Medical Bulletin 3/November/2022

The aorta is the largest artery in the body and carries oxygen-rich blood from the heart to the rest of the body. Aortic disease occurs when the aortic wall is weakened and either bulges, causing an aortic aneurysm or tears, causing an aortic dissection.

A ruptured aneurysm or severe dissection may be immediately fatal. If either is discovered via imaging tests, lifesaving treatment can include careful monitoring the injured aorta, surgery, medication and/or lifestyle changes. Symptoms of aortic disease include chest pain or pressure, back pain, fatigue, neck pain or jaw pain.

The American College of Cardiology and the American Heart Association have published a new guideline on the diagnosis and management of aortic disease, focusing on surgical intervention considerations, consistent imaging practices, genetic and familial screenings, and the importance of a multidisciplinary aortic team.

Reference:

Eric M. Isselbacher et al,2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease, Journal of the American College of Cardiology, DOI: 10.1016/j.jacc.2022.08.004

Dapagliflozin clinically and cost effective in patients with chronic kidney disease: DAPA-CKD trial

A recent analysis in CJASN indicates that in patients eligible for the DAPA-CKD trial, dapagliflozin is not only effective from a clinical standpoint, but also from a cost standpoint.

The burden of chronic kidney disease (CKD) to both healthcare systems and patients is considerable. Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, was shown to be an efficacious treatment for CKD in the Dapagliflozin And Prevention of Adverse outcomes in CKD (DAPA-CKD) trial.

The DAPA-CKD trial showed treatment with dapagliflozin and standard of care led to a slowing of decline in kidney function and a reduction in the incidence of kidney failure and risk of cardiovascular- or kidney-related death, compared with placebo and standard of care. In this latest analysis, Phil McEwan, PhD (Health Economics and Outcomes Research Ltd., Cardiff, UK) and his colleagues estimated the cost-effectiveness of dapagliflozin added to standard therapy, compared with standard therapy alone, based on the results of the DAPA-CKD trial and considered from a multinational European healthcare system perspective.

Reference: DOI 10.2215/CJN.03790322 AMERICAN SOCIETY OF NEPHROLOGY

Evidence found for "substantial" pre-symptomatic monkeypox transmission

Although case numbers are now declining, it's still important to understand the "transmission dynamics" of the virus - for example, how it spreads from one person to another and how quickly symptoms appear - to help inform policy decisions and future interventions.

A UK study published by The BMJ found evidence for "substantial" monkeypox transmission before symptoms appear or are detected (known as pre-symptomatic transmission).

Transmission was detected up to a maximum of four days before the onset of symptoms, and the researchers estimate that more than half (53%) of transmission occurred in this pre-symptomatic phase, meaning that many infections cannot be prevented by asking individuals to isolate after they notice their symptoms.

Reference:

Thomas Ward, et al, Transmission dynamics of monkeypox in the United Kingdom: contact tracing study doi: 10.1136/ bmj-2022-073153, Editorial: The dynamics of monkeypox transmission: Pre-exposure vaccination and vaccine equity are urgently needed worldwide doi: 10.1136/ bmj.o2504, The BMJ, DOI 10.1136/bmj-2022-073153

Morning blue light therapy improves symptoms in PTSD patients

Sleep is crucial for maintaining physical and mental health, and inadequate sleep over time can impact all aspects of life with serious implications for long-term health, relationships, cognitive abilities such as learning, and healing.

The influence of sleep disruption on PTSD symptom severity is well established. Those who seek treatment to allay their PTSD symptoms often face a vicious cycle where poor sleep interferes with the effectiveness of treatments, negating any lessening of symptoms, which in turn contributes to sleep disruptions. To reduce and eliminate the emotional impact of traumatic memories, the patient needs quality sleep to integrate healing mechanisms achieved through cognitive or exposure therapy treatments.

People with post-traumatic stress disorder (PTSD) experienced better sleep, a reduction in the severity of PTSD symptoms and more effective treatments after exposure to blue light therapy, according to a new study conducted by researchers in the University of Arizona College of Medicine – Tucson's Department of Psychiatry and recently published in Frontiers in Behavioral Neuroscience.

Reference:

William "Scott" Killgore et al,Morning blue light treatment improves sleep complaints, symptom severity, and retention of fear extinction memory in post-traumatic stress disorder,Frontiers in Behavioral Neuroscience, DOI 10.3389/fnbeh.2022.886816