormone (TSH) that isn’t severe enough to cause symptoms, is especially common during pregnancy, affecting as many as 1 in 4 pregnant people. While subclinical hypothyroidism isn’t inherently dangerous, overt hypothyroidism comes with serious symptoms including fatigue, depression, and heart problems.
Researchers reported that progression to overt hypothyroidism was more common in individuals with thyroid-stimulating hormone levels that were more than twice the normal level. The investigators found that diagnosis of hypothyroxinemia, a deficiency in the thyroid hormone thyroxine, before 21 weeks of pregnancy was not associated with the development of overt hypothyroidism after delivery.
Hence, the authors concluded that Subclinical hypothyroidism is associated with higher rates of overt hypothyroidism or thyroid replacement therapy within 5 years of delivery than is hypothyroxinemia when these conditions are diagnosed in the first half of pregnancy.
Ref: Michael W. Varner et al, Progression of Gestational Subclinical Hypothyroidism and Hypothyroxinemia to Overt Hypothyroidism After Pregnancy: Pooled Analysis of Data from Two Randomized Controlled Trials, Thyroid (2024). DOI: 10.1089/thy.2023.0616
Glycated Hemoglobin A1c Levels and Dementia Risk in Older Diabetics: A New Perspective
Individuals with diabetes commonly experience Alzheimer disease and related dementias (ADRD). Factors such as hypoglycemia, hyperglycemia, and glycemic variability have been associated with increased risk of ADRD. Traditional glycemic measures, such as mean glycated hemoglobin A1c (HbA1c), may not identify the dynamic and complex pathophysiologic factors in the association between diabetes and ADRD.
The HbA1c time in range (TIR) is a previously developed measure of glycemic control that expresses HbA1c stability over time within specific ranges. This measure may inform the current understanding of the association between glucose levels over time and ADRD incidence.
Therefore, the present study was conducted to examine the association between HbA1c time in range and incidence of ADRD in older veterans with diabetes.
The study sample for this cohort study was obtained from administrative and health care utilization data. Participants were required to have at least 4 HbA1c tests during the 3-year baseline period.
The study included 374 021 veterans with diabetes. During follow-up of up to 10 years, 11% developed ADRD. Furthermore, the direction of out-of-range HbA1c levels was associated with incident ADRD. Having greater time below range was associated with significantly increased risk.
Hence, it was concluded that in this study of older adults with diabetes, increased HbA1c stability within patient-specific target ranges was associated with a lower risk of ADRD. Lower HbA1c TIR may identify patients at increased risk of ADRD.
Ref: Underwood PC, Zhang L, Mohr DC, et al. Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes. JAMA Netw Open. 2024;7(8):e2425354. doi:10.1001/jamanetworkopen.2024.25354
Atypical type of Macrophages Enable Alveolar Regeneration Following Lung Injury
The lung is constantly exposed to airborne pathogens and particles that can cause alveolar damage. Hence, appropriate repair responses are essential for gas exchange and life.
Here, the authors deciphered the spatiotemporal trajectory and function of an atypical population of macrophages after lung injury. Post–influenza A virus (IAV) infection, short-lived monocyte-derived Ly6G-expressing macrophages were recruited to the alveoli of lung perilesional areas.
Ly6G+ Macs engulfed immune cells, exhibited a high metabolic potential, and clustered with alveolar type 2 epithelial cells (AT2s) in zones of active epithelial regeneration. Ly6G+ Macs were partially dependent on granulocyte-macrophage colony-stimulating factor and interleukin-4 receptor signaling and were essential for AT2-dependent alveolar regeneration.
Similar macrophages were recruited in other models of injury and in the airspaces of lungs from patients with suspected pneumonia. This study identifies perilesional alveolar Ly6G+ Macs as a spatially restricted, short-lived macrophage subset promoting epithelial regeneration postinjury, thus representing an attractive therapeutic target for treating lung damage.
Ref: Cecilia Ruscitti et al. ,Recruited atypical Ly6G+ macrophages license alveolar regeneration after lung injury.Sci.
Immunol.9,eado1227(2024).DOI:10.1126/sciimmunol.ado1227
Study finds possible link Between Sleep Issues, Substance Use, and Suicidal Thoughts in Depressed Adolescents
Sleep difficulties and misuse of drugs/alcohol have been associated with suicidal ideation in young people. Using cross-sectional representative surveys of adolescents , the researchers conducted adjusted logistic regression modeling to assess the relationships between sleep difficulties, substance use, and suicidal ideation among adolescents with a history of depression.
Data were analyzed from 66,422 adolescents aged between 12-17 years. 38,418 participants responded affirmatively to the mental illness screener. Among those, 11.6% reported thinking about suicide, 5.7% reported planning a suicide attempt and 3.8% reported making a suicide attempt. 16.7% reported sleep difficulties. Of the analytical sample, 2.8% reported alcohol abuse/dependence and 4.6% reported illicit drug dependence or abuse.
In those reporting alcohol abuse/dependence, sleep difficulties were associated with attempting suicide. In those reporting illicit drug abuse/dependence, sleep difficulties were associated with thinking about and attempting suicide.
So the authors observed a significant association between sleep difficulties and suicidal ideation (e.g., thinking about) among adolescents who reported symptoms of a major depressive episode. These findings are consistent with extensive evidence linking sleep difficulties with mental health concerns, such as suicidal ideation.
Ref: Rebecca Robbins, Matthew D. Weaver et al, Exploring sleep difficulties, alcohol, illicit drugs, and suicidal ideation among adolescents with a history of depression,
Psychiatry Research, 2024, 116116, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.116116.
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