Medical Bulletin 09/ January/ 2025 - Video

Here are the top medical news for the day

Study Shows Non-Opioid Alternatives Outperform Opioids for Post-Dental Surgery Pain

A combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) controls pain after wisdom tooth removal better than opioids, according to a Rutgers Health study that could change how dentists treat post-surgical pain. Findings are published in The Journal of American Dental Association.

The trial in more than 1,800 patients found that those given a combination of ibuprofen and acetaminophen experienced less pain, better sleep and higher satisfaction compared with those receiving the opioid hydrocodone with acetaminophen.

To compare opioid and non-opioid pain relief, the researchers conducted a randomized trial on patients undergoing surgical removal of impacted wisdom teeth, a common procedure that typically causes moderate to severe pain.

Half the patients received hydrocodone with acetaminophen. The other half got a combination of acetaminophen and ibuprofen. Patients rated their pain levels and other outcomes, such as sleep quality, over the week following surgery.

Results showed that non-opioid combination provided superior pain relief during the peak-pain period in the two days after surgery. Patients taking the non-opioid medications also reported better sleep quality on the first night and less interference with daily activities throughout recovery.

Patients who received the over-the-counter combo were only half as likely as the opioid patients to require additional "rescue" pain medication. They also reported higher overall satisfaction with their pain treatment.

Reference: Nonopioid vs opioid analgesics after impacted third-molar extractions, Feldman, Cecile A. et al. The Journal of the American Dental Association, Volume 0, Issue 0

GLP-1 Drugs May Lower Surgical Complications in Diabetes Patients

People with diabetes who were taking GLP-1 receptor agonist drugs such as tirzepatide and semaglutide had significantly lower rates of hospital readmission, wound re-opening and hematoma after surgery, according to a large study.

The study, published online in advance of print in the l, analyzed de-identified hospital records covering 74,425 surgical procedures in 21,772 patients with diabetes over a three-and-a-half-year period ending in July 2023. The investigators found that patients taking GLP-1 receptor agonists, had about a 12% lower risk of hospital readmission within a month of surgery, a 29% lower risk of wound re-opening within six months of surgery, and about a 56% lower risk of hematoma (a collection of blood in tissue caused by bleeding) at the surgery site, compared with patients who were not taking such medications.

The results showed that the patients with diabetes who had GLP-1 drug prescriptions were modestly less likely to require hospital readmission within 30 days of surgery, implying fewer overall complications.

The researchers also looked at some specific complications: wound re-opening, hematoma, bleeding and infection. They found that while bleeding and infection occurred about as often whether or not the patients were taking GLP-1 drugs, hematoma and wound re-opening occurred markedly less often— patients on GLP-1 drugs in the 180 days following surgery had just 71.1% the risk of wound reopening and 44.0% of the risk of hematoma, compared with patients who did not have GLP-1 drug prescriptions.

References: Aschen, Seth Z. MD, MBA*; Zhang, Ashley BSE†; O’Connell, Gillian M. MD†; Salingaros, Sophia BA*; Andy, Caroline MS‡; Rohde, Christine H. MD, MPH†; Spector, Jason A. MD*. Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes. Annals of Surgery ():10.1097/SLA.0000000000006614, December 20, 2024. | DOI: 10.1097/SLA.0000000000006614

Point-of-Care Ultrasound Reduces Emergency Visits by 81%, Improves Early Pregnancy Care

Published in Annals of Family Medicine, a University of Minnesota Medical School research team found that implementing point-of-care ultrasounds (POCUS) to assess the viability and gestational age of pregnancies in the first trimester enhanced care for pregnant patients and cut emergency visits by 81% for non-miscarrying patients.

Previously, early pregnancy care was provided through separate appointments for ultrasound, risk assessment and patient education. This new integrated approach allows patients who are under 14 weeks pregnant to receive comprehensive care during a single visit. This includes ultrasound-based pregnancy dating, immediate assessment of pregnancy viability, risk evaluation and on-site counseling — all based on real-time ultrasound results.

The research team introduced this integrated approach at M Health Fairview Clinic - Bethesda in fall 2022, allowing the clinic to quickly identify high-risk cases and offer timely intervention for issues such as miscarriage or abnormal pregnancies. They found:

• The clinic saw an 81% reduction in emergency visits, urgent clinic appointments and first-trimester phone inquiries for non-miscarrying patients.

• Clinic implementation led to more timely diagnosis of abnormal pregnancies and improved education and support for all patients, including those who experience miscarriage.

• For miscarriage cases, the time from initial concern to diagnosis decreased from an average of 5.8 days to 1.7 days.

“Our study demonstrates that the use of point-of-care ultrasound provides meaningful benefit to the patients we serve by addressing early pregnancy problems at the time they are identified,” said Allison Newman, MD, an assistant professor at the U of M Medical School and family medicine physician with M Health Fairview. “POCUS in early pregnancy helps clinicians more efficiently and accurately diagnose problems without compromising the quality of needed first trimester assessments — saving time, money and stress for patients.”

Reference: Newman A, Berg M. Enhancing First Trimester Obstetrical Care: The Addition of Point-of-Care Ultrasound. Annals of Family Medicine. 2024 Nov;22(6):569.

Research reveals the health impacts of consuming sugar-sweetened beverages

A new study published in Nature Medicine, estimates that 2.2 million new cases of type 2 diabetes and 1.2 million new cases of cardiovascular disease occur each year globally due to consumption of sugar-sweetened beverages.

In developing countries, the case count is particularly sobering. Colombia, Mexico, and South Africa are countries that have been particularly hard hit. More than 48% of all new diabetes cases in Colombia were attributable to consumption of sugary drinks. Nearly one third of all new diabetes cases in Mexico were linked to sugary drink consumption. In South Africa, 27.6% of new diabetes cases and 14.6% of cardiovascular disease cases were attributable to sugary drink consumption.

Sugary beverages are rapidly digested, causing a spike in blood sugar levels with little nutritional value. Regular consumption over time leads to weight gain, insulin resistance, and a host of metabolic issues tied to type 2 diabetes and heart disease, two of the world’s leading causes of death.

As countries develop and incomes rise, sugary drinks become more accessible and desirable, the authors say. Men are more likely than women to suffer the consequences of sugary drink consumption, as are younger adults compared to their older counterparts, the researchers say.

“Sugar-sweetened beverages are heavily marketed and sold in low- and middle-income nations. Not only are these communities consuming harmful products, but they are also often less well equipped to deal with the long-term health consequences,” says Dariush Mozaffarian, senior author on the paper and director of the Food is Medicine Institute at the Friedman School.

Reference: Lara-Castor, L., O’Hearn, M., Cudhea, F. et al. Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Nat Med (2025). https://doi.org/10.1038/s41591-024-03345-4

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