Medical Bulletin 30/ January/ 2025 - Video

A large proportion of babies born very early need intensive care, which can be painful. But the healthcare system fails to provide pain relief to the full extent. This is shown by the largest survey to date of pain in neonatal care, published in the journal Pain.

Every day for 4.5 years, neonatal care staff have recorded the occurrence of pain, the causes of pain, and how pain is assessed and treated in premature babies in Sweden. The study covers 3,686 babies born between 22 and 31 weeks of gestation from 2020 to 2024. The total observation time was just over 185,000 days of care.

The researchers found that babies born extremely early, in weeks 22 to 23, had the highest proportion of painful medical conditions and almost daily painful intensive care procedures throughout the first month after birth. However, this is not surprising.

90 percent of the most extremely preterm infants had to undergo painful procedures. Despite this, healthcare professionals reported that only 45 percent of babies experienced pain - which may be because pain was largely prevented or treated. However, a check of the drugs administered suggests other explanations may exist.

One limitation is that the study could not determine the duration or severity of pain for each day reported. However, it is a problem and a challenge that healthcare professionals are not always able to determine whether children are in pain.

It is very important to improve pain management for premature babies, as we now know that their development is negatively affected by the strong signals in the brain that pain causes.

“The vision for all neonatal care is to be pain-free. The results of this survey will be of great importance for improving neonatal care and for future research in the field,” concludes Mikael Norman, professor of paediatrics at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and lead researcher of the study.

Reference: Graham, Hillarya; Razaz, Nedaa; Håkansson, Stellanb; Blomqvist, Ylva Thernströmc; Johansson, Karia,d; Persson, Martinae; Nyholm, Annikab; Norman, Mikaelf,g,*. Pain in very preterm infants—prevalence, causes, assessment, and treatment. A nationwide cohort study. PAIN ():10.1097/j.pain.0000000000003528, January 21, 2025. | DOI: 10.1097/j.pain.0000000000003528

Statins, a class of cholesterol-lowering drugs, have no effect on kidney function, a research team led by the University of Iowa has found. The findings are published in Journal of the American Geriatrics Society.

The research team examined the association between statin use in older adults and changes in two important indicators of kidney function — estimated glomerular filtration rate and urine albumin-to-creatinine (protein-to-waste) ratio.

The researchers used data collected from a previous research trial that studied use of daily low-dose aspirin in more than 18,000 older adults from the United States and Australia between 2010 and 2017. Among that population, one in five participants had chronic kidney disease. The median age was 76 in participants with chronic kidney disease and 74 in those without.

Examining the data, the researchers found statin use did not improve kidney function, as had been hypothesized in some previous scientific studies. The drugs also had no ill effects.

“While older adults are at greatest risk of cardiovascular events and kidney function decline, they are also the population at highest risk of adverse effects from medications; therefore, evidence demonstrating no negative association between statin use and kidney function provides an equally important message to one of kidney benefit,” the authors wrote.

Reference: Fravel MA, Ernst ME, Woods RL, et al. Effects of statins on kidney function in older adults. J Am Geriatr Soc. 2024; 1-12. doi:10.1111/jgs.19319

A Cleveland Clinic study shows that patients with obesity and fatty liver-related cirrhosis who had bariatric (weight-loss) surgery significantly lowered their future risk of developing serious liver complications compared with patients who received medical therapy alone. The results were published in Nature Medicine journal.

Obesity and diabetes are the leading causes of metabolic dysfunction-associated steatohepatitis (MASH). Accumulation of fat within liver cells triggers a cascade of events ultimately leading to liver scarring. About 20% of people with MASH can progress to late-stage liver scarring which is called cirrhosis.

The aim of the SPECCIAL (Surgical Procedures Eliminate Compensated Cirrhosis in Advancing Long-term) study was to examine the long-term outcomes of bariatric surgery on the risk of developing major liver complications in patients with obesity and compensated MASH-related cirrhosis, compared with nonsurgical management.

A group of 62 Cleveland Clinic’s patients with compensated MASH-related cirrhosis and obesity who had bariatric surgery were compared with a control group of 106 nonsurgical patients and followed for 15 years. Study participants had similar characteristics such as severity of liver disease at their baseline liver biopsy.

Fifteen years after enrollment, study results show that 20.9% in the surgical group and 46.4% in the nonsurgical group developed one of the major complications of liver disease including liver cancer and death.

Over the course of 15 years, 15.6% in the surgical group and 30.7% in the nonsurgical group progressed from compensated cirrhosis to the decompensated stage. At 15 years, patients in the bariatric surgery group lost 26.6% (31.6 kg) of their weight and patients in the nonsurgical control group lost 9.8% (10.7 kg) of their weight.

Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and lead investigator of the study, said results show that bariatric surgery should be considered as a treatment option in patients with cirrhosis and obesity. “Bariatric surgery was associated with a 72% lower risk of developing serious complications of liver disease and an 80% lower risk of progression to decompensated stage among patients with compensated cirrhosis and obesity.”

A new study evaluated an AI-based machine learning biomarker tool that uses speech patterns to detect moderate to severe depression, aiming to improve access to screening in primary care settings.

The study analyzed over 14,000 voice samples from U.S. and Canadian adults. Participants answered the question, “How was your day?” with at least 25 seconds of free-form speech. The tool analyzed vocal biomarkers associated with depression, including speech cadence, hesitations, pauses, and other acoustic features. These were compared to results from the Patient Health Questionnaire-9 (PHQ-9), a standard depression screening tool. A PHQ-9 score of 10 or higher indicated moderate to severe depression. The AI tool provided three outputs: Signs of Depression Detected, Signs of Depression Not Detected, and Further Evaluation Recommended (for uncertain cases).

The dataset used to train the AI model consisted of 10,442 samples, while an additional 4,456 samples were used in a validation set to assess its accuracy.

The tool demonstrated a sensitivity of 71%, correctly identifying depression in 71% of people who had it.

Specificity was 74%, correctly ruling out depression in 74% of people who did not have it.

The study findings suggest that machine learning technology could serve as a complementary decision-support tool for assessing depression.

Reference: Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression

Alexa Mazur, Harrison Costantino, Prentice Tom, Michael P. Wilson, Ronald G. Thompson

The Annals of Family Medicine Jan 2025, 23 (1) 60-65; DOI: 10.1370/afm.240091