Latest news with #longitudinalstudy
Medscape
06-08-2025
- Health
- Medscape
Intrapartum Events on Gut Microbiome in Vaginally Born Twins
TOPLINE: The duration of membrane rupture and number of vaginal examinations significantly influenced early gut microbiome colonization in vaginally born twins. METHODOLOGY: Researchers investigated intrapartum events during vaginal twin births — specifically the duration of membrane rupture and the number of vaginal examinations — as factors affecting early gut microbiome colonization patterns between first and second twins. This prospective longitudinal cohort study was conducted between February 2021 and January 2024 at a tertiary referral centre and enrolled 20 women with twin pregnancies ≥ 36 weeks (40 infants requiring identical care) undergoing vaginal birth. The gestational age at birth was 37.07 (36.75-37.57) weeks. Maternal age was 36.50 (30.00-38.75) years, and BMI was 25.48 (23.46-27.62). Paired stool samples were collected on days 4 and 28 postnatally. Gut microbiome was analysed via 16S rDNA sequencing. Microbial diversity was determined by calculating the Shannon-Weaver diversity index and the Bray-Curtis beta diversity index. The primary outcome of the study was to evaluate the impact of membrane rupture and vaginal examinations on the infant gut microbiome. Secondary outcomes included infection rates, dermatologic diagnoses, and infant growth metrics over the follow-up period. TAKEAWAY: First twins had significantly more vaginal examinations (median, 5.50; interquartile range [IQR], 4.00-7.25 vs median, 1.00; IQR, 1.00-1.00; P < .001) and had a longer interval from membrane rupture to birth (median, 524 min; IQR, 324-734.5 vs median, 7.5 min; IQR, 4.5-9.0; P < .001) than second twins. On day 4, the abundance of Bifidobacterium spp. was > 50% in first twins vs < 25% in second twins. Bifidobacterium longum was the dominant species in 20-40% of the samples and was more abundant in first twins than in second twins. By day 28, 75% of samples showed similar Bifidobacterium profiles between twins, indicating microbiome homogenization (Shannon index: mean, 0.520; 95% CI, 0.427-0.614 vs mean, 0.614; 95% CI, 0.526-0.703; P = .646). During the 25.5-month follow-up, no significant differences were observed in growth (weight percentile: median, 65.50; IQR, 45.03-70.85 vs median, 65.50; IQR, 48.03-77.88; P = .881) or infection rates (10% vs 20%; P = .661). IN PRACTICE: "[In] twins who share the same environment and mother, not all vaginal births are equal. Although the gut microbiome appears to progressively homogenize when similar nurturing and environmental conditions are met, clear differences exist in the early days of life," the authors wrote. SOURCE: The study was led by Marcos Javier Cuerva, Department of Obstetrics, Hospital Universitario La Paz, Paseo La Castellana, Spain, Madrid. It was published online on July 30, 2025, in European Journal of Pediatrics. LIMITATIONS: The study was limited by the absence of maternal vaginal sample analysis, which prevented the assessment of birth order effects on maternal microbiota, and an insufficient sample size to robustly evaluate perinatal confounders such as intrapartum antibiotic exposure or feeding practices, as these factors were inherently controlled equally in the twin design. DISCLOSURES: This study was supported by The Health Institute Carlos III. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
14-07-2025
- Health
- Medscape
TNF Inhibitors Linked to Lower PsA Risk in Severe Psoriasis
TOPLINE: In patients with chronic plaque psoriasis, long-term treatment with TNF inhibitors was associated with a lower risk for psoriatic arthritis (PsA) than narrow-band ultraviolet B phototherapy. METHODOLOGY: In a longitudinal cohort study, researchers included 946 adult patients treated for chronic plaque psoriasis between September 2005 and September 2010. Two propensity score-matched groups with 297 patients each were formed: those who received TNF inhibitors, including etanercept, infliximab, and adalimumab (mean age, 52.2 years; 65.7% men), and phototherapy using narrow-band ultraviolet B (mean age, 51.5 years; 64.6% men). Patients underwent a rheumatologist assessment before therapy initiation. The incidence of PsA was assessed over a mean follow-up duration of 9.1 and 8.9 years per person for those who received TNF inhibitors and phototherapy, respectively. TAKEAWAY: The incidence rate of PsA per 100 patients with psoriasis was 1.18 among those who received TNF inhibitors and 2.48 among those who received phototherapy (incidence rate ratio, 2.1; P = .0002). Treatment with TNF inhibitors was associated with a significantly lower risk for PsA than phototherapy (adjusted hazard ratio [aHR], 0.32; P < .0001), which was noted across different psoriasis severities (on the basis of Psoriasis Area and Severity Index [PASI] scores). Arthralgia was the strongest independent predictor of the risk for PsA (aHR, 7.68; P < .0001), followed by nail psoriasis (aHR, 1.93; P = .0004) and higher baseline PASI scores (aHR, 1.03 per point increase; P = .0096). IN PRACTICE: "A multidisciplinary approach involving dermatologists and rheumatologists in identifying and managing arthralgia could be crucial in modifying disease progression," the authors wrote. SOURCE: This study was led by Stefano Piaserico, MD, PhD, Department of Medicine, University of Padua, Padua, Italy. It was published online on July 03, 2025, in Rheumatology. LIMITATIONS: Unmeasured confounding factors may have influenced the outcomes. All the patients were recruited from psoriasis referral centres, potentially overrepresenting those with more severe or long-duration disease. Certain TNF inhibitors, such as certolizumab and golimumab, were not included. DISCLOSURES: This study did not receive any specific funding. Several authors reported serving as consultants, speakers, and/or advisors for and receiving honoraria from various pharmaceutical companies including AbbVie, Eli Lilly, and Novartis. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
12-06-2025
- Health
- Medscape
Muscle Fitness Linked to Bone Health in Youths With T1D
Higher muscular fitness, measured through handgrip strength and muscle power, was strongly associated with higher bone mineral content and areal bone mineral density across multiple skeletal regions in children and adolescents with type 1 diabetes (T1D). METHODOLOGY: Young patients with T1D exhibit compromised bone strength, demonstrated by reduced areal bone mineral density and bone mineral content, leading to an elevated lifetime risk for fractures. Researchers in Spain conducted a longitudinal cohort study to examine the association between muscular fitness and bone mineral content and areal bone mineral density outcomes in children and adolescents with T1D. They included 83 participants (mean age, 13.7 years; 55% boys; mean diabetes duration, 5.8 years) who had been diagnosed with T1D for more than 6 months; participants were followed up for 2 years, with evaluations conducted annually. Muscular fitness parameters assessed were handgrip strength, one-repetition maximum strength, and muscle power, measured using a digital dynamometer and other methods. Outcomes of interest were bone mineral content and areal bone mineral density, assessed using dual-energy x-ray absorptiometry whole-body scans across multiple body regions (total body less head, arms, legs, pelvis, and spine). TAKEAWAY: Significant positive longitudinal associations were observed between muscular fitness parameters and bone mineral content for the total body less head (beta coefficient, 16.713, 19.535, and 28.179 for handgrip strength, repetition maximum strength, and muscle power, respectively; P <.05 for all); the associations persisted for other regions of the body as well. <.05 for all); the associations persisted for other regions of the body as well. Significant associations were also found between muscular fitness parameters and areal bone mineral density for all body regions. When standardised reference data from the general population were used, youths who had higher z scores of handgrip strength showed higher z scores of bone mineral content (beta coefficient, 0.194; 95% CI, 0.088-0.300) and areal bone mineral density (beta coefficient, 0.350; 95% CI, 0.210-0.490) in the total body less head region. IN PRACTICE: "The findings support current clinical guidelines recommending regular monitoring of bone health in youth with type 1 diabetes via DXA [dual-energy x-ray absorptiometry]. They also reinforce existing recommendations advocating at least three days per week of muscle-strengthening activities, as a critical component of care for this population," the authors wrote. SOURCE: This study was led by Jacinto Muñoz-Pardeza, Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain. It was published online on June 05, 2025, in The Journal of Clinical Endocrinology & Metabolism . LIMITATIONS: Dual-energy x-ray absorptiometry scans were used to monitor bone mineral content and areal bone mineral density, which limited the measurement of geometric or microarchitectural properties. The analysis was limited to whole-body scans and excluded the hip and lumbar spine regions. Lean mass was not included as a covariate because of multicollinearity with BMI. Moreover, the analyses did not account for participants' fracture histories, which may have confounded the associations. DISCLOSURES: This study was supported by grants from the Instituto de Salud Carlos III - ERDF. One author was granted fellowship from the funding institute of this study. Other authors reported having no conflicts of interest.
